You're listening to cubicle to CEO episode 260. I always say the best business ideas come from looking outside your own industry. Today's case study affirms just that, in three short years, this CEO has 3x her revenue without increasing her marketing spend at all. In fact, she's spending a fraction of what her competitors are with greater success, the client acquisition engine that grew her business from 1 million to $6 million a robust, mostly automated referral network.
Vanessa Rissetto is the co founder and CEO of Culina health, a revolutionary Clinical Nutrition care company giving best in class virtual nutrition care covered by insurance instead of selling their services directly to the patient, they've structured a referral system with doctors and physicians who send their patients directly to them. This referral program has grown by nine times in the last three years, generating 85% of the company's overall revenue. Here's the kicker, though, there are no financial incentives involved for the referring partners. So what motivates them to keep sending new clients to Kalina health? Keep listening to find out.
Welcome to cubicle the CEO, the podcast where we ask successful founders and CEOs the business questions you can't google, I'm your host. Ellen Yin, every Monday, go behind the business in a case study style interview with a leading entrepreneur who shares one specific growth strategy they've tested in their own business, exactly how they implemented it and what the results and revenue were. You'll also hear financially transparent insights from my own journey bootstrapping our media company from a $300 freelance project into millions in revenue.
Hey, everyone, today we're joined by Vanessa Rissetto. I think you'll really love her case study, because we've been talking a lot about the importance of relationship marketing this year on the podcast, and especially referral marketing and how powerful it can be. So we've got a really juicy case study for you today. I'll tease it in just a moment, but first, Vanessa, welcome to the show.
Thank you for having me. I'm so excited to be here.
So excited to have you. Before I give the details of your case study to our listeners, let's get into your cubicle to CEO story, because it's, it's a little different than, you know, some of the other guests we've had on the show. You had a very important role at NYU, actually, prior to starting your business. Tell us a little bit about how you made that leap from academia into entrepreneurship.
Yeah. I mean, I think first, you know, I did work in, like, many areas of nutrition. So I worked in the hospital, I worked in, like, corporate wellness, and then I was the dietetic internship director at NYU, but I always had a private practice, but it was really energizing to work with students and just like, motivate them and dieticians, if you're listening, I'm gonna say the truth, which is sometimes you're really mean to the students, and that's not cool.
And then I, you know, tomorrow, and I started this private practice, and then covid happened, and it was the first time that a telemedicine visit was being reimbursed at the same rate as an in office visit. And it was actually also one of the first times that a private practice for nutrition was made a million dollars, right in, like, in a year, right, like, with no marketing. It's just like nobody had ever, you know, covid allowed for that to happen, and so it had legs, and then venture capitalists started calling. So we're like, okay, there's literally been no innovation in this industry for 25 years. Let's go. Let's go do something. Let's go democratize access and see what happens.
That's incredible. And just to make sure I heard you quickly, did you say a million in a year or 1 billion in a year?
1 million.
1 million. Okay? With an M.
Billion? Ellen, I would be not talking to you. I'd be in a yacht in Greece. I'm sorry.
You'll get there. I believe in you. There's a unicorn there. Yeah, well, that is incredible. And innovation really is the name of the game for today's case study, because you've kind of turned this industry on its head in terms of how you are acquiring the patients for your clinic. So just to give a little backstory to our listeners, so Vanessa is the co founder and CEO of actually, I'll need your help with this. Is it? Colina health? That's right, okay, beautiful.
And that's a clinical nutrition care company as as she mentioned. And really, we're going to be looking at how they 9x their referral base from 150 active referring providers between the years of 2020 to 2023 all the way up to 950 plus active referring providers as of this recording in july 2024 and actually, just so you all know, her highest number of referrals from a single provider is over 200 patients. So that's incredible. I can't wait to get. To the details of this, let's maybe set the scene for what makes this so revolutionary compared to the rest of your industry.
You, you mentioned in your, you know, your pre paperwork that you submitted for this interview, that most of your industry relies on direct to consumer marketing. They're doing traditional mass marketing. Why did you decide to stray from this model and go towards B to B referrals instead? And what negative impacts do you see these high cost marketing campaigns having on patient care?
