Overcoming Healthcare Marketing Challenges for Stigmatized Conditions: Inside Oar Health’s Strategic Playbook

Stewart Gandolf
Hello, and welcome to our podcast. This is Stewart Gandolf, and today I'm pleased to welcome Neil Walker. Neil is VP of Growth for Our Health, and I recently met Neil, through my travels out in the world, and anyway, I'm excited about working with you, Neil. Neil, welcome.

Neil Walker

Thank you, thanks so much for having me.

Stewart Gandolf

Great. So, Neil, I'd like to, for our listeners' sake, tell them a little bit about yourself, your background, and what you're doing at Ore Health. I think that'll be a helpful place for us to start.

Neil Walker

Great, yeah. So, I lead growth at All Health, which essentially means encouraging more and more people to seek the help that we offer. My lifelong career in marketing. The last 5 or 6 years, though, I've really been dedicated to stigmatized healthcare. So, hearing loss, erectile dysfunction, premature ejaculation, weight loss, and now alcohol use disorder. That's what OHR specializes in, and that's helping people with alcohol use disorder to either drink less or to quit altogether. And we do that by the telehealth mechanism of providing prescription medication that is 30 years proven at helping people to control their cravings. And if they do have a drink, making sure that one drink doesn't become 2, doesn't become 5, doesn't become 10.

Stewart Gandolf
Yep, and, I'm excited about this topic, and yes, this has been around a long time, and most people don't know about it, so it's an interesting marketing challenge, and on the one hand.

you know, nobody knows about it, which seems like a total bummer. On the other hand, wow, what potential, right? So, let's… we'll dive into that in just a moment. So, so this field of telehealth has been really booming since COVID, obviously, and it's funny how it's shaken out. You know, it was pretty… I remember during this process that the health systems and people that we knew you know, had been talking about telehealth for years, and that went to maybe 1% to 2% penetration, right? And within, you know, weeks, they had 30, 40, 50, 60%. And during that period, it was pretty clear the rubber band would snap back. Not everybody was going to… nobody was going to go see surgeons. You know, to get a surgery through telehealth, but certainly the idea of it, the appeal of it was big. different fields have really embraced it, others have snapped back, and we see a lot of specialized applications, like, for example, rural healthcare. Mental health is a big one. And, you know, it's become part of routine care. You know, I live here in Orange County, California. And both my wife has doctors that, you know, we see physically, but a lot of times they say, would you like to do a telehealth instead? And I'm like, yeah! Instead of driving down. So that's all… that's all good and fine. And, I haven't looked at the stats lately, but, you know, it varies a lot by specialty in terms of, I mean, psych and mental health is hugely telehealth these days.

But even primary care is, I don't know, 20-30% probably. It's not as big as it was, but maybe it's 10%, I don't know. But it's definitely smaller, but it's still substantial. But what we're talking about today is pure play businesses that really are going after very specific niches. And I love that. It's the, you know, when we talk about marketing, you know, people always think about the promotion site, but it's really about the product, right? Product place, price promotion, remember that? From undergrad. And so, the specialized care of these companies, like Ora Health are going after very specific niches, so…you know, like, let's talk just a little bit more about OR. And we'll go much deeper in just a moment, but, you know, what, what makes it special, what makes it stand out? You know, let's drill down a little bit more about it.

Neil Walker

Sure. Well, I think, going back to your point about the growth of telemedicine, a big driver of that, certainly when it comes to my experience, has been treatments and conditions that have heavy stigma. Yep. So, anything where you might not want to talk to another person face-to-face, or maybe more importantly, you don't want to stand in the pharmacy line and have them call out your name. Anything where we can, in our…You know, socks at home, on the couch, maybe with your phone or laptop, get the help you need without having to sort of go out into the world. So that… that's a trend that is, you know, definitely grew during COVID, but it's, you know, greater than that change. So that's definitely the sort of through current for my career, and it's certainly the important part of all. I think when it comes to the stigma, there's the stigma on the condition side itself. So, erectile dysfunction, premature ejaculation, alcohol use disorder, all stigmatized. But then in some cases, there's also stigma on the treatment itself. When GLP-1s came along, they were very stigmatized, and frankly, still, to some degree, continue to be. That's true for Oar as well. The medication that we offer is frowned upon by some. There's a lot of myths about alcohol use disorder. There's a myth that you… you have to be at rock bottom, you have to be a full-blown alcoholic, some people would term it, before you can seek help. Others would say there's only one way to solve this problem, and that's abstinence. Others would say there's only one way to solve the problem, and that's going to a meeting in AA. And so, we're here offering a telehealth solution that says none of those things are true. You don't have to hit rock bottom, that's… that's not a requirement. You can choose moderation as a goal, if that suits your needs. We believe in harm reduction. And…

