Why UK’s Leading Online Pharmacy, Echo, Paused Growth at Height of Pandemic

Episode 44 March 17, 2021 00:57:20
Why UK’s Leading Online Pharmacy, Echo, Paused Growth at Height of Pandemic
The Breakout Growth Podcast
Why UK’s Leading Online Pharmacy, Echo, Paused Growth at Height of Pandemic

Mar 17 2021 | 00:57:20


Show Notes

“Ultimately, what it meant was we had to figure out ways we could resonate with an older audience . . . Stop talking to 18-year-olds and start talking to 50-year-olds!" 


This turned out to be a key, data-driven learning for Bradley Fehler, Echo’s Head of Growth, and fortunately, he and his team started to figure this out before 2020 brought unexpected and explosive growth.


Brad joins Sean Ellis and Ethan Garr on this week’s episode of The Breakout Growth Podcast to share Echo’s story of growing into England’s leading online pharmacy. The journey began when the company’s two co-founders faced different health problems and saw an opportunity to create a mobile app to meet an unsatisfied need. For many, a trip to the pharmacy is just one of life’s minor inconveniences, but for some getting their medication is a matter of life and death.


Before Covid, the business was growing well. The company had found ways to help consumers solve problems of adherence by creating a simple three-step process to get users to their first prescription delivery and then by optimizing notifications and reminders to ensure those same users were taking their doses and ordering refills as needed. But then Covid hit, and the company’s patient-base doubled in just three weeks.  


Brad explains the operational challenges of meeting that demand, and the mission-driven decisions the company made to ensure successful patient experiences.  At one point the company actually paused acquisition efforts just so everyone in the organization could focus on helping customers get their medications. Echo is a business that depends on patient trust, and one late delivery could shatter that relationship.  The company takes this responsibility very seriously.


So dive in with Sean and Ethan as The Breakout Growth Podcast looks to uncover key growth learnings with Bradley Fehler, Echo’s Head of Growth. 

We discussed:


* A mission to deliver the medications people need to get better or stay well (3:21)



* Anxiety and Asthma, the co-founder’s journey that led to Echo (4:51)



* Why Brad was excited to join a company with a patient-led approach (8:40)



* Growth to nearly 400,000 patients, accelerated by the pandemic (12:01)



* McKesson’s acquisition of Echo in June 2019 and its impact (16:34)



* Driving profitability by talking to the right audiences (17:50)



* Organizing for growth and using a North Star Metric (25:29)



* Word of Mouth Growth efforts with regulatory challenges (36:03)



And much, much, more . . . 


