Meet Guest, Dr. Mark Tomasulo
Dr. Tomasulo founded PeakMed Direct Primary Care with the goal of redefining access and decreasing healthcare costs. PeakMed is redefining healthcare transparency, costs, technology, care coordination, and has created a continuum that is doctor-centered and patient-focused.
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Mary Grothe: Welcome to the House of Revenue™. I'm Mary Grothe, Founder and CEO. I love scaling companies to their first 5 million, then 10, 15, and 20. If you've reached a revenue plateau and aren't sure how to get past it, you're in the right place. Listen in as we interview CEOs and solve their most pressing revenue challenges. If you want to be on our show or want to learn more, connect with us at houseofrevenue.com. Some businesses are fortunate to have direct sales teams, they can go directly to the Consumer Direct to the customer, the business, and that's a great model, you're cutting out any third parties, middlemen, you can just have the conversation with the person that is positioned to buy from you.
But then there's a whole slew of companies where they actually have to sell through a third party or through a channel. And that creates a layer of complexity that feels to that company, especially to that CEO who's on that path to scale, that they're entering into a little bit of the unknown. And there are extra pieces that are uncontrollable, I remember growing up in the sales profession, that anytime I had someone else that was responsible for selling on my behalf, I always felt like they could never do it as well as me, they didn't have all the information, they may not be incentivized to sell my product or service if it was an ancillary product in their bag. And it always felt uncomfortable knowing I had this layer in between me and the customer buying. So, it was hard for me to overcome and to learn how to be proficient with channel sales. And I have noticed that many industries are bringing this in as a pathway.
And our guest today is Dr. Mark over at PeakMed. He has a very innovative model in the world of healthcare that I'm excited for him to talk about today. But he is one of those companies, they've done extremely well with bringing in small business employers, we're going to talk about the large business market and how he is required to work through the broker channels when those challenges that he has with that, and how anyone listening any business where you are working with a third party or channel sales, this will be relevant to you, Dr. Mark, welcome to the show.
Dr. Mark Tomasulo: Thank you very much for having me.
Mary Grothe: Can you tell us your story, tell us about PeakMed, I want the audience to understand how crazy this model is, how powerful it's been in the community, very innovative, love to hear your story.
Dr. Mark Tomasulo: Yeah, thank you very much for having me on the show. I think… So, I'm a family physician by training, I spent a lot of time in the military and then jumped out of the military and entered the civilian world and really started really understanding that dysfunction that we had in healthcare in this country. And that was maybe, you know, 15 years ago or so, a lot of movement in the healthcare space at that time with the Affordable Care Act that came through and there was always a barrier from the patient to the doctor in terms of how much time you got to spend with your doctor, how long it would take to get into your doctor's office. And this made kind of a really negative experience for everybody involved, including the physicians, you know, and it all backed up into finances, right.
So, physicians, especially in primary care, basically took whatever payment, the insurance carrier paid them, so they might invoice for $100 in the carrier says well, we're going to reimburse you $50 and there was no recourse. And so, for a family physician, the only way that they can stay in business is to drive more volume. And when I say volume, I mean patients. So, 50 years ago, where a doctor might have seen seven or eight people a day, and you knew who they were, they know who you're where they knew your children and your husband or wife. And it was a great experience. And you always had access to it. When you tried to keep your company in business. And the only way to increase your revenue to increase and keep up with inflation was to see more people and to fast track to you know, 20 years later and family physician see 2530 people a day, you wait two or three weeks to get into the scene, you sit in the waiting room for 45 minutes. You see the doctor for 10 you don't know what happened in those 10 minutes, and then, you leave.
Yeah, it's a very frustrating experience and the doctors you know, it's extraordinarily depressing to be honest with you. We spend a lot of time getting educated, you know, before we can actually touch people, we've spent, you know, eight years in college and three years in residency and so you're talking 11 years, 12 years before you even get to interact with somebody.
And so, I got burnt out as a doctor at a very young age. And I said there's got to be a better way of doing this. And so, what I looked at was if the finances are driving this decision of how many people you have to see, why don't we change the financial model of how a doctor gets paid. And the way that works is, you know, PeakMed was spawned and it was based on a membership approach, right, just like Netflix or Amazon or anything else, here's a flat monthly cost. With that flat monthly cost, you can have 24-hour access to your doctor in office text messages, emails, phone calls, let's minimize the number of patients that a doctor sees, to give the doctors their life back. And so, let's go back to a time where we saw, you know, maybe six or seven people a day by design, but put a financial model in place that allows the sustainability of the company as a practice to thrive. And that was the spawning of PeakMed. And it's literally as simple as kind of Netflix, you know, it's, it's an easy way as a, as an owner, to be able to understand what your revenue is, and understand your expenses and to make sure that you're keeping both of those in check. And I think by doing that, you have the ability to redefine an industry. And that's kind of where we started.