You don't just have to go to meetings, you can do that, but you can also do medication, you can do therapy, you can combine those things and stack them. Evidence-based solutions tend to be complementary, certainly in this space.

Stewart Gandolf

So, I think that's really important, and I love that insight. The, it's interesting, because I have, my family history, there's… I'll be really open honest; I have nothing to be ashamed of here. There's some people in my family that had… were truly had struggles with alcohol. They were alcoholics, and it was, you know, not a good part of their life. My family tree, not immediate family, but in my family. And, you know, I saw the devastating effects of that, and for me, it's like, I enjoy having occasional drinks, right? And I think a lot of people, I'm your target audience, right? Where it's like, okay, COVID, now we're drinking too much, not… we don't like being out of control. And so, the idea of something that… I don't really label myself as an alcoholic if I'm a user. That doesn't apply to me, but I don't want to ever be in a position where I am one, or where I can never… you know, I was laughing with my wife, we went on a wine tasting trip recently, it's like, man, I know how it could sell people when they retire can fall into alcohol… some of them actually become alcoholics at that point, because they have so much time to kill, and it's like, that would really be bad. So, a product like yours is really helpful, right? For people to stay on the right side of the guardrails, so to speak. And I think those myths are really…prevalent, and I'm going to ask a bunch of questions, but I just can't help myself here. Neil.

Neil Walker

Totally.

Stewart Gandolf

The, you know, the parallel with GLP-1, so my wife is open about this, she won't kick me for sharing this with our audience here. You know, she's only about, I think she was probably 20 pounds beyond where she wanted to be, and all of her friends are much heavier, and they're like, why would you even consider this? In fact, she thought she was too… She couldn't, … Be accessed because she was too, … then… And, anyway, so she was literally crying at her family doctor's office, and she's like, you know, you can't do this. And she's like, what? What? And so… but the stigma is amazing, so she's becoming kind of a spokesperson among her friends because of that. It's just like, you know, I have nothing to be ashamed of, but a lot of people do, and there's still a lot of… there is, there's still stigma around each of these categories, and

you know, I've worked in all these categories professionally, and it's a big deal. So anyway, congratulations to you and Oral Health. I think it's really important to help people know.

About this. So, … why? It's naltrexone is the drug that you guys are using, correct?

Neil Walker

The medication that we prescribe currently is naltrexone. There are others out there. This is the one that we favor, as sort of the frontline medication. It's the most proven and effective, from our point of view. But we… we don't…We are not, 100% wedded to just naltrexone. If other medications come along, we would supply those as well.

Stewart Gandolf

I get it. Okay, so the reason I was asking is it's been around a long time, right? Do you have any idea why it's been so long? Is it because of competing interests in the…in the medical space, or in the addiction space, although certainly in healthcare, it's known to move glacially many times. Do you have any insights as to why it's just taken so long? People don't even know this exists. Most people aren't having a clue this even exists.

Neil Walker

So, naltrexone, as I understand it, was sort of, discovered as a formulation in the 60s. It… the FDA paper to get it approved for alcohol use disorder was written in 1994 by, one of our advisors, Dr. Volvicelli, and so that…that 30-year anniversary passed just 6 months ago, so it's been FDA approved for 30 years, even though it's been around longer than that. I think one of the reasons it's not… one of the major reasons it's less well known is

by the time that FDA paper was written, the lifespan of its patent was coming to an end, and so nobody in Big Pharma has ever had much of a financial incentive to talk about it for that.

Use case, because it was almost immediately a generic.

….

Stewart Gandolf

Interesting, very….

Neil Walker

The brand name was Revere; Naltrexone is the generic.

Stewart Gandolf

Got it, got it. So, let's talk about, more the unique challenges you have, creating a telehealth brand for alcohol disorder. Is there, you know, with Oar specifically?