Yeah, I mean wellness and chronic disease management are entangled, right? And there's a lot of noise here. It's like, oh, hey, you know, should I spend $1,000 a session? Should I buy this course? Should I, you know, drink this tea? Nobody knows like, what to do. And so it's very, very noisy. We are a very well recognized brand, and that's very helpful. But what else is there? And so great check. We proved the concept. Everybody knows who we are, and now VC wants to invest in us, awesome. But this is not a path to a billion dollars. The CACs are way too high.
Like, think about what's gonna happen with this election. Like, you're gonna be spending, like, you know, hundreds of 1000s of dollars a month on digital marketing and all these, you know, ads. It's like, no thanks. And so it was like, Hey, we know physicians. We work with them very well. We understand what goes on in the patient's mind. If the doctor makes the referral that is paramount for the patient, yeah. So let's go to the physicians and offer them something that they're not getting. We're going to give them information back on their patient.
We're going to collaborate with them. We're going to keep less acute patients out of their offices, so people who are actually really sick can be in there. We're also going to deliver better outcomes to their patients, and that's going to allow for them to go back and negotiate higher rates. And by the way, we're going to tell them all of this, they need to know this, and we're going to make this process very easy for them.
So we just went and called on doctors. First we called them, the doctors that we knew, just go knock on their door, be like, Hey, guys, give it to me. And then it's like, okay, great. Started servicing the patients. They were getting good care. The physicians are happy. They're telling their other friends in the practices, and this is where we found this product market fit. Then we went back to those doctors, and we said, yeah, like, Who else do you know? So like, one physician group in New York City, a gastroenterology group.
They have dieticians, but they still refer to us because they don't take insurance, and so they so if it's cost prohibitive or there's overflow, they send us those patients, and only to us. Went back to one of their partners, and I was like, Who else do you know? She's like, Oh, let me text my fellow in DC. Text The fellow in DC. That guy's like, oh, my god, please come here. We don't know who to send our patients to. We have 200,000 patients and 150 physicians, and we don't have anywhere to send these Oh, right. Like, great. And so that was it. We just started to, like, rinse and repeat that. Nothing flashy, nothing sexy, what we could afford, and it works.
What a gold mine of opportunity. I'm almost wondering, why are your peers in your industry not doing this? Like, what? What do you think is the reason that you guys were different? Or maybe one of the first?
Okay, here is the mindset of the dietician. You are thinking that you are going to be famous and you're going to write a book and everyone is going to care, and you're not going to have to talk to patients anymore. You're just going to make your money off of like your media and your books and all your things. And this is where the disconnect is.
So you actually don't care about servicing the patients and understanding about outcomes and working with the physician, you are focused on building a media brand which is an entirely different business. And there's something wrong with that. It's just like this is different than what we're doing, and so that is how we broke away and are rising to the top.
Interesting, super interesting. And I'm saying this as a founder of a media business, right? And you're so right. It is a completely different business model, you know, with entirely different priorities, like you said, in terms of like, who the real stakeholder is at the end of the day. So you straight away from this mass consumer marketing. You went to physician referrals. You already talked about how at the beginning it was really just like, let's look at our inner circle and then kind of expand from there. But nowadays you also use consistent, automated, scalable outreach systems to get to new physicians and healthcare providers who can refer patients to you.
So I would love to know what does this process actually look like, because what is most impressive to me is you were able to kind of make this switch over and really see this hyper growth in a period of about nine months and with no additional team resources. So what does that process actually look like when you're outreaching to provide. Where are you finding them? How are you getting their contact information? Is it all cold outreaches? Do you? Do you still have warm introductions? Give us all the the details?
Yeah. So we, we have this, really, these great automated systems, right? Like, we're using HubSpot. We're using iterable, where, you know, we have, like, here's how we cold target somebody. This is the initial outreach to them that, you know, the email comes from me, and then, you know, then we're also sending them newsletters with a lot of information in there that is pertinent to them, things that they would be interested in reading.
So definitely, like, keeps it sticky. I go to conferences. And then, like, make connections with people. We reach out to these people on LinkedIn right. We send them a note. Then then founder to founder, like, Hey, how's it going? Like, let's, let's set up a meeting. Let's have a lunch. And then it's like, you know, this pharma model, right? Just go knock on the doctor's doors. So what is the region that we're targeting? Here are the top 100 we're going to send them something automated. First, let's see who's referring and then, you know, back into it that way.