View Full Transcript

Episode Transcript

Speaker 0 00:00:08 Welcome to the breakout growth podcast, where Sean Ellis interviews, leaders from the world's fastest growing companies to get to the heart of what's really driving their growth. And now here's your host, Sean Ellis. Speaker 1 00:00:24 So to the breakout growth podcast, Ethan Gar and I interviewed Bradley feller head of growth at echo England's leading online pharmacy. So their growth exploded when COVID hit, when in just three weeks, they doubled the number of patients. They served. Ethan, what jumped out at you as particularly interesting from this episode, Speaker 2 00:00:42 Nobody could have accounted for that kind of growth surge, and it was pretty, uh, amazing how they had to react. So what jumped out at me is the huge challenges of meeting new operational demands that surfaced overnight. It was really neat to see how their patient led mission has carried them through that and into this new phase of growth that they're going through. And it's super interesting to learn how they even paused acquisition. At one point, I'll be at temporarily, as everyone in the company was forced to focus on driving successful patient outcomes. Speaker 1 00:01:09 Yep. No. And that was one of the things that Bradley explained that yeah, unlike a lot of businesses, their business, there's a lot of people that are depending on their service to stay alive. So it makes sense that they would probably temper growth to make sure that they can handle the new demand, but slowing down, help them in other ways, too. So for example, they were able to process some of that learning. And one of the things that surfaced was that a lot of the people on the platform now, a lot of the people who were, who were getting, uh, prescriptions through echo were actually more of the older demographic rather than the early adopters that had been adopting their solution before the pandemic. So they had to adjust the language and, and just really the usability and everything to, to address this. Speaker 2 00:01:59 Yeah, I think he mentioned that like their oldest users, like 97 years old, but so I think that adjustment was made easier because of their strong sense of mission. As I said, aligning teams around that shared mission, placing principals before profits, those are two critical components of growth and they're ones you and I highlight on our website, breakout growth.net and our eight core principles. Um, so I think echo story is a great example of those principles in action. Speaker 1 00:02:22 Yep. Definitely. So let's jump in and find out what else is behind Echo's breakout growth success. Absolutely. Let's do it, Speaker 1 00:02:38 Brad. Welcome to the breakout growth podcast. Hello? Hello? Yeah, we're excited to have you on. So joining me once again is my cohost. Do you think our welcome Ethan? Hey Brad. Hey Sean. Good to have you guys together. We're on a Friday here. So, um, Brad's over in the UK, so he's, he's just getting ready to kick off a weekend, but we want to dig in and hear the echo story from him and, uh, why don't, why don't we start, um, before we really kind of dig into the growth story, but just really what echo is and, and maybe a little bit about the problem that it solves. Speaker 3 00:03:12 Thanks very much for having me on guys. I'm big MRO, both again, I think, uh, uh, being listened to the podcast for a while, so I feel honored to be here. Yeah. So, uh, echo is a repeat prescription fulfillment service, essentially, an online pharmacy. Um, and what we do is we deliver people, the medicine they need to, uh, get better or stay well, then that's a Speaker 1 00:03:37 Start. So how does, how does that actually work? Speaker 3 00:03:39 You sign on to echo you tell us who your doctor is, GP. Um, you tell us a medicine you're on and we are the conduit between you and your doctor. So once you place your medicine requests with echo, we send that request off on your behalf to your doctor, your doctor approves your prescription, you fulfill your medicine, we dispense your medicine for you. Speaker 1 00:04:04 That's great. And then what, what's the business model Speaker 3 00:04:06 We operate in the exact same way as every other pharmacy here in the UK that provides services to the NHS, the national health service here. Um, and he centrally the model is, um, very similar to a subscription model that you would have. We get, uh, reimbursed from the NHS for every item we dispense on their behalf, but we ultimately reliance on that to repeat, uh, repeat business, right? So very much you don't pay for our service. You know, the, their repeat nature of our relationship is, is really the fundamental, but Speaker 1 00:04:43 Got it. Got it. And then what would you say is really the problem that you're solving with echo or that, that the founders initially set out to solve? Speaker 3 00:04:52 Yeah. Yeah. So it's an interesting one because two co-founders came from two distinct, had two distinct problems, one, uh, suffered from, uh, well, uh, anxiety, um, and the other had, uh, asthma. So to put this thing problems, but ultimately, which I, I can elaborate on it a bit, I guess, but, but ultimately the problem with solving's one of adherents, right? Um, people need their medicine to live out their lives as healthy, a way as possible. And the first hurdle to that is getting your medicine. And what we do is get the medicine to the people that need us, um, Steven, our co-founder who, um, uh, uh, has anxiety. He, one of his real reasons for starting echo was the gauntlet that he had to face sometimes to get the medicine he needed. Um, you know, we'd have to go to the doctor, the GP they'd have to approve the request. You'd have to then walk down to the pharmacy. Um, and that sounds not too terrible, but imagine you're doing that while are having a panic attack. It's almost impossible. Right. That's it right. Speaker 2 00:06:03 It looks to me like Echo's been around about five or six years. I know now it's a, it's really an app based service. Did it start that way? I mean, with that vision, from his taking his anxiety and figuring out a way to solve that problem or has it evolved over that time? Speaker 3 00:06:17 Um, I think like every, every startup, right? The, the initial, if you look at what echo was when they first started, it's evolved quite significantly, but it did start off as an iOS app, which was the idea that, that, um, it's always in your pocket, right. It's always with you, it's your compact. Speaker 2 00:06:38 Yeah. And I think that probably makes a lot of sense too, because as a, you know, as a consumer where you need to think about your medications, it may not be when you're sitting in front of your desktop. So, you know, uh, your phone goes with you. So I think that it's a logical way to handle that, you know, to solve that problem. Yeah, Speaker 3 00:06:56 Exactly. And as, and as the, it evolved, you know, we obviously launched the Android app. Um, and then the web app was launched, um, early 2019. And that was just again, um, about accessibility, right? We want as many people to be able to use echo as possible throughout, you know, across a different, uh, an age spectrum. So making echo available in as many places as possible, made sense. Speaker 2 00:07:26 You're the head of growth there. You've been there about two years. Speaker 3 00:07:30 Yeah. Uh, to you, as on the dots, pretty much. Speaker 2 00:07:32 Has it been a pretty distinct evolution since you've been there? Have things changed a lot? Speaker 3 00:07:38 What a ride, you know, I think, I think when I joined, um, it was still a young scrappy startup. Right. Um, and within that year, a whole bunch of things happen that, that, um, influenced the company