Neil Walker

Yeah, so I think, …

the stigma is a huge one. It is, as I say, the subject matter of alcohol use disorder is an uncomfortable topic for many the fact that they would seek treatment through medication is uncomfortable for many, and unheard of. As you say, very few people have heard of it. Data was just released that now 2.5% of people with AUD use medication to treat this disorder. Sounds like a small number. It was sub-2% a year ago. So, you know, from a small base, it's growing quickly, and I'd like to believe us, and our marketing efforts have contributed to that growth. So, yeah, I think lack of knowledge, the stigma, And … and in some cases, folks outside of the medication-assisted route, throwing stones or being naysayers is a contributing factor. So, … in several marketing channels, we have had pushback from typically long-standing, members of the AA community, accusing us of, all kinds of things. I have a few quotes here, …

Oh, how many people did you kill today that watched your commercial? That was an email my founder got after our most recent ad started airing in June. Shame on you for sending a scam pill like this. So, we've had that feedback on LinkedIn, on TikTok, in response to TV ads.

So, there's a lot of… folks who are not comfortable with the idea of medication-assisted treatment, and I think that still goes back to that myth I mentioned before, that for some people, there is one way and one way only to solve this problem, and it is their way, and no other path is valid, or should even be considered.

Stewart Gandolf

Yeah, and I feel like, and we certainly work with providers in the addiction community, and I feel like the…I'm not expert at this, I'm not a clinician, but what I'm seeing is it feels like, at least from the conversations I'm seeing, is a more balanced approach is beginning to emerge, where… because it kind of does become like a religion, and so there's, very strong viewpoints on this, but from a marketing point of view, there's, …certainly opportunity here, for sure. So, let's talk about, the, you know, the unique challenges. We've talked about some of the categories, like you mentioned, hearing loss, hair loss, you know, weight loss, and these other things. Let's talk about, your approach, because you're really pioneering in a way. You've just mentioned some of these case… some of these quotes you guys have had. What is uniquely important in a field like yours when you're thinking about dealing with a stigmatized without sharing all of your confidential ideas, but, like, what are some of your secrets to success?

Neil Walker

Yeah, I think… what I've learned from dealing with stigmatized conditions is

Unlike traditional marketing, where you sort of set up the problem, and then you talk about the features and the benefits, …typically skipping over the problem, or only touching on it as lightly as you can, is worthwhile. Sometimes. If you dwell too much on the problem, people can be…

offended, take offense. So, you know, I remember running ads for hearing tests, and people were livid on, you know, in the comments on Facebook. We, you know, ads for erectile dysfunction and premature ejaculation can feel like an attack. Wait, why don't… why am I being served this? What do you think? So, we focus the language on the solution, so… don't talk about premature ejaculation, talk about lasting four times longer. We touch on alcohol use disorder only very lightly, and we try to talk more about the benefits of you can drink less, or you can quit, you'll have less cravings, and hey, here are all the benefits of doing so over, say, a 6-month period. So… as soon as you start focusing on those positives, those positive emotions, rather than dwelling in the negativity, people are so much more open to hearing the message. So that's a major learning. And then the other is just trying to be as trusted and as transparent as possible. It really helps us that our founder has basically been down this path. He struggled with his drinking for 15 years, and it took him 7 or 8 to even figure out where to even find help. He tried everything, and they not… you know, very few things in life work for everybody. He tried several different paths to get help, and they didn't work for him. So, his story, as sort of like a patient zero for us, is, … that origin patient is really valuable. It's not an uncommon, situation, like when Roman Zee would talk about his need for erectile dysfunction medication. So, that's… that's a big thing that people lean on, go, okay, you get it, because you've been down that path.

Stewart Gandolf

Yeah, I think that authenticity of his… yeah, the founder talking about his rectal dysfunction is such a disarming thing, right? It's like, that is the taboo of taboos. I remember…

I'm old enough to remember, when a presidential candidate, Bob Dole, came out, when Viagra was first beginning to happen, and many had rectal dysfunction, and I almost fell out of my chair, like, wow, that is something that…back then, people just didn't talk about it. And by the way, we've covered before sensitive healthcare topics before in our blog, on a few… a fair number of occasions, and one of the blogs was inspired by my wife telling me that she told her trainer, he said, what do you want her to help me… what do you want me to help you with? She said, menopause. And, like, that word was not even used. We've come a long way, baby.