Also, like, sometimes you just get, like, a bunch of referrals from a physician group, and you're like, oh, we don't know these people yet, so let's send them a note. Hey, we have your patients. This is how they're doing. Can we meet with you? Nine times out of 10 they say, yes, there's always, like, that one outlier that's like, I don't want to talk to you. You do good work, so I'm gonna keep sending the patients and like, you'll hear from me if it's bad, and you're like, okay, great, cool, too. So yes, it starts as an automated process, then you're, you know, getting more and more referrals, and then, you know, a quarter of our sessions last month came from one medical so we're in talks with the chief network officer on how we can paper a formal deal.
Wow. I like that you mentioned, by the way, you know the kind of big pharma model. Because I think one thing that is interesting about your your outreach to these physicians is they are used to being wooed by big pharma budgets when people are trying to earn their business. And you are very clear that you are very cost effective in how you outreach to them.
So could you maybe just for those who are listening that are outside of this industry and are not familiar with those types of dealings, like, what is a typical approach for someone trying to earn a physician's business with a big pharma budget? Like, what kinds of things are they doing to capture their attention? And then, in comparison, what are you guys doing to capture and compete for these same physicians attention in a way that doesn't require you to have this large advertising budget?
Yeah. I mean, you know, in recent time, physicians aren't getting presents and things anymore from big pharma, right? It's not allowed. I have been witness to some wild things when I worked in the hospital. Like, did that guy just get a car? Like, wow, you know. Or, like, vendors would come onto the floor and give social workers like Prada diaper bags because those social workers were making referrals. So, yeah, like, those things we do not do.
Definitely, you know, high referring partners, like, Hey, we're gonna have lunch for your practice, right? Like, that's like, as much as we will do or feel comfortable doing. So there's that it is about the outcomes. It's about them being able to negotiate higher rates. And then it's also, is there an opportunity for us to do a rev share? We are the nutrition provider for certain groups like, solely that, we've been, like, brought in and credentialed under them, and then they are billing for our services and paying us. So there's a rev share there, and they are making money that way, in a very, like, legal way, right?
So, like, so those are, like, the smart things that people can do that are still kosher. But honestly, at the end of the day, if you don't provide a good service, they don't care. Because, you know, like, the doctors, like, my life is already hard. Like, if you make it harder, I don't want to ever talk to you again.
That's, very fair. Okay, that's a really interesting point, because I do remember reading somewhere in your notes that you had submitted that referral commissions are not allowed in your industry, right? It's not legal to pay someone for a referral, but the rev share that's an interesting model. So in those cases, the partners that you do have a rev share model with where they're billing and keeping a portion of whatever the revenue is.
Do you typically like? Are you offering that option to certain groups or physicians where you see a large potential for a large volume of referrals? Or is that something that comes up more organically? Are you actually utilizing it as like, part of your pitch to get them to sign on as a refer?
Comes on later in the in the process, right? So, you know, we're working together. There's like, very high velocity of referrals. Everybody is really happy. How do we take this to the next? Level, if you have 200,000 patients, how do we get more of those patients? Or, you know, like one medical has 858,000 patients we I think, like last month, it was like 150 new physicians from one medical referred at least one patient on top of all the other one medicals that are referring, right?
So there, it makes sense. But you know, just because somebody sent you a referral once or twice, it doesn't make sense there. And so just like being really judicious and constantly refining, like we have weekly growth meetings, we're looking at the dashboards. We're seeing who the higher refers are. We're making sure they're continuing to refer.
What are the webinars and the different things that are free for them and also free to us because we've already created them that we can share with them, that makes them engaged with us and know that, like, it's not just about the patients, about them too, and like, really helping their practice thrive, those are the things that they are most interested in.
So give me an example of a webinar like that. Help me understand, like, what do you talk about in these webinars that are helping the practice?
Yeah. So, like, for example, you know, we did one recently where we trained the medical assistants trained, right? So training the medical assistants on how to talk to patients about their biometric screen, so like, their you know, their blood pressure, right and and their oxygen levels, and what are they there for? And what are they interested in talking about with the physician. And then you know how the medical assistant will disseminate that information to the doctor.
That cuts through a lot of questions that the doctor doesn't have to now ask, because the medical assistant is like, I asked here. I checked all the boxes like now you can spend less time in here and more time in the next room, right? And so it's those kinds of things that seem so silly and stupid, but it's like, again, how are we making their jobs easier? Because remember, like private practice, not a one medical obviously, but just like a mom and pop, private practice has to see 200 patients a day to make their rent. Wow. How many hours in a day? How do you get through that, right?