positively, uh, where I think we are now versus when I joined was maturing, we understand our product and we understand the problems a lot better, um, than what we did two years ago. One, because just the volume that we're dealing with today, so different that, that we're able to really use data in a way that we just weren't able to, uh, two years ago at all. Um, yeah, it's a, it's a completely different proposition that we're able to look at, um, trends in a way that we just couldn't, uh, before both from a product perspective, but also just medicine usage and distribute, and those sorts of bits, um, has completely changed too. Speaker 1 00:08:41 Brad, I'm really curious what attracted you to the company in the first place? Speaker 3 00:08:46 Yeah, well, um, I think the, the biggest thing that attracted me was the fact that this was a problem that no one was really solving in a way that was patient led, um, the founders again with patients and that nodded. And I think the other thing is that feeling of wanting to do something that is impactful, not in a broader sense, you know, I'm, uh, you know, on the Neil and Musk level, let's say, but more at a level, a personal level, right. I want to be able to have a positive impact on people's lives and people that walk past on the street every day. And the second thing was, you know, um, I've worked at quite a few startups now and, and teams are very important. And the thing that attracted me to ACCA above other butts was, um, that echo had a team and was building a team that could execute on this problem. And that I think is super important. Right. Speaker 1 00:09:46 I actually, one of the things I noticed was that, uh, rocket internet was one of the early investors in the business. Was that, I mean, as someone who's been in growth for quite a while, I know they are a, they're a really sharp growth team, uh, you know, a growth, growth investment fund. Was that attractive for you or had you worked with a rocket back company before? Speaker 3 00:10:07 Um, so I hadn't worked with a Rock-a-bye company, but what was attractive was that, um, a chap called Roger, his son who had worked at many actually was the CEO of echo when I joined. So you had experience of, uh, he was a credit, hello, fresh taking them public, all that sort of jazz. Um, and Roger had that rocket experience of course, but also experience of scaling businesses and executing on pretty complex problems, especially when distribution sort of stuff was involved. So he brought a lot of that experience and insight along. That's so cool. So you've, you've explained that over the last two years, you guys have really grown immature. Can you tell us a little bit more about that growth? And I guess really, I would think that COVID, must've been a great accelerant. I'm curious to hear how that's impacted the last two years for the last year for you. Speaker 3 00:11:01 Yeah, yeah, absolutely. So, you know, when I joined, we were around 20,000 patients, which was tremendous, you know, the, the January was huge for the business. I think we signed on 6,000 patients in that January and I, and everyone was ecstatic. These were crazy, crazy days, you know? Um, and then when I joined, we didn't actually have any budget for the first two or three months, a couple of months. Right. We just didn't have budget. So it was, we were looking at things we could do more broadly and then a little bit of budget came in. Um, and what we started seeing was that, you know, what we've started delivering with that modest budget really was we were doubling in size every three months. Now, now most businesses, we would be, you know, ecstatic about that. But as you can imagine, the, the mission that we wrote was to get more people to take the medicine they need to stay well, you know? Um, so, so that wasn't good enough, but we had a doubling every three months, um, and then COVID came around and we doubled in size. Now, obviously, you know, the, the, the scaling factor there, we, we doubled in size in a sort of two, three week period. Speaker 3 00:12:15 So this is tremendous from, from a, just a general growth perspective of course. But, um, what was also interesting is shit. How do we scale out services to be able to deal with us? How do we scale that distribution United to be able to deal with those? Because the last thing we'd once, um, is for someone to, once you use our service and then for us to miss the Mark, because unlike maybe some other areas, if we don't get you the medicine that you're on, we'll set some conditions, one life sort of consequence, but on the flip side, you'll never touch us again. Never wouldn't even like sniff at us again. Um, so these were big things, you know, but, but from there where we hit about 200,000 patients, we're now still, um, you know, we learned a lot during that period as well. And now we're closing in on 400,000. So in that two year period, it's tremendous, tremendous growth for this particular space. Speaker 2 00:13:20 That's amazing. And I guess with, you know, it's really a good point. I mean, trust is always really important for any business trying to grow, but I guess for you guys, uh, you get kind of one bite at that Apple, if it, if you lose trust, it's going to be desperately hard to get someone come back because in some cases it can be life and death, but it's interesting, like when you, when you talk about COVID, I guess, you know, the original use case that where your founder had anxiety and, uh, felt uncomfortable going into the, into the pharmacy, like that's a must have for a small population, but, you know, so it's kind of an, at that point, it's almost like a niche, but when COVID hits now, it's, it changes from a niche to a must have for everyone, right. It goes from, it's a nice to have, if, you know, I need my, whatever, you know, my, whatever regular medication I get. But at this point, if you can't walk into the pharmacy because of a lockdown, it becomes an absolute necessity. So that's, I guess that's the real driver here. Speaker 3 00:14:19 Absolutely. Absolutely. And, you know, during the late March in the UK, I think I locked down our first like town, I should say, um, kicked in on the 17th of March and I'd lost it a couple of months. Um, the most astonishing thing we saw there, I think just in terms of our patient profile was the age demographic and the shift. So one of the things we did very early on was trying to, um, speak to a slightly older audience, but what we found when that lockdown hits and even a lot of that still continuing now was a surgeon, older people adopting digital, adopting a server, being comfortable to, to, to take that leap or let's put it this way, being forced in a way to take care Speaker 1 00:15:09 Where the hook may have been convenient somewhat before that, like for older people, tech is often not convenient, it's scary, it's cumbersome. And, uh, but suddenly it went beyond convenience where it's like, I don't want to get sick if I could go to a pharmacy anyway. And so I'm going to figure out the tech side. Speaker 3 00:15:27 Yeah, exactly. And, and we actually have a couple of features, which we handily call internally. The next of kin feature. We probably need a, a better name and family it's family medicine management. Right. But we also found that not only that our median age sort of jumped during those periods of sort of 60, right. Um, at a median, which is astonishing, we also found that families, friends and so on and started adopting this feature about which wasn't heavily used because the, the need, and then also the appreciation for distance sort of health management, um, became sort of pretty, pretty evidence as well. So it's a really interesting shifts in behavior during