And, you know, the, now, through legitimate… I subscribe to Wired Magazine, and once in a while they'll send vibrators as an ad. Like, what? Things have changed a lot over the years, for sure. That's not something you would have seen 10 years ago. Well, let's drill down on the erectile dysfunction, since you brought that up. The, you know, the… the… even the words, like the… that, … you know, the idea of saying you've got erectile dysfunction, which is, you know, a euphemism for impotence, even that's tough. And then you get into some complicated things, like, because low T can be part of that, but it's not… they're not… they're a separate thing. So, like, what have you found, you know, having worked on that category as well? Like.

just explain, like, some of the messaging there, and how that could be different, and how that might work. I think that's interesting.

Neil Walker

Yeah, I mean, the language is so critical. The, … the folks behind erectile dysfunction drugs in the first place went out of their way to create that new category, bending over backwards so that they could say something like ED and not impotence. Because that word is unbelievably loaded. You know, if you went back 500 years and walking around Shakespeare in England. Being impotent, having hair loss, these were insults that men were facing at that time. So they come with so much unbelievable baggage. Low T is a new term. It is scientific, there's no playground insinuations associated with it. So when we were at Roman, when I was at Roman.

say we were trying to do, you know, get a podcast host to talk about these things, the awkwardness when it came to ED was very, very palpable. They would, I remember we did, …

there was a read that we had with Conan O'Brien, and he spent more of the 60 seconds talking about how the fact that he didn't have ED than he did about, actually, the solution to it. Hair loss wasn't quite as stigmatized, but it was definitely on the category. But then, when it came to testosterone, guys were falling over themselves. They were like, oh, yeah, I would love to talk about that. It's so interesting. Because for them, it was science, not stigma. And I…

That's why this, you know, when it comes to marketing and stigmatized conditions, it's so interesting, because stigma is all up here. It's all perception, so it's totally in the realms of marketing. And how we can change that perception. Hearing aids are another one. The fear and anguish that those cause is really hard to put into words. The average person puts off dealing with hearing loss for 7 years. It is… An unbelievably big problem that so few people want to tackle, and… you know, there's something deep within us that says that is… that's a no-no. So, all of these things are challenges, and yeah, anything we can do to overcome them, changing the language, changing the emphasis, and then subtler things about who you show in the ads. You know, for an ED ad, so let's say the average age is, like, 45, 50, you'd want to show someone a little younger and, like, virile to say… and that's why there was, in Viagra ads, they always had, like, retired athletes, because they really, really wanted to, like, shift that emphasis.

Stewart Gandolf

Yeah, I think it's really interesting, too, having watched low T become a thing. When I first saw pharma commercials for that category, little did I know, we would end up helping build the largest, testosterone chain, or the… well, we bought one of the brands, and they bought their biggest competitor and became the largest testosterone business in the country. And so, we worked with them for years, and it was interesting how… and that was clinic-based more than, telehealth-based, but the… they would literally have fire trucks pull up where the guys would go on their way, you know, on their way back.

Neil Walker

Yeah, yeah. Whatever. It's like, wow, that has changed, baby. That's a change. You wouldn't have seen that.

Stewart Gandolf

Years ago, and so the reaction to these different categories sometimes is surprising. I was surprised how relatively easy low T took off versus some other categories. But it, you know, it's also, it's not something that implies there's a problem with you, and it's a medical thing, so I guess I can kind of see that.

Neil Walker

It's all about moving the fault from the patient away from the patient. It's not you, it's your low T. Before, you know, again, this comes down to the baggage. If you were… if you had erectile dysfunction, the old word impotence, that was, you know, that was deemed to be your fault, you were to blame. Whereas with low T, oh, this is like, it's like if your lipid levels were up. That's not you, that's like a part of your body that is distinct, or… abstract for you. So, by removing the blame, you remove the stigma, and so people were thrilled to deal with it.

Stewart Gandolf

Yeah, and I think that the difference, too, is, you know, when they do talk about it, they're excited, right? So, it makes it just a lot easier, and that's why you have fire trucks with guys coming.

Neil Walker

I can believe it.