Yeah, that is so smart, okay, oh my gosh. My brain is spinning because you're essentially coming alongside them, almost as like as a partner, and being like, hey, like we see that the more I guess, like, attention capacity you have to really serve your patients, the better the entire patient care model is going to be, including the quality of the referrals that you make, hopefully to us and so, like, let's help your staff help you be successful, so that you can have the capacity to really make the things that you know benefit you as well.
That's so interesting. It makes me This is why, like, I love level of talking to entrepreneurs like you who exist outside of the just like the online knowledge space, or, like, you know, bubble that a lot of our guests tend to revolve in, because I feel like I get so many ideas, and it makes me start thinking, okay, like, if we want to build referral systems for our type of products, how are we coming alongside our partners, and more than just being like, here's a commission for sending someone you know our way. But really, how are we helping you solve, like, a big problem in your business? Very interesting thought.
So listeners pay attention, be thinking through how you can apply a similar approach in your business. So going back to then, the automated aspect of the initial outreaches. Maybe like walking us through what that automation actually looks like, like, maybe how you have it set up in HubSpot, like you mentioned, or just like, Who's calling the contacts? Are they using a specific tool to do that? Then what are they doing with that list? Are they just like, plopping it into your CRM system and it's automatically sending that first message out, and then what happens from there? Like, what's the flow? Look like? Walk us through the flow.
Yeah. And so we, we do have, like, a contractor that will go through find the people in the region. Like, okay, we want all gastroenterologists in Oregon. Like, okay, great. So like, now we're gonna send them, you know, an automated message, like, Hey, we're clean health. Here's how we work. Here's like, the link for your patients to just like, come into the funnel, let us know. Like, we can have we can set up time to talk to you here, here and here. And then we wait, did anything happen? Right? Does anyone? Did anyone send us anything? Then we send them another message, and then we send a third message, and then, you know, after the third message, if there's nothing, then we move along and get to the next ones, right?
And so we're just tracking that every week, and we're seeing who responded, who didn't respond, and then obviously, like, we go back into the cycle and, like, go back to try to engage them. Sometimes people, like I said before, they don't actually answer, but they just start sending patients. And then that's then we have, like, okay, here is an automated message. Like, hey, you're sending us patients. Thanks so much. Do you want to set up time so we can discuss through with your patients? We also automatically send the notes back to the physician so we know they get them, but if they want to have something more in depth to to. Walk through how their patients are doing. And like social determinants of health, we will do that as well.
So it is on automated. But then there also is that personal touch. And then if it's something bigger, like a one medical and Eden Health, a junk things like, of that nature, then I will personally reach out to them on a LinkedIn and try like, Hey, how's it going? I'm going to this conference, like things like that, to try to get people a little bit more engaged.
Okay, that makes a lot of sense. So a lot of the automations really depend on a specific trigger point. Like, have they responded yes or no, then it kind of does a different tree. Or, like, have they sent a patient yes or no? Different That's right. Okay. Do you have a specific staff member that manages this whole series of workflows.
Yeah, yeah. So our, our co founder, Tamar, this is really a lot of what she does. So she, like, gets the new contacts into she'll put them into HubSpot as well. She will also reach out. She does all the Grand Rounds. So when physician practices do respond, oftentimes she will go into their like weekly or monthly meetings and talk about, because she's a clinician, talk about Kulina and what are the benefits and how we get paid by insurance. Talk to the patient for 60 minutes, where they only get to work with the patient for seven to 12 minutes.
And you know, she talks through the clinical outcomes. We send over the sales deck so it is very detailed. Once that practice bites, like the second, they are, yeah, we're one in. Then it's like, okay, here are all the things we can do. And they're like, Oh, yes, you're gonna make my life easy, perfect. Let's do it.
What percentage of these cold outreaches, would you say results in either one a bite of any form, like some sort of response or a referral sent your way, regardless of whether they respond, like, what percentage ends in a positive outcome, I would say?
Yeah, it's like 70% Wow, because physicians have always tried to refer their patients to dieticians, and they never get anything back. They don't know, like, the patient just like goes into the abyss, or the patient incurs a cost. There's always something extra. And so now here it's like, we're engaged. We're communicating back to you. There are no surprises, there's no hole. You are very clear. You know what's happening.