Mary Grothe: And you have how many locations now?
Dr. Mark Tomasulo: We have five brick and mortar locations that we own and operate. Throughout the last seven years, we've helped probably over you know, four or five dozen physicians open their own practice in the same type of model. Currently, we have about 110 affiliate practices that we help manage. And we're in about 11 different states with those affiliates. And it's all trying to get other doctors to understand that there's a different way of practicing medicine that's more conducive for quality, and in value for both the patient and the provider. And we want to do everything we can to help grow the movement.
Mary Grothe: It makes sense. And you're here based in Colorado Springs, Colorado, and you have those five locations they are from Colorado Springs to Monument or what's your brick and mortar stretch here locally?
Dr. Mark Tomasulo: Yeah, we have three in Colorado Springs. And then we have two in South Denver, one in Littleton and one off of county line and 25. So Southern Denver, and then we leverage all of our other partners that have clinics north of those locations all the way up through the state line, in order to help serve as clients.
Mary Grothe: So for Colorado employers, specifically, you're able to care for the employees of Colorado corporations from top to bottom, in our state. And that's incredible. This model is bringing back something that is so required, I believe, for people, for doctors to take a step forward into getting back what we once had in healthcare, it's extremely frustrating the way that healthcare is structured, I know that the industry was rocked very hard. And for the last year or so in this time that we're in with the pandemic and has reshaped the way people are getting care. There's a lot of telehealth now. And it sounds like you're this 24/7 access to these doctors and text and email and other forms, there's probably been a rise in the telehealth aspect of it as well. But even before that, I think that if I remember correctly speaking with one of your clients a couple of years ago, that they actually loved that part because they maybe didn't even need to come in, you just have a conversation with the doctor before even knowing if they needed to go in or not. And boy, that saves everybody time, doesn't it?
Dr. Mark Tomasulo: Absolutely. And I think that's the, you know, it's interesting, we've been doing, you know, telemedicine type of platforms and texting and emails for years now, long before telemedicine was kind of this up-and-coming thing. And, you know, to understand, historically why it was never really implemented is because physicians had to see patients face to face and collect a co-payment in order to build the insurance to get paid. When you went to a membership model, it didn't matter to collect a co-payment because there was none. We didn't build the insurance because we don't do billing. Our relationship was direct with the individual or the company.
And so, as a physician, you know, about 70% of everything that we do has to do with a conversation has nothing to do with touching you. It has nothing to do with bringing you into the office. It has to do with one hearing you that's the biggest component to this thing, to giving you enough time to explain yourself and then allowing us to kind of use our education and experience to filter through what you're telling us to figure out what's important to us, and then come up with a game plan moving forward. So, using technology is just a natural fit for that. The pandemic was really interesting because it allowed patients to get more comfortable with technology and communicating with their doctors. It forced doctors that never use this technology to get comfortable using the technology because they weren't getting paid. They couldn't get people into the clinics because they shut them down.
So, the state put in this federal emergency that they would pay for telemedicine for doctors, and hence doctors started doing telemedicine again. But imagine trying to retool an entire industry that hasn't changed in the last 50 years. It's it doesn't work very well, they're not very nimble. So, companies like ours really thrived in that process, because we've been doing it for a long, long time. And this was kind of second nature to us. But it has definitely opened up the ability for patients and doctors to communicate much more effectively, to where you don't ever have to come into the clinic unless your doctor says you know what, Mary, I think you need to come in, because I need to have a face to face with you. Or this is the information we probably don't want to talk about on a text message or phone call. And then just know that it's in your best interest, your doctors not asking you to come in to bill more insurance, they're asking you to come in because it's in your best interest, not theirs.
Mary Grothe: This is so powerful. I love this model, I'm so glad that we are allowing listeners to hear about this, especially those that are in our community that could take advantage of this type of membership for their employees. I understand that in the small business space, it's a no-brainer for most small businesses that meet with you. They can speak with your company directly, they can secure in that membership. But as soon as you get past the 100, employee mark, you enter into the large employer group. And this is where the broker must be present in the conversation with you and the business and vice versa, you, I mean PeakMed. But you and the business that's looking at this as an option.
There are a lot of companies that have to work through a channel or a third party. And this is often a barrier. So, there are a few reasons why there's a barrier here. One is you're relying on someone else who's not you or an employee of your company, to sell your product and service in a way that it feels like they work for you. So they have to be knowledgeable about it, they have to understand it inside and out, not just from a technical perspective, but they need to understand why it is important and why it's of value in the perspective company who's looking at the service in their eyes, it has to be able to be communicated in a way that that employer with that 100 to 1000 employees can look at this and say, yes, that is a value to me, this meets our needs this where we're at, we have this challenge, we're looking to solve this problem. But if that broker, that third party who's representing your company is not educated, not just in the technical specifics of the product or service, but then also in the way, which is all of what sales is it sales is solving a problem.