Stewart Gandolf

Yeah, that just blew my mind when, we found out about that. It's like, well, it's working, you guys. We have firemen popping by. Like, I guess that means our marketing is working. That's cool. And it also has… and sometimes these, today in our social media world, some of these things are easier to get going than they're not. And I want to go back to something you said earlier, with the… Everprint today, the algorithm has changed so much, … with Google, where it's now favoring AI overviews, like, half the time, many times, and people are seeing their traffics rocket down.

And then ChatGPT, Perplexity, those are tiny by market share, but rocketing. I mean, there's an incredible speed in terms of, adoption rate, growth. So, the world of search is something that we do at a, … enterprise level every day, and we talk about this, like, almost every hour, like, what to do. And the reason why that's relevant to this conversation is, when you're looking at the SEO side, or those, dealing with LLMs, the large language models, the, ratings matter, a lot. They've always mattered, but now they really, really matter, reviews and ratings. And so, you know, when you have such a touchy subject. I'm guessing you… that could be a challenge for you guys, where you have people that just viscerally hate you guys, and how do you manage that? How do you try to work and get reviews? Because even if they don't… even if they're not a customer, they may find you and go put up a rating on Google or wherever. So… and that's actually a whole different issue. You don't have the Google locations when you're doing telehealth, but how has that been? Any secrets to the review process? You know, ethically, making sure you can address these things beyond just saying we don't agree. Like, what… is there any secret sauce there?

Neil Walker

So, I think the first element about doing a better job of showing up in AI, the focus is definitely… the last 6 months, we've had a real focus on trying to get more reviews from folks, because we know that that's a massive way to feed the engine, and we've had… we've basically had… We went from all very few reviews to sort of, you know, a really solid amount, and it's definitely now feeding into the AI engines. … I think… One of the good things about alcohol use disorder is when people have come out the other side and they are starting to do better.

A, it's extremely tangible, like, the effect on their life is remarkable. Like, they lose weight, they suddenly have better relationships with their friends, family, partner, they're doing better at work, more energy, more focus, and they are so thrilled and happy to talk about it.

And so, actually, getting people to say positive things hasn't been as big of a challenge as some of the other stigmatized categories. … I think it's just… it's just one of those nuances of the conditions, but like, you know, if someone was to say to you, oh, I'm a former alcoholic, I've been… I've been sober for 10 years, that's something that they're going to… you know, they're going to be proud of, and they're going to, you know, really tout it. So, we've been lucky, that so many of our members have been so kind with the time it takes to write reviews. We get… at the moment, we get, like, I don't know, 3 or 4 a day. And yeah, the lion's share… I mean, we're rated number one on Trustpilot in our category, and it's because our members have been so generous.

Stewart Gandolf

That's wonderful. Yeah, it's interesting, because the… it's so funny how some things, as we're talking about this, remind me how things… some of these things are new, but they're also timeless. So, like.

Neil Walker

Dope.

Stewart Gandolf

20 years ago, or more, Kathy Gaughran, who works with me, and I, were out teaching marketing at seminars around the country, and we used to talk about… you mentioned hearing aids and the stigma we would have hearing care practices back in those days. And, you know, completely in the canal hearing aids, and how do you market that? And then, the other thing that you just mentioned there, I used to do a chart about… I call it the happy factor. It's like, when they first come to you, they're like, but then all of a sudden, they're really excited, that's a peak moment, and that's when you want to try to get them to refer or give you a review, and then after that, they're still happy, they kind of forget. But for you guys, that peak is probably really high, where … because that is life-changing, right? feel controlled. I can see how…

that aspect of your life could be so, life changing. That's really exciting. And so, they're probably really emotional. And there's a lot more to, of course, to the SEO. Well, I should ask another part of it. So, one of the big things now is authority, with the new algorithms. And so, again, these things have always been important, but the relative importance is huge now.

Are you guys working toward authority in addition to the review side? Is that something that you guys are finding is important for your category?

Neil Walker

Yeah, the last couple of months, we've also pivoted to a much stronger investment.

time, money, energy into PR. So, we hired a great PR agency that came highly recommended. We're grateful that we have a great set of medical advisors, so they're able to talk to journalists with a great amount of authority. Our founder, as I said, Jonathan, has got a really powerful, amazing story. And so, we're gaining traction there, and so that's definitely… the goal is…

You show up in the Washington Post, the Wall Street Journal, the New York Times, Bloomberg, the LLMs are going to say, oh, these guys are legit. It's going to take the same signals that a person would, but at scale.