And they're like, Okay, why wouldn't we do this, right? Why wouldn't we do this? And also, the patient kind of leaves them alone, right? The patient comes to us, and then we're like, Hey, your patient has this and this. Do you like, let's talk about this. And do you want us? Do you want to have the patient come see you? Do you want us? We think we should work it this way. So it actually also is really nice for us as clinicians, because we get to talk about things with physicians and hear it from their perspective as well, which just helps to facilitate learning.
Okay, so this is another takeaway that's coming for me from what you just shared, is that that follow up piece, because, again, I'm thinking through, you know, all of the times I've referred people to other programs or products or service providers, I'm not sure, say for maybe one or two instances that I've ever received any sort of feedback from like, what happened after that?
And I mean, I'm guilty of that too. Like people have referred all sorts of customers and clients to me, and I don't think we've ever sent like, a follow up report and said, like, hey, like, these people are seeing these results in our programs, or like, hey, we helped so and so do whatever it is. So that's really interesting thinking about that, that feedback loop, and how important it is to them.
It's really important because, like, in this translates for every business, like, somebody gives you a referral, or people are referring you at, like, it's this at the same rate, all the time, all the time, all the time. You can very easily for us, right? We're taking notes in session, so it's like, super easy for us, like, right? And then we just, like, do a little like, summary, and then say, like, okay, if you want more information, we can give it to you.
But, you know, here's where we what we think of this is what our summary is. But it's so helpful for people. Maybe they're not going to read it on the day that you gave it, sure, but then when they're thinking about, Oh, I need to, like, somebody's asking for this, you know, and I'm going to give this referral like, oh, well, I'm going to refer Ellen, because Ellen always tells me what's happening. And she like, and then I'm looking like, she's just sent me, like, 15 pages of these people, these referrals, right? And she says, Thank you.
And it's like, this is like, so helpful. Yes, I trust Ellen, and I'm going to send people to her. And that's the thing. It's establishing trust and giving visibility to people. I think that's what people want, and they want to know that they can speak confidently about the work that you're doing.
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Absolutely. That makes sense too, because, like, based on individual client results, they probably can, like, use that more readily for an example, for future patients with similar markers. So yes, I also see too, how that helps them stay invested in the, you know, the people that they're sending your way.
And to your point about you staying top of mind for future referrals, it actually reminds me of, again, looking to an entirely different industry, retail. I remember, I don't know who I heard this from, but I do remember this anecdote about someone who is subscribed to Old Navy's email list, and they never, ever open any of their emails, but twice a year, they drop a ton of money on their like, semi annual sale, just because, even though they don't read the email is just the fact that they show up all the time in their inbox. They're like, oh, like, they're just triggered to remember that, hey, I need to go restock up on my clothes at Old Navy, which is like, so random, but I feel like it serves the exact same point that you're saying here, where it's like, even if they don't read all the notes about each individual patient, just the fact that they see you show up again and again. It kind of keeps you as the foremost person they're going to recommend for whatever services are needed.
Yep, because you it's, I do the same thing actually, with the retail, like, it's, you know, you know, like, Zara is like, oh, like, delete, delete, delete, delete, delete, delete, oh, semi annual sale got it. Yeah, exactly, because they keep emailing you all the time, like, and you're, that's it. That is, that is literally it just like, be in their face, in a way, though, that's like, supportive, not annoying. I don't know how we do it. Yeah.
No, that makes complicit and you are being supportive with with, you know? I mean, everyone wants to know more data about the success of whatever it is they're doing, right? So for them, obviously it's the patient outcomes. The personalized piece, though, I think, is really interesting as it relates to, you know, setting up all these automations. I actually want to get into a few of these details. I wrote down some notes here. You guys are always testing.
Actually, I love the word you use. You have disciplined optimization, which I've never heard anyone phrase it that way. But that is so true, like anything else, you have disciplined optimization of campaign content. So you said any combination of subject line, sender, name, email, body, CTA, incentive, send, time, audience segments to incrementally increase open click and conversion rates. And you said. Not sexy, but it works.
So I kind of want to walk through examples of each of these to really help our listeners understand just how much these marginal changes, or even marginal increases, like you said in open rates or click through rates, can really make a difference in your bottom line as a business. I was just going to start with send earning because I just thought that was something I hadn't really thought about. Like, most people are like, Oh, well, my business name is my business name. So when I send it, it comes from the same name each time. What are some of the options that you've tested first?
