Subscription Medicine

Shawn: You’re listening to the veterinary Innovation podcast. You’re listening to the veterinary innovation podcast my name is Shawn Wilkie and along with my awesome co-host Ivan. We interview innovators in this space every week Ivan want to go ahead and introduce today’s guests.

Meet our guest – Dr. Rory Lubold of Paion Vet

Ivan: Hi. I’m Ivan Zak. I’m happy to introduce you to Dr. Rory Lubold, the topic of today’s conversation is subscription medicine and worries the founder of path. Visionary group and the Vets kitchen. He’s he holds a degree of DVM from Western University of Health scientists. And he is a veterinarian with World bets on the personal side of things. He has four dogs and two cats and in heavy publicized case. He helped a puppy found with a metal rod and its head make a full recovery Jesus. What happened there?

Shawn: How does the rod get in a puppy’s head?

Rory: That’s a fun story, but not For the puppy but it ended up well, so it was really good. Wow, that’s neat.

Shawn: Can we jump into that for a minute where you can you show us a little

Rory: Sure, yeah like yeah it was so so I was working at a hospital in Pennsylvania. And then we have a gentleman who had a 12 week old puppy that came in with he was a trucker and it just driven across the country and he had picked up a hitchhiker on the way and he had a puppy that traveled with him and and somewhere along the way she basically rammed this metal sort of it’s one of those like fingernail. Cuticle things had rammed it into the puppy’s head and he brought the dog in to us for care.

Shawn: That is so dark. That’s it darkest thing to be very Hands-On training in Pennsylvania. That’s what we do.

Rory: Apparently. Yeah. It was it was really, it was it was quite a bad thing because it went to right through both of his eyes or eye sockets at least at the time. We thought Through The Eyes through his brain the other side which was really a crummy position for it. It actually ended up being he and it’s rendering the dog and he had a non-profit Foundation that paid for everything and we ended up doing CT scans and 3D modeling sort of figure out what it was and kind of pooled our resources and and Foundation paid for everything which is great. But what we were able to sort of collaborate with our surgeons and dermatologists who were unfortunately out of town which left a hole that care to me and one of the other yard docks that was there and so we ended up taking him to surgery and just backing it out taking that metal rod just backing it out and we were this big Sort of it was a lot of fanfare. We were ready for like the worst case scenario, you know, he’s going to do poorly in anesthesia or we’re going to cause more damage trying to take it out. But actually nothing happened. It was really anticlimactic. We backed it out and it sort of we started to slide it slowly and then it just kind of pulled out really really quickly which we all kind of stopped and looked at each other waiting for something bad to happen. And it didn’t he made a full recovery is actually we still follow them on Facebook. He’s doing great. He’s got tons of followers. He’s a really really great dog.

Ivan: That’s awesome. Awesome and a little bit of a cheerful start to the podcast. Thanks for that story, but I can’t not tell you another story and we’ll jump right into the topic. But we had this patient that came in with an arrow going through the abdomen like someone shut the dog from the crossbow and then it came in and someone had I was I was in school that’s cool and they was in the fourth year and I was a student of the case and then someone bright said let’s oh I know why so they said let’s cut off the edges of the arrow. And so the dog doesn’t damage its Then we’ll wait for the surgeon for next day to come in and pull it out. So we cut the edges right around the abdominal cavity and then the surgeon came in in the morning wearing the rounds and he says okay. Well we can pull it out carefully. But why did you cut the arrow? We can’t go in it’s just this dumb. Anyway, let’s jump in. So I met you through the university very specialist in Pittsburgh, and he was awesome. And then you left that you were medical director there and then you started this past. Pam that’s in your group. It was very interesting to see you at the bitter Innovation Summit when we chatted about it because this is one of the really hot topics you created an organization with the subscription. So basically, it’s a Veterinary Service where you subscribe to it and then you get certain services. So tell us what inspired you and and what did you learn so far?

Relationship-Based Medicine

Rory: So the I guess kind of the inspiration for it, you know, I’ve been in the emergency space for all of my career and so for the last 10 years or so and and really kind of guess that the For it was the fact that we’d see a lot of preventable diseases that people would come in and more or they would wait too long and really what ended up happening was these preventable things that their veterinarians didn’t have time to help serve educate them on everything that goes into that. Everything goes And preventive care in that 12 or 15 minutes, whatever the actual average doctor time on an appointment is it’s not long enough to talk about all the little things that you need. And so the more I thought about it. I just kind of looked and said, how do we how do we do a better job and have more Hands-On and educate our clients a little bit better and take a more proactive role in health care rather than just reactive sick pet care, which is important, but it’s also not something that needs to be our focus is just sick pet care. And so So I sort of figured that there’s a couple pieces to that one is this we have to have relationship based medicine, which I think is probably a better characterization. It’s more relationship-based than subscription or membership or Wellness plans or any of that. It’s about building relationships with your clients so that they trust you as much or more than they would normally but they are not afraid or there’s no barrier to them asking questions. If they just have a question that you know, probably doesn’t doesn’t need to come in for Exam but they actually have a relationship with you.