Stewart Gandolf

Very good. So, let's talk about how does Zora build trust with its members? We're going to pivot back more toward where we were. What are some of the trust-building mechanisms that you guys do?

Neil Walker

Yeah, so I think, … super… super big emphasis on transparency. What we do, what we offer, the limitations, … Those are really key, so I think people… I think it's pretty much proven that people believe you more when you are honest, and, you know, talk about your shortcomings, and that you don't promise the world. We really do lean on our founder's story a lot, because…

I mean, it's just… it's just the truth. If he had gone through this process, the business would not exist. So, we try to put that front… front and center. So that, you know, and our head coach and everybody who does the coaching, they've… they have either taken the medication or are still taking the medication, so there's a lot of empathy that we can offer. And then from a clinical point of view, you know, our… the physicians who advise us are experts in the field, as I said, Dr. V literally wrote the paper, he wrote the FDA paper. So, you know, we're lucky that between our expertise and our empathy, those are two big, you know, pillars that we can lean on. And then I think, you know, showing up in Trustpilot as number one, having served the most patients of anybody in our category, size and feedback from members, all the things that signal trust.

Stewart Gandolf

Yeah, for sure. So, outstanding. Very rich topic, this is great. What are the KPIs that matter to you and your team the most? Like, what are you guys focused on? Because that's important to know as you're into this kind of…healthcare category, but a little bit different, so….

Neil Walker

Yeah.

Stewart Gandolf

The things that you guys are tracking.

Neil Walker

The thing I'm working on right now that is most key, in my mind, is retention at the 3-month mark. So, … is someone… has someone managed to get to 3 months? You know, have they taken the… have they received the medication? Have they taken the medication? Have they had any side effects? If so, have we dealt with it? … you know, is there any change to medication we need to make? And then, are they meeting their goals? And if you get all those things right, if you… basically, you give someone the experience that they came to you for, and they start winning, then… they're usually pretty sold. They're like, oh my god, like, this is the win I was looking for. And, you know, they… if they… if you… if you can keep them by that point, your chances of keeping them long-term as a customer, as a member, are strong. And then on the other side is just… did we help this person? Like, we're in the business of helping people, and as a healthcare company, if you're not helping people, you're, you know, you're not going to be in business for very long. So, happily, what's, you know, helps us is good to help them. So that's, like, that's probably, like, my most important KPI at this moment.

Stewart Gandolf

That's interesting. And so, one question I have on that note, it's pretty famous. People that have depression, for example, they start feeling better. Oh, I don't need the meds anymore. Do you guys face that as an issue, too? I mean, even if it, like, you have to… I'm assuming there's kind of a bumpy road getting them there. Once they're there, is there also kind of like, they think, oh, no, I solved that problem, and I can just move forward?

Neil Walker

It is something that's… it's pretty important for us, … we… try to address it by saying, hey, look, the clinical guidelines are you should be on this medication for a year. That's the moment where you readdress. I think, in general, there's a sort of… most people don't like to take medication that they perceive they don't need, which makes sense. And so there are a lot of people who say, I'm good. What's curious, or perhaps important in this Aspect is we get quite a lot of returning members. It speaks to the fact that people think they're in good shape, and then they cycle off, and then, in many cases, or at least in some cases, the problem returns. I know from talking to Jonathan, he's been taking the medication now for 8 years. He himself tried to cycle off on several occasions, and found that, oh boy. it comes back, and so, you know, I'm not going to… I'm not going to… I'm going to stay on this. I think a lot of people find it very uncomfortable to think about any medication that you're on potentially… You know, long-term. … But… and that's true for GLP-1s, right? People are like, well, what happens when you come off it? But of course, if you… if you had a heart condition and you need to be on medication for that, you wouldn't worry that you were on it. You'd be like, this is just the medication I need. So… there's quite a lot of… I mean, there's… I mean, therein… there is some stigma right there of, like, oh, you can take medication, but by definition, it must be short-term, and anything that's long-term has stigma. So there's quite a lot of things to unpack, and you're right, that is an element that's important.