that period that we're still seeing. Now, I think one of our oldest patients who, who are, who are actively using our services 97, wow. Speaker 1 00:16:25 That's definitely probably setting a record for the oldest, uh, oldest customer of anybody we've interviewed on the podcast. Speaker 3 00:16:34 Right. Speaker 1 00:16:36 So Ethan, you, when you and I were talking earlier, I think you had mentioned that, uh, you you'd seen that that echo had been acquired by McKesson. Is that, is that in fact true? Speaker 3 00:16:48 Exactly. Exactly. So I mentioned in 2019, we got a little bit more budget and things shifted at all in June, 2019, McKesson took a quiet, well, it took out at 70% stake in echo, um, and the buyout, the, the conclusion of that will happen soon. Um, so that's where those extra funds came from. That's where those extra funds came from. Exactly. I mean, so, so, but, but it unlocked other things besides for the extra funds. So McKesson owns Lloyd's pharmacy here in the UK, which is the second biggest pharmacy, like a high street, a, you know, a pharmacy group. They also own the, one of the biggest medicine wholesalers here in the UK. So not only did we get, um, some extra money, which is great, and that, that has been incredible. And they've been very supportive. We also so many got access to a pharmacy in a high street network here that meant that we, you know, that have formerly inactive patients, right. Speaker 3 00:17:56 Which meant we could really engage that audience directly with purpose and with a relevant message as well. Um, so not only did it unlock funds, which is great, it also unlocked patients. It also unlocked some, uh, if you will logistical some, uh, operational efficiencies as well. Oh, that's awesome. And I hope your, your audience knows that McKesson makes the absolute best band-aids on the, on the planet. I think that's what they known for most people in Europe as me, you, you tell them who McKesson are and they would not have a clue, right. Not have a clue, but, but McKesson is this gigantic, gigantic business. Speaker 1 00:18:42 Yeah. Ethan's our bandaid expert. He gets lots of ouchies. So, But, uh, yeah, I mean, that's, that makes sense that that would have a really transformative effect if you could tap in to their network and their expertise, when you, when you look at kind of growth overall, is there, is there some, uh, key learnings that you've, you've uncovered along the way that have become really important parts of, of how you approach growth and, and how did you discover them? Speaker 3 00:19:10 Um, yeah, so, so I guess one thing, you know, when it comes to growth rather than performance marketing, right. I'm sure Sean, Ethan, you both, you both have to grapple with this pretty regularly is, um, you know, it's outdated first approach, right? So it's about trying to uncover, um, an insight that we can then try, you know, develop hypotheses that we can prove out. Um, so the, one of the first things that we did, certainly when I joined was, um, we shifted who we wanted to, um, talk to as a business. The reason for that is I mentioned we get, um, uh, reimbursed by the NHS would dispense the medicine on their behalf. Um, and we pick up the bill for the delivery, right? So it's free delivery and all that. Um, now whilst we want to help as many people as we can, what we have to do is, um, make sure that we've, to some extent, making money on every dispatcher, what that means is that, um, unfortunately someone who's on the contraceptive, but otherwise healthy and gets out prescription renewed once every six months, isn't, we're not helping them as much as we could. Speaker 3 00:20:25 Right. Um, and they're not as profitable to us as a business as they could be, but someone who is on, um, several items, um, take myself, I've got this, uh, uh, um, uh, genetic form of cholesterol, right? So no matter how much, uh, fats I eat or burgers, I eat and chips, I eat, it does nothing. My cholesterol keeps going up. So I have to, uh, take two pills a night. Um, now someone like me or someone who's on more posed is ultimately more profitable because we get the reimbursement for each one of those items that we can then send per package. So the first thing we did was, well, we looked at our audience data and we said, well, you know, we're not breaking even obviously per we're way, way before that, but, but they all have these little pockets of patients that are really profitable, that are on a lot of Bisons who are there. Speaker 3 00:21:20 Um, and what we really dug out from that, we, we looked at conditions we'd like to locations, we looked at as many sort of slices of that sort of profile as we could, but ultimately what it meant was that we had to start figuring out ways that we could resonate with an older audience. And that was, I think the, you know, it's really, um, digging into that data and trying to uncover those insights. And the biggest insight we had, the biggest thing that came out of that process was stop talking to 18 year olds and talk to kids. Right. Um, now that we went all that way, but you know, the sounds really basic, but I think one of the first things we did was we just stopped targeting people that were under the age of 30. Speaker 1 00:22:09 Yeah. I mean, it's such an interesting challenge because it really is younger people tend to be early adopters. And so you have a natural inclination to want to target them, but in your case, the people who are on those recurring medications are, are an older demographic. And fortunately, it sounds like you saw that the data, but I, I do think when you look at most apps and most, most online businesses in general, that one of the hardest things to do is to build a habit around using the product when, and in your case, you're really like tapping into a recurring set of behavior anyway, and you're making that easier and more manageable. And so it's a, it's, it's a really, it's a really interesting opportunity for you that, uh, I think a lot of businesses have to kind of create a habit for them. Speaker 3 00:22:59 Yeah. Yeah. Good point. Good point. You know, and we've tapped into that habit by releasing features like reminders. Right. Sounds like a basic one, but, but just, there's two types of reminders we have. One is just to take your polls, right? Take your polls people. Once again, adherence is at the heart of everything we do, but also if you take your poles and you finish or sort of around, you have to request again, right. And that's where it comes in. Um, or the reminder to order your medicine cause you're about to run low. So all of those sort of reminders is tapping into that habit, that behavior, and making sure that echo is, um, sort of poking its head through the door at the right time. You know, I was saying to someone yesterday, which is echo weirdly as it stands today, you know, it may evolve, but as it stands today, we're one of those few, absolutely few products that, um, you don't want to interact with any time that people mostly interact with the business is weirdly when something goes wrong, right outside, you know, um, for example, echos at my, you know, on my phone, it's in my pocket. Speaker 3 00:24:12 And, um, once every three months I get a little vibration, I take out the phone, I hit confirm. Um, and I stick it back in my pocket. Right. So in a weird way too, it's, um, echo is really humming away when you're not interacting with a, um, which is unlike a lot of other apps where you're looking at dolls miles, you know, that sort of stuff. Were you trying to get that behavior, uh, you instigate that sort of regular usage behavior, um, Speaker 1 00:24:40 Almost more like a, a S you know, security app or something that, that it's kind of working