It's piecing together a solution that feels just custom-tailored to their day in life, the challenge is meeting the needs of them their people and helping them reach that desired ROI. Well, if they don't understand that part of the conversation, or they're not proficient in that part of the conversation, then it's just going to look like another service on a sheet as an option being presented on a brochure that people aren't really understanding. And so there's really no reason why we would potentially look at that line item further. But that third component is there's just so much education that needs to happen with also going from the third party or the broker who's selling it to the company and how it compares. And there are other options and being able to weigh it out and a true ROI analysis and potentially not in the first year. But looking at the second year, the third year, the fourth year of what it means.
But the very last component would be who's incentivized to sell these most channel partners, third parties, brokers, anybody that you want to put into that bucket, they are commissioned salespeople, and they're going to go to the path of where they make money. That's what they do for a living. And it can be very difficult if the monetary component or if the incentives aren't aligned with them wanting to sell it, it's just going to be a mismatch. The broker may default or again, I'm speaking to Dr. Murkier about the scenario with PeakMed but I'm also speaking in general terms for any CEO listening to this who has a channel component or a third party through which they sell, we have to look if they understand the product or service? Can they articulate and educate the buyer in a way that the buyer says yes, this meets is where we are this solves our problems? Can they convey the ROI and conduct that analysis multi-year so that the person truly understands the financial commitment investment and there are no barriers to saying yes to something that's going to potentially cost more money than something else in the lineup? And then that fourth component being How are they paid? How are they incentivized to represent your product and service and to sell it and if these are out of alignment?
There's no buy-in. This is going to be a significant challenge for that broker to understand the process. So, is there anything that I didn't describe on that that you're thinking about? Well, gosh, there's also this component, or what else are you seeing as challenges and working with that third party?
Dr. Mark Tomasulo: Yeah, I think that the biggest thing for us is, and maybe me specifically, is really trying to remember to look through the lens of whoever is presenting this product, right. And so initially, what you would, you know, described as you know, no one's going to sell your product, the way you're going to sell your product. And therefore, especially when you're a young company, or you're still in your growth phase of trying to, you know, get on top of your expenses, you're going to be very hesitant to give that role and responsibility to some third party at the end of the day. So, you're gonna want to handhold it as much as possible. And that's great to continue to grow. But at some point, you realize, you've hit this rate-limiting step, and you need to incorporate other people into that process. And I think you hit it on the head when it comes to education, right. So, you have to understand why I don't care what kind of salesperson you are, if you don't understand why you're probably not going to be very successful at it. And so I think, really understanding that there's a huge component to the education of the third party, that selling the product.
First off, the second thing is, is understanding what challenges they're going to encounter, by presenting your product to that purchaser. Meaning, it may not always be an economic challenge, maybe they're trying to solve the challenge of they're trying to retain and recruit talent at this point as a company. And so, the broker has to present your product in a way that aligns with their challenges. So, it gets even more complex than just, hey, here's a, here's a widget, we're going to have a third party, sell the widget, and then that third party now needs to understand who their audience is, and how that widget is going to impact that purchaser. In healthcare. This gets even more complex at the end of the day. And then when you're presenting a product that really didn't exist before, like, it's pretty, it's a big challenge. It's a heavy lift. But I think what's been interesting to us is the thing that I've been able to do is really understand who our client is, and really focus on narrowly, how do we get in front of those clients in order to understand the challenges that they are going to have?
Ironically, most companies and most, most businesses have very similar challenges. You know, they have expenses and revenues, and their expenses are typical, you know, the top three items are, you know, personnel, healthcare, and whatever else their product is that they're purchasing. So, you have to understand we're trying to solve the financial challenge on the healthcare side. And so, educating our brokers on how do we integrate with a third party, how do we integrate to solve the challenge of that client? And then once again, what I've discovered is it's not always financial, you know, yes, it's healthcare is one of the top three expense items in your company. But some companies are really financially stable, and they're looking to retain talent, they're looking to recruit talent. You look at the restaurant business right now, you know, they've been shut down for a year. They now have, they're starting to open up. And they're trying to compete for all of the talents that have been sitting on the sidelines for the last year.