Stewart Gandolf

So, it's interesting you just said that, though, because I got to tell you my own story again. It's like, I can't resist. It's my podcast, I'll do what I want. The, … so, I've been in pretty good shape my whole life, like, sometimes better than others, and I just got through losing about 8 pounds, because, like, I work out way too hard to look like I do, so I'm back in pretty good shape here. But, recently, for what I was, like, noticing the, … my blood pressure was higher than it had ever been. I never had high blood pressure, and I talked to my doctor, and she's like, well, you know, it's like, it could be just because, you know, you've… I forget what she would call it, but there's, like, if you're… you're pushing your heart so hard that….

Neil Walker

Hmm.

Stewart Gandolf

you know, it's like, you could have this, and I'm like, or it could just be, are you under stress? I'm like, stressed? Me? Maybe a little? CEO of a company? So, she convinced me, and I'm like, that was what… even so, like, even with blood pressure medicine, I'm like, I don't want to take something forever. She's like, you don't take it forever, just take it for now, we'll readdress it later. Okay, I can do that. But I wanted to fight, because it's my identity, like, I'm healthy, I'm in shape, I don't want to take blood pressure medicine, I'm not going to take it forever. So, in a little bit different way, but it's still there. So, if you take heart, even when it's blood pressure medicine, it's like, I don't take that forever. And the, … I haven't gone back to readdress this yet, but it's like. I can see how people really push back on that. It's like, and the GLP thing, too, it's like… you know, having… observing this personally with my wife's her journey right now, people go immediately to, like, you have to take it forever. And there's all these stigmas, like, you know, the one thing that we talk about a lot, we laugh, is the whole Ozempic face, Ozempic butt, and that's rapid weight loss. It's not tied to Ozempic, specifically. It's just these people lost weight so fast. And so, you know, like, there's just so much… in our world, there's always been misinformation, there's even more right now, but there's definitely some… this is very emotional things, this world you're playing in.

Neil Walker

Definitely.

Stewart Gandolf

I don't know if you have any other comments on that, but I just think it's interesting, like, people really… this is healthcare, they have, like, their emotional… they're emotionally involved, and, they've got to be really careful how you message. So, the… you mentioned, our, …

when we talked before about the internal culture, and you know, you guys are changing the world out there. How do you develop a culture where it's, you know, people are willing to do that? And by the way, some people in any organization be more open to change than not.

Put five people together, there's going to be a big difference. So, how do you guys do that within your internal, processes?

Neil Walker

Well, for us, it's relatively straightforward, because we still passed the two pizza test. We're only, I don't know, 6 or 7 full-time employees, so…

when it comes to accountability, there's… there's only one of you in the large SUV… there's only seven of you in the large SUV, you know, like….

Stewart Gandolf

Yeah.

Neil Walker

You know whose job it is, so everybody is rolling up their sleeves all the time and having to help each other out. So, … that's a huge factor. I think, you know, it's commonly would be… it would not be a surprise to me that if we were to grow, in terms of the size of the team, we might feature some growing pains. That's a… that's a nice problem to have down the line, but right… right now. It's a… it's a close, super communicative team. I had an old… my first founder, when I moved into the startup world, would drill into me the… the notion of over-communicating. So, through, you know, the magic of Slack, we can be over-communicating all day, every day, and that… that keeps us pretty cohesive, and generally speaking, the train stays on the tracks pretty smoothly.

Stewart Gandolf

So, going that you guys are doing digital marketing, the cost of acquisition is always a key metric. What are some of the things you've found to help keep that in check, or to even lower it? Because that makes all the difference in the world, in your business model, right? At some CAC, it makes sense to continue. At others, it's unprofitable, you can't do anything.

So how….

