Charles Nelles, CTO at The Joint Chiropractic, has to deliver a customer experience that encompasses multiple moving parts, segments and stakeholders including patients, franchisees and doctors. In some ways, Nelles is building systems to herd cats.
I was interested in the business model of The Joint since it rhymed with businesses such as U.S. Physical Therapy and VCA Antech, which is now owned by Mars. The general idea is that a parent company can roll up independent practitioners and physicians and provide technology platforms and efficiencies. Many physicians want to focus on giving care instead of the grunt work involved with running a business.
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The catch is that it's hard to provide a consistent customer and employee experience in those models. And The Joint is scaling rapidly. In 2023, The Joint performed 13.6 million adjustments, treated 1.7 million unique patients, and added 923,000 new patients. For 2023, the company reported a net loss of $9.8 million on revenue of $117.7 million.
I caught up with Nelles in an interview at Constellation Research's Ambient Experience in Austin. Here's a recap of our chat.
The business. Nelles said that 75% of The Joint's clinics are not owned by doctors and the majority of them aren't owned by the company. "We focus on people that are looking for regular adjustments to just improve and maintain quality of life range of motion, health and wellness," said Nelles.
The Joint has a business model that's built on efficiency and throughput. The typical patient is not taking a lot of time out of the day for an adjustment but stopping in during errands.
During The Joint's fourth quarter earnings conference call, CEO Peter Holt said the company is refranchising corporate owned clinics. He added that monthly memberships in 2023 contributed 85% of system-wide sales, up from 84% a year ago. "As we move into 2024, we've renewed our mission to improve quality of life through routine and affordable chiropractic care, and we’ve advanced our vision to be the champion of chiropractic," said Holt.
Providing a trio of experiences. Nelles noted that The Joint is managing the experience of three different players. The patient needs the ultimate experience, but there's the franchisee as well as the doctors, who get more of an employee experience. "The other adventure for me is a lot of franchise owners are either successful franchisees that compare our tech to every other tech and every other franchise across the globe. Or they are successful business people that need another passive source of income," said Nelles.
Who owns the customer journey? The Joint controls the journey for new patients with intake and ongoing relationships. Doctors control more of the experience for existing patients. "We have a wellness coordinator who's up front patient intake new patients coming in existing patients coming through, we have the doctor who is at the core of that experience. And then we also have the franchised seed, who is running that clinic," said Nelles.
On the company level, Holt said The Joint is focusing on the top of the funnel to bring new customers to the company.
"We focused on initiatives to drive new patients including increasing our media efficiency by adjusting our channel mix and increasing our working media spend to reach even more prospective patients. This adjusted media mix pairs with our patient strategy to ensure that we're delivering the message of affordable, convenient chiropractic care to those most likely consumers.
Additionally, we plan new promotions and offers aimed directly at adding new patients. To take advantage of our local differences, we're creating more robust local store marketing programs by providing proven tactics and more nuanced tools for our system."
Nelles said The Joint just completed customer journey mapping and going through the experiences for people that new to chiropractic care and ones that are familiar. "With the journey mapped we can start talking about the outcome we want and the brand experience we're expecting," said Nelles.
The Joint will also enable initial patient bookings, reengage lapsed customers and automate messages to keep in touch.
The tech stack. The Joint has to deal with electronic health records, compliance as well as a series of business systems supporting franchises.
"You want consistency across all the sites. With The Joint you can go into any site in any state and get adjusted. It needs to be a familiar chiropractic experience. A lot of that comes through those systems and delivering content for training, measuring performance against company standards, and answering questions," said Nelles.
Nelles said The Joint decided to buy a base CRM system, SugarCRM, and then build customizations. "When we started this, we were doing something no one else was doing," said Nelles. "It was challenging but we had to build from scratch. We bought something we're not going to have to maintain and put our secret sauce on top of it," said Nelles. "We added on top of the CRM and built two portions--the back office where we're managing patient visits and the front office for managing the user experience."
Change management. Nelles said he has spent time with the contact center to handle the three flavors of callers--customers, doctors and franchisees. "It is very challenging to mix all of those together," said Nelles.
Generative AI. Nelles said the power of generative AI will be to use the right customer data to personalize experiences. The data will inform you what content needs to be delivered and in what channel. "I think we're headed toward handing over the experience eventually to customers and that's what we're looking for with a lot of different audiences," said Nelles. "How do I get the right information about them, deliver the right content and right channel so customers are getting whatever value they need out of the experience."
Employee and customer experiences. For The Joint, employee and customer experiences are intertwined. "You rarely have one without the other," said Nelles. "We are looking to remove complexity."
Most valuable metrics. Nelles said the number one metric is attrition. "We focus on conversion and attrition," said Nelles. "Did we keep you and are you happy? Or did you leave. Some people will come in and join driven by pain and when that goes away they leave."
The goal of the tech stack is to bring customers value and support the lifecycle with processes that are quick, easy and frictionless.
For Holt, The Joint’s most critical metrics are patient counts, conversions, and attrition.
Nelles said: "A lot of what we're working on is communicating with you in the middle. We've nailed how you talk about pain and what can do for you, but once you're in the middle and feeling good we need to educate better and maintain relationships longer. It's a mix of education, coaching and maintaining that doctor patient relationship."