Yeah, yeah. So they'll send it from just me. They'll send it from Tamara and I. They'll send it from just to mar we'll send it from, you know, our VP of Clinical Affairs will send it from just one of our staff, dieticians, just to like, see, like, who gets the most clicks, right? Is that what you know? And then you know the subject, right? It's like, How can I better service your patients today? Or, do you want to help your patients lose more weight. Do you want to help your patients manage their diabetes? Like, you know, it's like, so changing whatever the disease state is, like, what? Where do they click the most?
Right? They everybody clicks weight I mean, 50% of the people that come in are for weight loss. It's just because in America, we prioritize the NESs over everything else. So it's just like, natural, and that's what's on top of mind, because of all the GLP ones we send information that isn't any, isn't about asking them to refer right? It's like, in the subject line, it's, it's like, Oh, hey, like 10 new summer recipes to share with your patients. And it's literally just, like, 10 recipes with, right, with ingredient lists and like, do that. And so obviously, like, those things definitely get opened more, because it's like, oh, they're giving me something. I don't have to do anything.
Obviously, on the bottom, it's like, you know, if you want to refer a patient, click here. But that's not the leading thing, right? But, yeah, you know, all of that testing is interesting for us, and also it changes a lot based on, you know, what kind of physician group, what kind of specialty group is it? Where's their location, like all of those things. It's interesting thing to see. And then, like, you know, play around with it. And, you know, make things better as time goes on.
So I am, like, so curious about, certainly, back to the sender name. So if it's a cold outreach, let's say and people have not heard of Kulina health, whoever is receiving it, if it comes from you versus Tamar or like a staff dietitian at this point in time, if we assume that they have no frame of reference for your company, they may not know that you specifically are the CEO Right? Or if, like, Sally sends the message that it's a staff dietician. So how do you do you actually, like in the sender name, identify them, or yourself? Like, are you like, Vanessa comma, CEO, Culina Health? okay.
That you know, obviously gets more clicks than yeah, the staff dietician, yeah.
And is that what you found, that your personal name gets higher clicks than anything else?
Yeah. for me gets like, the higher clicks. And so at the beginning of this, they were just sending out emails just for me. And then, you know how HubSpot works, it just like answers back in your email. And I'd be like, Wait, what happened?
You're like, why do I have all these do I have all these emails in my personal.
Or like, people are emailing me back, like, hey, Vanessa, I would love to have a call with you. How are these dates and these dates? They're like, guys. We're like, Yeah, yeah, sorry, we set that up. It's working. I'm like, okay, cool. Your calendars open. Yes, it's open. They can book it's fine, but yeah, it's like, it's funny when you see it come through, but you see it working. And so, like, that founder to founder thing that works, like, very easily. Like, you know, you write to someone and you're, they're like, oh yeah. Like, you're sad because you're in the VC world, so am I, let's talk. Yeah, there's a camaraderie in there. But yeah, that, that stuff is real, and people sit, I don't know there was, like, some street cred there, because you're the CEO.
I think people like to, you know, interface, obviously, with who they perceive to be the decision maker for, you know, any number of things. Okay, that's super helpful. Thank you for sharing that. Then call to actions and send times. Have you found any specific insights from testing, testing different options there?
Yeah, asking people to book, or, I'm sorry, to send patients on a cold outreach does not work right away, right like they will send eventually, but not yet, but asking people like sending them the newsletter and Asking them to, you know, are you interested in a recipe? Are you interested in a shopping list? Are you interested in booking a call with a dietitian to, like, understand more about Kalina? Like, for your own edification. That works like no problem.
So that's where it gets tricky. But, you know, like, Call to Action. Call to Action, you're always asking people for business, so you just put it in there. And you know, sometimes someone will just send the patient, but they got to know who you are first, right?
Okay, that's helpful. And I know you're not obviously an email marketing expert, but just for a little disclaimer for our listeners, and I'm not familiar with the back end of HubSpot, because I use a different email marketing service. But how do you ensure, for example, with these cold outreaches that you are complying with because I know, I mean, anyone can cold email anybody, right? But in terms of, like, adding someone as a regular subscriber to a list, like, there are obviously email laws about your ability to do that and and also always giving someone an option to unsubscribe, how do you work around being able to send out mass outreach on a scalable level, but also making sure you comply with spam laws around email?