Neil Walker

I didn't mention the four KPIs, I didn't mention CAC, almost because it's, for me, it's like.

what do you eat? I drink, you know, I drink water. It's like, worrying about CAC is something I do morning, noon, and night to… I think our biggest wins with CAC have been understanding the micro… this is an obnoxious phrase, but the micro-seasonality of the consumer or the member. Like, they are much more likely to act in the morning than in the evening. They are much more likely to act on a Monday than later in the week, beginning of the month versus later in the month, and certainly the beginning of the year. And so, what we try to do is… We try to harvest interest throughout the day, week, month, but then we try to then try, … respond to them through CRM channels in the moments where we think they're most likely to act. So, for an example, a really pointed example, TV is one of our biggest channels. We were finding that only running ads in the morning was effective. Because we were running… sending people to the website. We changed the CTA, where people now text in to us. And that means that we can then remarket to them compliantly, because remarketing and healthcare is, you know, tricky, if at all possible. And so, yeah, we're able to talk to them. Monday morning, there's a text that goes to them saying, hey, you know, is now a good time to deal with it? Knowing that if they do have a problem with alcohol. they're probably going to have had a big weekend. And it's not just the weekends, it's any day after a major drinking event, so… straight after the 4th of July, after Halloween. You could… it's like clockwork. You know some… like, there's been a big…

drinking a Cajun in America, because our dashboard will be lighting up the next morning. So…

So really understanding that sort of micro-temporal nature of their, like, intent has been crucial for us.

Stewart Gandolf

I love that. That's really good insights. So, what's your, so we just talked about CAC. What would just be your North Star metric, and, the one that you're really most, most concerned with?

Neil Walker

We're pretty bootstrapped, so, hopefully our founder won't… my founder won't kill me, but, I mean, frankly, cash. Managing cash is, massive for us, so when is that check going clear? You know, how are we doing today on cash? … that… that's sort of like the… your poor man's metric. Once you don't have to worry about cash, you get to worry about higher level issues. So, yeah, that's my North Star today. Right now, we're really on a knife's edge, that's for profitability on a month-to-month basis, so after cash is profit.

Stewart Gandolf

Yeah, that's great, and I can totally see that. Again, going back to cost per acquisition. It's like, you know, that's the… because the moment you start making it, oh, the algorithm changed, oh, Google's charging 40% more, like….

Neil Walker

Jeez.

Stewart Gandolf

…things that you can't control, and that's a challenge in the business, because it either makes economic sense or it doesn't. So, but you're learning, too, at the same time, and you're building a brand, so hopefully that'll get easier for you guys. I love what you guys are doing. The last question is, what do you think the biggest opportunities are for the next 12 to 18 months for oral health?

Neil Walker

I would say a major opportunity for us is we're going to be launching, only in a couple of weeks, a fast-acting, compound. So, it's a mint that you put under your tongue. It should reduce the time, the efficacy time, by 75%, so from an hour to about 15 minutes. And it… also allows us to give somebody a lower dose, so, … probably, we're hoping, but yet, we'll have to yet to prove, low… fewer side effects. And… So, by having that point of distinction, no one, you know, nobody else would be able to get. We're calling it Clutch. You're the first person I'm, telling this to, so, ….

Stewart Gandolf

Fantastic.

Neil Walker

Yeah, so no one else is going to have clutch. And it will really help people…

Especially the ones who like to take their medication before they go to, say, a bar or a restaurant, either because they've decided not to drink, or because they want to have one and not seven or eight. So yeah, the faster it can act, the better. And I know from chats with my friends at Rowe, when they launched a similar-ish product, when they launched Sparks.

Stewart Gandolf

It sounded just like sparks, that's interesting.

Neil Walker

Major, yes, yeah. I'm not embarrassed to say I, like, I borrow other people's playbooks, for sure.

Stewart Gandolf

That's what makes you good, I love it. That's awesome. That is a really interesting insight. I've watched you know, this is my job, right? So, I watch what Roe does, and I thought that is amazing, because it takes away the whole timing issue, or at least brings it down. It's like, oh, I can be more spontaneous, I can see why that would be, and it's a competitive differentiator.

Awesome. Well, you've been, I got to tell you, this has been a really fun podcast, and I love talking to smart marketers. It's the kind of stuff that's fun for me. It's why I do this, right? So…

It's been… really, I've enjoyed this a lot. I feel like, hopefully our listeners have listened intently. You've shared a lot of good insights. It is funny how, like, there's so much innovation here, and there's a lot of principles that are just there. You just found a different way to look at the principle. That's been, to make it really successful. I love your… the new idea where you guys are going, so… Neil, thank you, this has been fun. I hope you've had fun. I know I have.

Neil Walker

Loved it. Loved it. Thanks so much, Stuart.