in the background. If it's doing its job, then you don't think a lot about Speaker 3 00:24:49 Exactly. Right, exactly. Right. I worked on apps that helped you with spin spam calls, and it's sort of a similar problem where all the interaction is when somebody, somebody interacts with you, as opposed to us interacting as a, as an app with you. So, uh, you know, uh, it only provides value when someone calls you trying to impact you. So as a secure, like, as you're saying Sean, like a security app, it's a, it is that kind of strange situation where it's really about the, this very sort of passive sort of interaction. I was curious, Brad, when, when users do interact with the app and you you've said you've added some of these features like reminders and things like that, who in the organization is really responsible for figuring out how to have those interactions when to have those interactions? Is it, how's it, how are the teams are organized around that for product marketing growth? Speaker 3 00:25:44 So I'll tell you the Tim's probably been reorged three or four times, you know, in my time as, I guess, nothing too unusual, but the way we've now set up the teams is in sort of squads if you will. So we've got our growth squad, which, um, encompasses that entire sort of journey. So we've got people at different sort of points in that, uh, I guess, um, journey with echo. So everything from top of funnel stuff, call that marketing right. And all the way down to, um, our product managers, engineers, and so on from a growth perspective. Um, and then we've got the same sort of squads and other parts of the business. Um, but everyone's got the growth hat on to make sure that what they doing is delivering that value to patients. So when it comes to notifications and reminders and so on, it's very much a collaborative thing because it it's everything from we'll watch. Speaker 3 00:26:44 What are we really trying to instigate? What behavior are we trying to instigate with a reminder? Um, so w you know, what we came to was that we shouldn't try at that time, at least predict when people take their medicine and so on, we draw them, let them tell us so that we can fits into their lifestyle, their behavior, you know, um, I take my medicine at 10 o'clock every night, um, and let someone want to take it. I, at lunchtime, this sort of thing, what we did there was ultimately it came down to a lot of conversations with our patient base and just trying to really understand how they are using. Uh, and when I say conversations, I mean, also speaking to people, but also observing their behavior, um, and really trying to get underneath the skin of how people take their medicine. And when, Speaker 1 00:27:37 In your role as head of growth, how, how do you think about that? How that scoped and, and is it, is it more of like influencing a lot of these other teams, or do you have direct reports in, in different parts of the organization? Just, uh, I think it's one of the big challenges of the head of growth role, is that right? Speaker 3 00:27:56 It tends to be structured differently for a lot of companies. I mean, my, my day to day, if you will, is, is, um, about managing a team that is focused on top line, patient growth. So getting people through through the door, if you will, however, the last that's my primary day today, that's not where the remits stops. Right. Um, it very much, I such within the broader growth team and, um, have regular sort of discussions and catch ups and so on without a data team, data group, like growth team, the project, product managers, and so on to really, um, focus on efforts on the, the initiatives that are going to, um, help us continue growing. And then do you have sort of Speaker 1 00:28:48 Both within the teams that you, within the, the areas that you manage yourself on the, and, and really everyone kind of playing some sort of a role in growth, is there, is there a sort of a centralized metric is you, you mentioned like, okay, I've got to, you're bringing in new new patients, but is there, is there like active patients or something that, um, kind of cross-functionally, everyone's focused on growing that, that, uh, measures more of that impact that you talked about Speaker 3 00:29:15 Important than the big picture of the business? It's very interesting one. So, so that's where I think our vertical, if you will, is slightly different from other companies in that. Um, one of the big, I mentioned that earlier, um, one of the biggest reasons, our understanding of why people churn is not, uh, you know, there's a non regrettable churn there, people unfortunately pass away or something like that, but then there's regrettable China. And the vast majority of reasons why people turn away from ACA is if we can't get them in medicine, right. So efforts when it comes to Chan or attention, that is really a operational logistical effort, right? So it's, it's engineering time. And so on, that's really focused on how do we get medicine to people's doors quicker? Uh, how do we get through that bottleneck as fast as we can. So weirdly it's less of a right now, at least it's less of a friends and product play and what is an operational one, because it's all about, okay, ordering the right medicine, right. Speaker 3 00:30:25 When you've got limited space, it's we operate very much on a, um, a model that means that we, we, we don't overstock and all that sort of stuff, it just time. But, but it's, it's really our number one reason for Chen by far is did we get you your medicine in a time, right. Again, that stuff I mentioned, if we missed, if you go a day without your medicine, for some people, they may be no immediate effect, whatever they may be. Right. So if someone is suffering from some mental health condition or, um, uh, someone with epilepsy, or, you know, the, the list that, that if we don't get, if you go diabetes, of course, if you don't have your medicine for a day, even there can be some serious competition Speaker 1 00:31:17 Asterisk. Yeah. I, you know, it actually reminds me a lot of TransferWise. Um, but that's a, an interview I did with, uh, Neil on Paris, that head of growth there when I was actually in London, um, about a year ago, almost almost to the D Oh a little bit about a year and a half ago, I guess now. But, um, you know, one of the things that he said is that they were, they're very driven by just word of mouth referral with TransferWise, and they track their NPS really closely. And what they find is that sometimes they grow so quickly that operationally things start to fall apart where, you know, customer service takes more time to get back to people. And just the things, things don't work as smoothly because growth is tough. And, and that, when that happens, they see a significant decline in the NPS, the net promoter score again. And so they have to, they have to kind of keep retrenching on operations. And I've heard that theme come up a couple of times with you that you, you know, even more importantly in your case that it's life and death, if your operations fall apart, cause you grow too quickly. Speaker 3 00:32:20 Well, this was a dry. So for example, COVID had there, uh, 17th of March, right? Huge. Um, we actually turned off all of our monitoring because demand was not a problem rise. Um, and because everyone in the businesses, so patient focused the patient first, right? Um, the whole marketing team obviously stopped what they were doing from a marketing perspective, but hopped onto doing patient care customer service. Um, as the product managers, everyone was just focus on trying to do the best for people that we possibly could. Um, our, our patient care team, our customer service team over that sort of period scale. Anyway, we