So, there's a reshuffling that's happening, right. So, I want the talented people coming into my restaurant, well, if you're offering the same package, and there's no differentiator for you, as an employer, you're just in there swimming with everybody else. But if you are able to create value for that individual, above and beyond what the other competitors in your space are offering, well, it gives you the hands up, and maybe you know, some leverage to bring in more talent. So, I think for us, it's really been understanding. When we bring in a partner to sell our product, like a broker, how can we educate and empower the broker to be the champion in this conversation and make allow them to be the winner? Typically, it's their client. And they're going to do what's in the best interest of their client, but we want to empower them with information knowledge, and a financial model that allows them to present it to the client to say, this is what I think you should be doing. And here's why.
Mary Grothe: Something we spoke about in the pre-show was there's a philosophy around demand generation that I think would be very powerful here. I think he did a beautiful job painting the picture of a child In the restaurant industry currently, and I want to expand on this, we have this philosophy that with what we spoke about at the beginning of the show that we have doctor seen potentially 20, 25 patients in a day that you do the math on that, you got to move pretty fast, you're not going very deep in conversation is spending a ton of time with your patients with that, they are looking for the best way to provide the best care that they can, in a most in the most athletic speed possible for this situation. And it can feel a little routine or conveyor belt-ish and just let's like get these people through and through and do the best we can in that short amount of time. But if a patient came in and said, I've done some research, I want to explore this type of therapy or medicine, or I've been told that this is my situation.
I did this research. I want to have a conversation about this potential diagnosis. I think this might be what I'm experiencing. The doctor is going to stop and pause and have that conversation. They're going to meet that patient where they are, and they're going to expand on what they're going to do right by them in that conversation. And that is creating dimension. And so, there's an education component that I believe isn't just about like you said, it's not always just ROI on healthcare costs. Because I think we all know, at this point, we get these notices every year as employers that our health insurance is going up 1020 30% year over year, there's literally nothing we can do to control that. And it's an expected increase that we deal with. So the ROI is huge. You have incredible ROI, hundreds of 1000s, at one school district was, you know, a couple of million dollars in savings that you're able to show through an ROI, a multi-year ROI analysis. And that is one component of this conversation.
What else do benefits do for an employer and there's an attraction method of attracting great talent and retaining that talent. And you look at some industries like what who's a hard talent to get truck drivers, restaurant workers, and you think about what's happening in our society right now there are industries that struggle to attract and retain the best talent. Well, what are you doing employers listening to this in your benefits package, and there are solutions, and there are opportunities for you to create something that is compelling and can help you win when it comes in that game of talent, and especially if your business like in the restaurant industry, or you know, through truck drivers out there as an example. But that is an industry where it's so competitive for talent, you can't operate, if you don't have that talent, it's required part of the business, it's one of the services if you will, that you sell or the conduit, the vehicle to producing the outcome of the product or service that you have to have to have the talent.
So, I love that there's a way to create the education and the demand within the community to get these large business employers saying wait for a second, I didn't know something like this existed, why is my broker never spoken to me about this, I need to be having this conversation. And if that broker is not willing to play ball and includes something like this in my package, then maybe they aren't the right broker for me. And that's a tough conversation because typically, brokers are so deeply ingrained in their relationships with organizations. And so, it really does take something monumental to create a shift in that.
And this is an area where my recommendation for you Dr. Mark, but also, for anyone listening that wants to create demand from the end-user customer or buyer of your product or service, even though you're selling it through a third party or channel is that through your own content and social media and blog and potentially starting a podcast and other methods to where you are reaching the end person and they're digesting this information. And they say wait a second. Why is nobody spoken to me about this, I need this. And they know their pathway to buying it is through that third party or that channel, it could work with technology sales, if you buy your technology through a master agent or a VAR as an example, anything you're buying through the channel, anything you're selling through the channel or a third party create the demand, then they will come looking for it. But I do believe also for the third party and in this specific example for the broker, there is this element of they also need to be educated.
And so creating that same type of SEO through a content blog strategy, attracting them to what you have to offer, filling in all the blanks, educating the pieces, and potentially they can start to see wait for a second, could this not make me as a broker more competitive and more sticky and retaining these relationships if I'm coming forward and saying I have found a way to create this multi $100,000 of savings over time and to help you attract better talent. Truly tremendous conversation today. My hope is some of this is valuable to you, to our listeners. How do people find out more about PeakMed and how do they connect with you?
Dr. Mark Tomasulo: Sure, I mean, you can always go to peakmed.com P E A K M E D dot com at the website. And we have a lot of information in case studies on that as well. And if you want to get a hold of me, call me at 719-460-2159 that's my cell. So feel free to give me a call.
Mary Grothe: That's bull. He's gonna have his phone number after. Well, thank you so much for being on with us today and boldly talking through this challenge that I'm sure a lot of companies are facing as they figure out how to effectively sell through the channel through a third party creating that demand generation with the direct buyer. Thank you so much for joining us.
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