Yeah, so we definitely like do it in tranches, so that we're, you know, not seen as like spamming anyone. We there are all the areas for one to unsubscribe. If people unsubscribe, we do not continue to send them messages. And then also, you know, there's that, like HIPAA component for us too, because, you know, we not only, we not only send to physician partners, but we also outreach to patients, right? But only when they become a patient. When they become a patient, they still have to opt in to any communication to us.
And so if patients don't opt in, then we don't communicate to them. But we actually, because of the nature of our business, we have like, securities in place, and people that are like, constantly telling us what to do and how to be compliant in all of our systems. We're like, we cannot, like, we are with the pay. Or they're like, yes, we know, so they make sure that we don't get ourselves in any trouble.
Awesome. No, that's that's such a great reminder. Hire the experts for the things that you're not sure about. What incentives, by the way, have you tested? You mentioned that and because you said, you know, you can't send commission referrals or for referrals, what? What other incentives are you referring to?
Ror patients, we like, if you know, sometimes we will ask patients to, like, answer surveys, or like, maybe, like, you know, hey, if you refer a friend in the month of December and they have two sessions, we will give you a $25 Amazon gift card. Like, all those things are like, pretty okay. With regards to physicians, it's like, pretty tightly controlled, so we're not able to do those kinds of things for them. It's like, sometimes we can get away with, if you do the survey, then we can give you a gift card. And so, you know, we'll, we'll get the physicians to answer the surveys, but they're pretty good about, like, telling, you know, can you rate our service?
Like, you know, they want to. They want to give us feedback, right? So we don't have, we haven't had any issues with that. But, like I said, you know, like, we'll bring them in lunch. We have, like, this one top refer, who's like, from one medical who's like, now our friend, and so it's like, you know, it was her birthday, and so, like, we sent her a birthday gift, but it's not because we're trying to buy her referrals. It's literally, there's a relationship.
And, you know, we really appreciate her and her advocacy for Colina. So we're like, hey, it's Dr Jenny's birthday. Like, let's send her a gift. And we know what, she loves sushi. So like, let's give her a gift card so she can, you know, get a nice dinner, like, things like that. So it's, like, a lot of thoughtfulness without, like, being over the top.
I love that, and I think that really, actually does stand out, like in a world of harkening back to your original examples of like, doctors who are getting cars, or like these proto diaper bags, like, yes, obviously, who wouldn't want a free car? But at the same time, it is those little moments of thoughtfulness, I think, that actually really stick in someone's brain, and the frequency of just feeling seen by someone, and so that makes complete sense to me.
And one thing actually that you mentioned earlier, that I forgot to call out for our listeners, but I think was really, really smart, is because you're not able to give them monetary gifts, if you will, for their referrals. But you mentioned how you help educate them on how they can utilize the patient success and data that you give them to go ask for higher salaries from wherever they work. That's so brilliant. Like, what a cool way to still incentivize them in a roundabout way monetarily, but, like, not actually, you know, break any rules around around that that's super interesting.
Yeah, we're like, Hey, you bill insurance, you're going to take these outcomes over 12 months. And this is because we have these dashboards. So it's like, Oh, these are your patients, and 60% of them reduced the amount of medication that they're taking. So like, you did that with our help. Like, now go negotiate the rate, and they're like, oh.
And then they go, and they're like, it worked. I'm like, yeah, guys, you can do a lot of things here, and so that's the other thing, right? It's because we do have these deep relationships with payers. We're able to let them know as well, which they also find valuable. It's like, Hey, this is what's happening in the world of insurance. Or we've actually put physician group practices in contact with the right people at the insurance. Company, like, higher levels, and so those relationships, like, they couldn't access, you know, otherwise. And so then they are grateful for that too. So there's a lot that we can do that isn't overstepping any bounds.
Wow. No. That personal, like, let me connect. And again, that I feel like everything you're saying kind of ties together, but it's like everything you're doing is to help them save time, even connecting them to the exact right person they need to speak to. So so smart spend time. This is obviously very, very varied for each industry, each type of business, maybe even your own audience.
But I always just like to know, like, have you noticed a difference in action or open rates depending on Send time, and if so, what has been your ideal send time?
Yeah, I've asked this, and they said, No, they don't notice any any difference. But what they do say, though, is that the physicians, like, over like, 50% of them access like, the email went out like the day before, and they don't open it until like, 4am the next day.