went into our hiring, um, and it scaled from eight people. I think it's sitting at closing in, on 50 people now. Um, and that was all again about going well, if someone with a, with a real question or problem or issue has to speak to someone, we have to try and make ourselves available as quickly as possible. Speaker 3 00:33:27 There's not worse than you going. Okay. Where's my, I dunno my, uh, my laundry basket order, right. Or something else. That's right. Um, yeah. Okay. It's going to be a day or two, but if you, if you are really, um, having a panic attack with something more serious, when it comes to, is my medicine arriving, there's this global pandemic things are going crazy. Where's my medicine. Um, the first thing, you know, we had to make sure that we, and it still do, and it's still a process have to make sure that people have that outlet. They have that sort of points of reference, but then our warehousing, which is effectively our pharmacy, um, that was just not, I mean, you know, no business plan, we had expected that sort of rapid scan. Okay. So what was fascinating was I could have Dominic, uh, he did an incredible job of finding a location, um, doing all the licensing stuff, of course, but essentially lifting up our warehouse, our pharmacy out dispense, sorry. Speaker 3 00:34:31 Um, moving it to a brand new location in a couple of months that was, would allow us to get to something like 10 X where we were at that stage. Um, and all of that had to be done in record time, you know, with no disruption to patients. I'm curious if the relationship with McKesson was, uh, extra valuable during that period. I imagine they have a lot of the experience with the logistics that you probably were dealing with with di did that come into play during that? Um, well, interestingly, you know, I think, um, not so much a McKesson where they've been really good as providing the resources and the, uh, and facilitating for us if you will. Um, but then they'd been really good at letting us get on with the things that we are good at. So as, you know, move fast. Speaker 1 00:35:18 Sure. Yeah. Sometimes like a scrappy startup mentality is going to be faster for, for addressing a rapidly changing market. Speaker 3 00:35:25 Yeah. A hundred percent. Right. Whereas if, if it has to go through a more established approach, there would have been many hoops, many committees, many meetings, you know, to get through. Um, but what we were to do exactly right, is that scrap, we still had that scrappy sort of startup culture. So, um, that allowed us to get that done where McKesson's help really was, you know, he was backing us, right. Signing the check and you need to sign it, um, putting the financial clock behind us, you know, because as a younger startup, you don't have your financial history. Right. You don't have that. That's where that relationship just really was. Um, essential. Speaker 1 00:36:08 Yeah. So if you guys took your focus off of top of funnel, yet you kept seeing all of that growth. How were people finding out about it? Yeah, Speaker 3 00:36:18 Let's try it. I think, um, uh, word of mouth. So we've always known that people, um, refer right. Um, we always know that because they tell us, you know, they, because the best thing I've ever had, um, I'm telling all my friends about this, but, um, during that period, it was very much word of mouth driven. It was also, um, when I had my own friends who, you know, for the first time in my life, I became that cool friend that could get something for someone. I had friends getting a hold of me going, Hey man, my mother suffers from, um, you know, a condition. Um, can you help me out? Can you like help make sure that my mother who is in a completely different city and lives on her own, um, can still be there when I see her next essentially. Right. Um, so it was word of mouth driven. Now what's interesting there on the word of mouth friends, the, and showing your, the, uh, the most, uh, referral Mr. Referral we'll stop. Right. Um, but weirdly in the medical space here in the UK, you can't actually incense wise people, you can't run a traditional referral program because, um, well, effectively it's illegal. Right? You can't incentivize people to take drugs. Um, as much as we'd like to, Speaker 1 00:37:41 Although there is a multi-level marketing group that's been selling on street corners for you. Speaker 3 00:37:49 Yeah. But that's it. So it's like, we, we've always known that people are talking about echo or echo and all that sort of stuff, but we've never been able to set up a program, um, that, that really bubbles that up, you know, and gives us a way to sort of iterate on that. How do you think people become comfortable spreading the word about echo? Like what, what is it about the experience? I mean, I guess it would be somewhat medications specific. I mean, if you're, if you're dealing with anxiety, it might not be the thing you'd like to talk about with others, but I, I guess certain, you know, especially certain audiences are gonna be more comfortable talking about certain problems they're having brought on Nathan, sweat on, you know, I think so some people are not necessarily comfortable talking about, let me think. I mean, erectile dysfunction, right? Speaker 3 00:38:36 I'm not going to go and talk about that necessarily. Um, or others, you know, some people are uncomfortable talking about their mental health. Some people are uncomfortable talking about the fact that they've got type two diabetes, right. Because it's often seen as well, that's your fault. You're the one that the stuff to face with McDonald's for 30 years and that sort of stuff. So you're absolutely right. A lot of people are not comfortable about talking about their condition or making people aware of it, but then they are a big group of people who all comfortable or are caring for someone right. Where they are talking about how they care for the person, especially parents. For example, if I'm caring for my mother who, who does have, you know, she's on a good handful of poles every night, um, any sort of 70, 75 year olds on way. Um, I'm very comfortable talking to my friend partner about how I saved my self, you know, save time efforts and getting my mother, her medicine. So those sort of behaviors are very prevalent, you know? Absolutely. Speaker 2 00:39:43 And it makes sense that, you know, those, those people are, they're proud to share that story. I guess if we get to take sort of a step back from that, what's sort of the, the path of discovery for the typical echo user. Like how did they, how did they go from discovering the service using it and then becoming a raving fan and then hopefully sharing that experience with others? Speaker 3 00:40:02 Yeah. So when I joined echo again, a hundred percent of our budget was on Facebook. The business grew up on Facebook, uh, advertising, I should say specifically. Um, and that was sort of the bread and butter for a while. You know, now Facebook accounts full five, 6% about overall marketing spend. But really the, the way we, we, um, reached out to people at the time was, uh, early in phase, uh, in Facebook and echo his life was all about, you know, let's just hammer home ads. Um, that again, evolved. And, and, and for example, we ended up doing in November, 2019, we ran some door drop activity. We thought, okay, well, you know, let's give this channel and go, there's lots of insights there that makes it interesting. Um, but we didn't see uplift. We didn't see uplifts, but, you know, with, uh, despite having all the, you know, custom URLs and whatever on that, but then COVID hit, for example, again, March 20, 20, and suddenly you see these huge spikes in sign-ups from people that receive these