But you also have to figure out how to do that in compensate veterinarians appropriately because right now as it is they’re already feeling overworked and so that’s kind of where it was born out of was how do we give veterinarians fulfillment patients better care that’s proactive and really make sure that the client buys into that care doesn’t just feel like we’re trying to sell stuff super interesting a hundred questions. So still in the one is that how does that work? Because Is it is it you have like packages or is it individually and custom to the to the pet owner to their condition that they have to the age breathe. How do you come up with a model m in a little follow-on? Like how do you price that and make money that was like three questions that I was able to know skirt yet.

Rory: So we don’t think it’s something we perfected yet. And I think it’s something that we’re working through and I kind of I guess from a high level the way that I see that sort of perfect. Model is as a complement to appropriate insurance and I kind of approach it from that angle and say if you have a really good insurance plan and you have a really good membership plan that covers the preventative stuff in the insurance covers all of the sick pet care. What wouldn’t the insurance side cover and how can we provide all of that as part of the membership and that’s kind of how I looked at services. So basically all the Well Pet Services a few exams per year, which is actually really key and we can talk about that later. Few exams per year and then all the preventive care. So if you’re in a flea and tick area that should be included if you’re in you know heartworm area or there’s any risk of it that should be included in. All your immunization should be included and so building those packages backwards and saying what wouldn’t insurance cover if they had it that’s kind of how we approached it. And then we said look, you know, you need at least two or three exams per year and the basic package and that’s the idea. There is just that you can’t have relationships based medicine if you don’t have a relationship because See him once a year. So that was that’s kind of how the base model was built. And honestly, we’ve gone through probably a half dozen iterations of our model of our plans. We started with a bow inclusive like they pay nothing but it was crazy expensive like the pay nothing beyond their base membership. But in order to do that, it was really really expensive and then we sort of came up with some more Wellness plans for healthy pets that just said look, you know, we’re going to figure out what our what our actual costs are and find out what that value is to a client and that mean It’s sort of settling in at 45 to 50 dollars as kind of a monthly membership for a well pad that includes their exams includes their flea tick and heartworm vaccines. And then the basic, you know, either a feline leukemia FIV test or heartworm test every year and so that’s like 50 bucks a month. And what we found is that we can actually set that up with a doctor at a few hundred somewhere between three and four hundred clients and still give them a salary that is competitive and even above what they would make in a traditional Clinic With a better quality of life because they’re not working 10 hours a day four days a week on a rigid schedule.

Shawn: You have Rory one of the things that comes up for me just listening to you say it. So one of the businesses that I’ve run in the past is a services company and IT services company and so early on we discovered that if you had relationship-based relationships, the quality of the interaction of the quality of the clients was much better because it wasn’t, you know, you weren’t coming in to save a disaster that he had nothing to do with you were on The team and you were the trusted provider that could take care of the issue and so it sounds like you’ve been able to kind of home in develop relationships. So that average time with the pet annually increases the relationship with the pet owner increases and it seems like you’re starting to slowly perfect the business model with that to turn it in something that’s even potentially more profitable than the traditional Your medicine.

Rory: Yeah, I think that’s really been kind of our focus is let’s figure out what are the clients actually need. What are they going to use? And we found that some of the services we tried to offer people just wouldn’t use because they didn’t see the value in it. And so I think building the model based on the services or billing the price based on the services didn’t work for some things but we can be settled in on sort of three different pricing plans based on life stage and health level that include more of that preventative stuff and they really again it does it comes back to Those relationships and I don’t think we’ve got a perfect yet. I think we’ll probably tweak continue to tweak years down the road. But realistically I think coming up with way to say look your touch points are not optional. You’ve got your exams which are not optional. We don’t we don’t really let those go by and we hit those scheduled for sure, you know, you were constantly in contact through lots of other telemedicine tools to which I think is a tool that we use but it’s not who we are.

Shawn: So that’s the achieving relationship is really key that makes tons of sense and I thing that I picked up on there like as you were answering First part of Ivan’s question was the brno, you know the suicide the quality of life, like what you’ve done is you’ve been able to come up with a system that takes some of that like pressure stress off the physician, which is really incredible. Like that’s I’m sure I haven’t got I know he’s got a question. So I’ll just leave it with that, but that’s amazing. Good job. Thank you.

Applying a Subscription Model to Vet Care

Ivan: Well, the other question that have sort of along the line, we love how veterinarians approach the work in the hospital with the heavy use of Wellness, you know, relationships subscription-based compensation model beyond that how you pay them? That’s also an interesting question. But what I found when I talked to the there’s a couple initiatives in the wellness sector of the veterinary medicine where you know, there’s there’s a proprietary software that because the subscription there is just the Model like yours, but how do you feel and how do you or doctors feel about providing or selling for the lack of a better word of the plan? Because what I found is that the hospitals where that’s enforced or recommended heavily and the and the software is that that sell Wellness they struggle because as the idea it’s great because they understand that the clients will come back and utilize it but the hate Selling it they hate providing and saying hey, you should sign up for this thing. So that’s why there’s a huge difficulty in the software products that are trying to sell these Wellness models to kind of actually motivate the staff or the veterinarian or the reception to sell that as a service. So the client signs up. So did you overcome that? Do you see the resistance? How do you feel about that?