They're like, it's like, a weird thing. Like, a lot of them do that. I'm like, Oh, well, it's probably like, they get up before, like, the world wakes up. They then they're like, Oh, let me click and see what these Kalina people are doing, because I sent a bunch of patience to them. It's not but, like, no rhyme or reason, like, otherwise, like, it's just like, oh, this is random. Like, they just all open up around that time. Yeah, that's kind of funny. Yeah, it's like, the same personality trait.
Yeah, it's really and then knowing your body, right? Yeah.
Like, what time do you wake up? Ellen, like, don't you wake up at like, five?
Oh, goodness no, no. I am not. I am not an early bird. If I have no alarm, I will easily sleep in to like, 10:11am, yeah, I could sleep forever, but if, usually, on most days, I wake up around like 7:30 - 8am, but it's because of an alarm. Like, if, again, if there was no sleep forever, because my brain definitely works better. Actually, at night, I'm much, much more of a night owl. But no, that's really funny, and I think that is, again, kind of both an encouragement to our listeners, don't obsess over the minute things like send times, because it probably doesn't make the biggest needle mover overall, right for your strategy, but B do still pay attention to those details, like what you notice, because maybe that you know will help inform other pieces of your strategy, sure if there's like, recurring patterns.
So that's awesome. To wrap up this case study, I kind of wanted to just high level look at some of these numbers. You mentioned that if you had achieved the same results that you've gotten through referral marketing, you would be spending anywhere between 300 to $400,000 a month, conservatively, like if you were using the traditional model of like mass consumer marketing, by comparison, what would you estimate that you spend monthly Now to run and grow this referral system through this strategy.
I mean, we have, we paid to Mars salary, so, I don't know, $10,000 a month, maybe, like, really, literally, $10,000 a month because it's her salary, because she's doing it like, and, I mean, I guess, like my salary, because I go in and I but, like, labor, maybe, maybe 20 grand. Like, it's labor. It's nothing else. We've just been, like, riding that, those coattails for a while, and, like, we will continue to do it because it works.
Yeah, why change what's not broken? That's amazing. Okay, so that's, that's, I mean, that's a huge opportunity, right? 300,000 400,000 versus 20,000 is a big difference. And then in the lifetime of having this referral system, what would you estimate, if you can, and I don't know if you know this figure, off the top of your head, what would you estimate your company has received in revenue from the patient referrals that you've received?
Okay? I can tell you right at the end of 2022 the referrals for our from physicians were 7% and at 20 in 2022 we made $1.7 million as a company. Okay? At the end of 23 it was over 70% and we made $3 million as a company.
Wow.
We projected, we projected for this year to end the year at six and a half million, and we were at 6 million run rate on Monday.
Right on track.
That's the business. And not have increased money on marketing or anything. We just run very lean. Because, you know, we've never, we never had, like, conflated valuations, and we never raised a ton of money. So we had to work with the things that we had.
And do you feel like at the end of 2024 that the percentage of your business? This that comes from referrals will stay steady at about 70% or do you anticipate an increase there as well?
Should be like 85% is where we would see us going. But yeah, like it just every week is more referrals, more business than the week before.
That's so cool. Oh man, what a dream. What a dream. Business model, great. Great job. Vanessa, I'm so excited for you that was really helpful. Thank you, by the way, for your transparency and the numbers there. Where can our listeners continue to connect with you and or maybe, if they know someone that could be a great patient, how can they refer to you? Where should we send them?
Yeah, so culinahealth.com you can there's a direct to initial, so you could just self select, and if you want to talk with someone, you can also do that as well. You can find us on Instagram at culinahealth. You could find me at Vanessa rissetto rd, but you're only going to get things about cooking and nutrition myths. So you might not like that so much.
I'm willing to bet there's quite a few people who would enjoy that content, myself included. That's awesome. Well, thank you so so much for sharing your time and your wisdom. Today, we'll make sure all of Vanessa and Culina Health's links are below in the show notes, so please go check them out. And I hope that this case study for all of you listening really gave you some new ideas.
This is why I again, always emphasize the importance of getting outside of your silo, your you know, the tunnel vision of whatever niche or industry you're in, and looking to other industries and other entrepreneurs and business owners. Because I get my best, best ideas from talking to people like Vanessa, who you know are running completely different businesses than I am. So anyways, Vanessa, thank you so much today.
Thanks for having me. It was really nice to meet you.
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