door drops many months before. Speaker 3 00:41:16 Um, but anyway, tones, you, a question was specifically the typical sort of, uh, an historical it's, there's a few streams now, typical is, you know, they'll see an adverse of bowels they'll download the app, will visit the sites. Um, and then there's sort of a, it's very quick process to sign up to echo, um, your request, your medicine. Um, and then there's a bit of a lag, right? Because your GP you're a doctor. Do you guys call it GPS general practitioners in the U S I don't actually know. Yeah. Okay, cool. No, no. Right. Um, but yeah, so you'll, your GP would approve that now, depending on how long that takes, that's where it bottleneck is often. And some people don't necessarily appreciate that. Um, once your GPS approves that we get it, we dispense the medicine, most medicines dispensed in under 48 hours. Um, but it's in 48 hours is the, is the, um, worst case scenario from getting that approval. Speaker 3 00:42:18 Then we don't really see raving fans immediately. You don't see people sort of, you know, thanking us, uh, immediately. What we do see is that happening after they've received them meds once with two or three times, because that's where it's a while to build that trust, because the first time is very, you know, you're, you're talking about what if this goes wrong? You know, it's a, it's a really, there's a bit of a trust anxiety going on, but then as soon as they start receiving orders and they get to know, okay, yeah, I should, my, my notifications come up that I need to reorder. I should probably be, you know, we, we time that, so that there's enough time to get your meds and such you don't run out. So people are now also comfortable. They'll get, they get comfortable with us, reminding them to reorder or re request, I should say, um, you know, seven, eight days before they are likely to run out. And once they get into those sort of habits and flows, then, um, the light bulb clicks, right. The light bulb clicks. Great. I can never, why would I go back to standing in line at the pharmacy again? Speaker 1 00:43:30 Do you see any interplay between like, people who may have been told about it a few times by their friends and then, and then they see an ad on Facebook and then they, that it's the ad that maybe they attribution comes in, but when you, when you actually ask them, it's like, Oh, people told me about it. And then I saw an ad. Do you see anything like that? Speaker 3 00:43:48 Sometimes, sometimes not, not dramatically. And I'm not dramatically. Now that marketing mixes is significantly broader and more complex. It's even more difficult, right. Because it's all over the place. Um, and what we don't have, and again, there's privacy things in medicine. What are we doing to have is how did you hear about us? Right. We don't ask that question. Um, uh, and we probably should, we probably should, but we have to find ways to ask it that doesn't infringe on, on people's privacy too much. Um, it's very hard to sort of give you a definitive answer there, but we said, when we've interviewed people and we, and we do that a lot, you know, um, and so we all patients speak to them and everyone in the business can help onto these interviews. Right. You can always listen in, um, or, uh, yeah. Uh, but when we speak to patients, a lot of them will just say, I came across your ad and I thought, I'd give it a go. Um, having said that though, that is, um, there's more complexity there that we recognize that we haven't been able to prove out. Speaker 2 00:44:54 Interesting. So on that theme that, you know, once people experience this and have a good experience, they probably are never going to go back. But over the, over the, you know, the coming months, we hope that the vaccine and, uh, we'll help COVID subs subside a little bit. And, uh, we'll go back to some sort of normalcy. How do you expect, how do you see that changing the world of echo and, and in what ways, and what are, what's the plan for expansion now? Like, where will you grow and go from here? Speaker 3 00:45:22 Great question. Great question. So, so a couple of things, one, actually we sold the peak, the real sort of peak of demand only lost about six, seven weeks off to the initial lockdown date in the UK. Um, so interestingly that, that wasn't, and even though we doubled in size and some competitors grew dramatically, you know, and the whole space was totally, everything was getting crazy digital, like delivery penetration, uh, services like echo in the UK is any sitting now at just shy of 3%. Um, and that percentage, even in the U S you'll find is actually really low. Um, I believe last time I checked, so I'm sure it's high and now, but last time I checked, which was ages ago, um, I think, uh, the delivery pen of digital penetration in the U S was only 8% and that's probably mostly Canadian pharmacies Canadian, both of these. Speaker 3 00:46:21 Yeah, exactly. And the, so the first point is that there is huge opportunity for us to transform people's lives and make sure they get the medicine again in England, we don't even operate throughout the UK. It's just an English. Um, but because all the healthcare services in the United Kingdom are so different, it's almost easier for us to launch in Ireland or the U S or Germany as, as it is for us to launch in Scotland. So, you know, I don't think there's an, obviously the relationship with McKesson means that where they've got a strong foothold or presence, we can piggyback of that. Right. However, having said that the UK mob, the English market is still so untapped. Now don't forget that half the adult population in the UK are on some form of repeat prescription. And so that is what does that add an a 20 million people, right. Speaker 3 00:47:23 But only 3% of them are currently getting their medicine delivered. So huge opportunity, uh, in this market to still expand and to figure out, I don't think, figuring out, you know, the logistical and operational end and sort of app experience, um, things are, are on the crux. I think there's a lot about how behavior generally that we still need to understand. Right. And I mean, behavior it's, what is your relationship with your medicine? Do you see yourself as a patient, right. Or a victim or not, and, and what things we still want to uncover. Um, but yeah, they wouldn't probably be any immediate expansion anytime soon, because this market is, is still untapped. Speaker 2 00:48:11 Yeah. I mean, I think when you're, uh, when you've got an open market like that really dialing in product market fit there and really understanding it, that's probably the key to any future expansion anyway. So if you guys can really own and, and understand how to, how to really deliver value for end users and in the UK, it seems like that's a good way forward. Um, so we are running out of time. I just wanted to ask, uh, one question that we, uh, we always like to, um, uh, ask all our guests is what do you feel like you understand about growth now that maybe you didn't understand as well before your echo experience a couple of years ago? Speaker 3 00:48:49 Uh, again, you guys are full of, uh, full of great questions. You know what, um, I think pre COVID, um, maybe naively, maybe not, you know, the thing that I didn't have an appreciation for at all was the effect that real demand can have. And, and, you know, as someone in sort of the spatial about generic CRM, uh, you know, all these sort of little bits where you're trying to eke out, you know, find your percentages and find that little quick win. But what I learned from suddenly March, April last year was that if there's real demand, right, a real demand for your service and product, um, your people will fight to be able