Rory: Yeah. It’s a good question because I still see that I still see that today when I go to some clinics that are really heavily sort of pushing the wellness plans and obviously, we’re not the first set of come. With a wellness or subscription plan, but everybody’s got their own little sort of spin on it. I think in this is this is as an outsider. I think a lot of that probably comes back to the fact that they are a fee-for-service model, you know, they’re cash-based. We do an exam you pay us for that exam. We give the vaccine you pay us for That vaccine. It’s a challenge I think to have two models running in parallel and we struggled with that a lot initially and for the first probably six months or a year we did that because we’re trying to build business and we would Use that initial exam to try and for lack of a better term cell The Wellness Plan or the membership plan. I think that there’s probably a disconnect when people are used to paying just what for what they use and not paying for something forward or committing to something going forward. I think that’s probably a big part of the disconnect. We haven’t run into that as much and I think it’s because our team buys into the vision. Our team is really committed and we’re hiring people with that plan like we hire people who want to be Provide ongoing service and that means that our doctors in a full-time day when we get them up to full time full schedule. They may only see four hours worth of appointments in the morning. And this is again this comes back to the quality of life thing. They may see three four hours worth of appointments in the morning and then they’re done for the day sure. They’ve got records and you know in communication to do but if they have an emergency same day thing, they know they can go see that patient and it’s still not a full day and they know that they Can communicate with their other clients during their downtime and then it gives them fulfillment because they’re not just stuck in a clinic twiddling their thumbs waiting for patients. So I think at least again from The Outsider perspective, I think it’s probably a lot of trying to run those things in parallel because we struggled with that and then I get to see somebody and we talk about the membership plan. They would say no I just want this visit but there’s a different expectation when people find you because they are the right people there. Relationship implant experience

Shawn: It’s really interesting Rory. So one of the things that comes up that came up for me as I was hearing you talk and Ivan’s question is this whole idea of a sales professional inside a Veterinary Clinic and it is a profession there’s strategies to do it really well and to not do it well and do you think that there is an opportunity to take advantage of somebody that had that specific skillset to both inform and educate and consult with clients to really ramp up. Ability to sell these Wellness plans in a very strategic way or do you think it has to be done as a team?

Rory: I think it probably has to be done as a team. But I think having a point person whose sole job is to educate people not just to sell it but to educate people on the from the value because I think once you can communicate that value in a somebody who has a sales bent probably can do it a lot better. I think probably it’s a team approach but it probably should come back to one person who that is their Forte. I don’t know how that would Work for us because we’re primarily mobile which is you know from an efficiency standpoint. It’s not a great approach, but we’re taking sort of a different bent on it, but I don’t know how having a single sales person would work for us unless that person went on first visits and or was a phone contact for them, which would be a really interesting way to look at it.

Ivan: Sean, you know, there’s a salesperson in you you’re one of the best sales people. I know. I mean that’s that’s actually interesting concept, especially in the mobile clinic model to have actually outbound sales, you know calls to to attract people to actually sign up but that’s that’s probably a scope of this podcast. But what I heard which was amazing is and this is where it sort of my passion is recently. In the company’s and just like you outlining yours having the vision and then having some sort of core values and then hire people that aligned with your vision core values and I look for the customers that share that Vision what a novel concept. I mean that’s that’s really the formula to success. We are not trying to pitch something to someone that is not aligning with what you’re trying to do. But this is sort of been, you know, last couple of years in running couple organizations are teams. It’s that that’s what I’m trying to do. Trying to build out the you know division the core values and then align everybody along that axis and it’s amazing how you can actually have much less stressful environment and veterinarians are just these none of that that is just trained in vet school when you work you just don’t see any of it. It’s just come in do the thing, you know, leave hate everybody right records like that. So you can tell a kind of expired of a bit medicine for myself, but that’s really cool. And I appreciate that that you’re Thinking in those lines and that’s your running your organization that way in

The Difficulties of Selling Wellness Services

Shawn: Rory one of the things that just to dive into my point a little bit more is maybe not necessarily a dedicated sales person but a dedicated or determine sales process that everybody can follow, you know, so, I don’t know if that’s something you do, but it’s just something that I can’t help but mention because if you can Define the process and people can follow it and get on board with it. It may help improve your Liv you to sell the plans

Rory: I think it’s a really really good idea and it is something that its sales is not by any means my forte, you know, I’m just not that guy and so it’s something that I as we work through sales and marketing and PR which is huge part of building something like this that people don’t you know, that’s like the iPhone in 2005 units it be blind know they wanted it didn’t know they needed it. So somebody had to tell them people don’t know that they want or need this kind of membership based medicine, so It is something that we’re working through and I love the idea of it because it’s the process is a loose wire frame right now for us, but having the team have a very structured process really great big

Shawn: Thanks so much for listening to the veterinary Innovation podcast. We’re pretty social people. So you’ll find us on every social media channel. Also, you can check out our website at the veterinary Innovation podcast.com. Thanks so much for listening.