to access a draft. Um, your, your onboarding experience can be rubbish. Your branding, who cares, right. If people really wants to be able to access a server for product, whatever they will fight, they will jump through hoops. Speaker 3 00:50:02 They will do everything possible to get that, not to say that everything else isn't vital and I'm still a hugely, a huge proponent. However, what I learned was that actually the, it needs to be about that. You need to focus as much on demand generation as what you do on demand harvesting, because if people really want one to use your products, really, really, uh, you'll marketing, you know, uh, cash is probably your budget. Doesn't need to be as great. Let's put it that way. Right. You can focus on delivering, uh, other, I guess, uh, efforts. But yeah, that's, Speaker 1 00:50:45 I think what you're really talking to there is something that Ethan and I are really aligned on that that probably the most important growth factor in any business is product market fit. And yeah, probably market fit essentially is exactly what you're saying, demand for a solution to a problem that exists. That's not currently being fulfilled by other solutions. And so, um, you know, if you, if you have that dynamic, you, it is just so much easier to be successful than if you don't have that dynamic. And sometimes in that, in that case, you actually want to spend more on marketing because it's a matter of kind of getting the word out there that the solution is available. Speaker 3 00:51:24 So that's a drive, that's a joy, you all, your marketing focus shifts, right? So you're not looking to mop up sort of a sort of bottom of funnel, a need stage. You're looking to generate that, but also your right product market fit is pretty much. And, and what's tricky is that a lot of startups forget about that, right? Forgot about that. They end up doing, is they okay? We've got to raise money in six months time, we have to show, uh, some level of growth. Let's spend as much money as efficiently as possible. So we can show you that out-patient, while a customer numbers, whatever have increased by that 30% we on this investors. And just look for that next investment round rather than solving what is fundamental, you know, that fundamental problem of is this something that people need and will once that isn't full currently. Yeah. Speaker 1 00:52:18 And that's definitely, so that's one of the key takeaways I take from this, you know, particularly in a, in a COVID situation, that what people are afraid to go to the pharmacy that created a real opportunity to, to tap into it. But one of the things that I, that really jumped out at me from what you said in the very beginning was, you know, we're growing really fast, but we're not happy with that because, or we're not satisfied with that because we have such an important mission that we really want to push the envelope. So it's just like push and pull between. We want to make sure that operations are good, are good enough so that we can very effectively fulfill the demand that we're creating. But at the same time, there's lots of people in need that are not on the platform yet. And you want to be able to get them on there. Speaker 1 00:53:04 And, and then being able to really use the data as you have done is another key takeaway that the data helped you hone in on who that target is. And then, you know, everything from the interviews that you talked about, just understanding that target and understanding the dynamics of how, how they think about medication and how can you tap into those existing, uh, you know, data. I don't want to use the word habit around medication because it's, it's almost, even though it's like, I think an important word in growth, but just, just the sort of consistent action that they have around that medication, that if you can tap into that and make it easier for them, you, you can, uh, you can become an important part of their life much more quickly than, than a product that's kind of starting from scratch, where they don't have any sort of day to day, um, things that they're doing that are related to that product. But, uh, there's a ton of great learnings that I took from this. I'm curious, Ethan, do you have anything else that jumps out at you? Speaker 2 00:53:57 Yeah, I would echo the same things, but it's, it's interesting how interesting for me, it's just that the subscription mindset is in a co in a business that isn't actually a subscription business. Um, but you essentially echo not to, not to be corny, but you're echoing the idea of, um, how subscription models work, because you're trying to get that repeat usage and, uh, yeah, it, it, it just really, it it's, it struck me how the patient led approach has really been the key to growth for you and how that's driven this cycle of just keeping speaking, you know, speaking to, to your, your audience, learning from them. And, um, you know, it was a key point for me that you guys really dialed in that you had to learn how to speak to an older audience. So, uh, lots of great learnings for me as well. Speaker 2 00:54:46 I really enjoyed this, those, so that's flattering and I'm sure, uh, when the team hear this back, there'll be very thankful and grateful for those comments. I mean, that's what it comes down to it's I think we are a very mission driven business. So to your point, Sean, you know, we'll never be happy with where we are, because our mission is about, you know, adherence about getting people, the medicine they need to get, well, we'll stay, sorry, stay, stay well or get better. Uh, and, and that is an endless sort of battle, right? And the easiest way to do that is to have the medicine in your hand. So with that being a constant mission, it's, um, you can have it be happy, right? Speaker 1 00:55:31 And that's just such a powerful thing. I think if you, if you have that in any business, it's just, it's a lot easier to get out of bed in the morning and be pumped up to go to work versus like, all right, back to the grind to hit a steeper curve up until the right. But, but like when you can really contextualize the difference that you're making and the good that you're doing, um, you just, it, you tap into a much deeper reservoir of energy in your, in your day to day work and meaning. And it sounds like not just you, but really across the company that people are doing that. And that that's awesome. Speaker 2 00:56:04 Well, that's it, you know, most people in the company either have a condition or are caring for someone with a condition, right? So they not only motivated by the work they doing, but they motivated by the people they've been in the workforce. Yeah. Speaker 1 00:56:17 Well, Brad, I know Ethan and I could, could pepper you with questions for the next few hours. You've got a weekend, that's a, that's there, you need to recharge for another week of, uh, uh, working on that mission. But thank you so much for taking the time and sharing the story with us. And, uh, I'm, I'm really impressed with everything that you're doing at echo. So congrats on all of that success. And I, I know you're not going to rest on that success that you guys are going to keep pushing from here to, uh, you know, get, get everyone in England, then more broadly across the UK and then hopefully, uh, find opportunities even beyond that. So thank you for sharing that and for everyone listening, thanks for tuning in. Thank you. Very Speaker 0 00:56:59 Thanks, Brad. Thanks. <inaudible> thanks for listening to the breakout growth podcast. Please take a moment to leave us a review on your favorite podcast platform and while you're at it subscribe. So you never miss a show until next week.

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