19 May May 19, 2020 – Stem Cell Bank Pioneer Cynthia Fisher and Professional Blogger Alex Nerney
The physicians and surgical centers that charge low cash prices
are doing it about 40% cheaper than any other providers.
Cynthia A. Fisher is a life sciences entrepreneur, best known for her pioneering work as Founder and CEO of ViaCord, Inc., a leading umbilical cord blood stem cell banking service which she started in 1993. In 2000, she co-founded ViaCell, a cellular medicines company that became the parent of ViaCord and the subject of an HBS case study. She took ViaCell public in 2005 and sold it to PerkinElmer in 2007 for $300 million. In 2011, she founded WaterRev, LLC to invest in novel technologies that enable sustainable practices in water use. She serves on the public company boards of The Boston Beer Company (SAM) and Easterly Government Properties, Inc. (DEA). Apart from that, Cynthia is also the Founder of FitMoney, providing schools and teachers curriculum for K-12 financial literacy, and PatientRightsAdvocate.org, a non-profit 501(c)(3) advocacy organization for the American public seeking to greatly reduce the cost of healthcare and coverage through systemwide price transparency and creation of a functional and competitive marketplace in healthcare. The wry encapsulation Cynthia uses to describe her professional activities is “If I look back at my career, I’ve focused on liquid assets: blood, water, and beer.”
Alex Nerney – Co-Founder of Create and Go and Avocadu – Read interview highlights here
There is not a benefit to posting more, but instead
to post high quality.
Alex Nerney, Co-Founder of Create and Go, is a professional blogger, adventure junkie, and digital entrepreneur living the dream! Alongside his business partner, Lauren McManus, Alex was able to grow his side project Avocadu into a six-figure per year health and wellness blog with over 3 million yearly visitors. After making a bunch of money blogging and traveling the world, he and his business partner started Create and Go in early 2016, growing this business at an insane pace, ending 2018 with over 1,000,000 website visitors, 10,000+ students and over $1,000,000 in revenue. Alex decided to start Create and Go to teach others exactly how they did it and share their journey as professional bloggers with them. Alex has been quoted and recognized in many publications, including Forbes, INC, Yahoo!, and more. Reaching 500k subscribers on all his platforms combined, it’s clear that Alex’s passion to help others make money while they follow their dreams has inspired many like-minded people to live a life full of adventures, constantly evolving and becoming a better version of themself!
Highlights from Cynthia’s Interview
The ViaCord business, believe it or not, back in 1993 when I started it, we were not only a telemedicine company way before its time, but we also were price-transparent. So back in 1993, we started a medical service company in the biotechnology world of stem cells, where any expectant parent mother could choose to bank for newborn baby’s stem cells for their potentially life-saving use as an alternative to bone marrow. So we did the very early transplants for treating cancers like leukemia, certain genetic disorders, and that child’s cord blood was either used for the baby itself or another family member. It was price-transparent, so people knew the price before they actually procured the service. A novel concept in health care and much of the care was handled via the telephone. So in the days of healthcare today, fast forward, that’s what we’re fighting for now in Washington with the nonprofit organization I founded, PatientRightsAdvocate.org, to allow patients to have the right of access transparently to such critical information and be in control in the driver’s seat to control their precious harder and healthcare dollar.
Well, the interesting thing is, only in healthcare, unlike grocery can you see this lack of price-transparency. Can you imagine that you go to the store and you go get a gallon of milk, and then you come home and you don’t get the bill until weeks or months later, and you find out it’s a $500 gallon of milk? But if you go to the hospital, most likely having an extended stay with all sorts of complications, one could say you were mistreated, possibly even misdiagnosed at times, and I would bet you were mischarged. If you went and bought a dishwasher that ended up going south and not working, or you got a car that malfunctioned right after getting it on the lot, you wouldn’t be charged for that. You would be able to take it back. The healthcare did save your life, but one could also argue how much of that was caused by a medical error.
But taking it back to the milk real fast though, another thing about the price of the milk, not knowing for six weeks what it’s going to be, but then not only do they send you a bill for the milk, but then they send you a bill for the refrigeration of the milk, they send you a bill for the distribution of the milk to get it to the grocery store where I bought it, and then the anesthesiologist sends you a bill for keeping the milk asleep in your refrigerator, and then they also charge you a facilities fee for the honor of having the milk stored in the grocery store. So many Americans have their own stories of going for healthcare, not knowing what it’s going to cost, being blindfolded to know prices before we get care. Then when you get care, you’re blindsided by outrageous prices that you never expected to pay. On top of it, you’re expected to pay with a blank check, whatever they choose to charge you. Even if you’re insured, you get surprised by other bills from physicians that are only on contract with that hospital and have their own billing outside of your insurance coverage. So the healthcare system is broken and Americans are held hostage to this opaque system, with many egregious levels of middle players and players at the trough, capitalizing on the patient’s misfortune.
The good news is actually there’s a big opportunity that lies ahead because of entrepreneurship and innovators, and that is, those physicians and surgeons that have basically stepped out of that broken system and have started surgical centers like Texas Free Market Surgical, Oklahoma Surgical Institute, OSS surgical in New York, Pennsylvania. These enterprises are doing surgeries at transparent prices and if you went in for a bowery section at their surgical center, they would stand behind one price that they would quote you. It would be posted online, and you and all patients would be charged the same amount. If anything went south or wrong, you wouldn’t pay anymore. Why? Because they’re going to stand behind that one price that they quoted you for their quality service, and it’d be both quality and price-transparent. A novel concept! These physicians and surgical centers and even primary care doctors that are charging cash price low prices, are doing it at about 40% lower than any other insured or claims data that is looked at historically. We actually saw Dr. Larry Van Horne at Vanderbilt, looked at the actual data, and it’s about 40% lower to go to these quality physicians and providers. That’s the future. The good thing is they can still make money. Why? Because they attract customers from all over our country. Before COVID-19 and travel, people were actually traveling out of state and employers were paying for travel expenses to go to these centers, because it would save tens of thousands of dollars. They would keep bonuses and increased wages back in their pockets as incentives to go to these innovative new entrepreneurial physicians and surgical centers.
You’re starting to see the same in optometry, so the eye industry is where true competition is happening in medicine. In fact, if you look at the laser surgery, LASIK surgery is what they call it, or if you look at plastic surgery and you look over the past 10 years, the prices have nearly come down more than half in the marketplace because of competition. That can actually be applied across the healthcare system, if we just can see prices before we get care and let competition loose, to drive down the costs of care and coverage.
I was actually going to organizations and businesses and saying this is your solution to your healthcare problem and to your insurance premiums going up 42% a year, and I think that’s the long-term solution. Businesses and American workers, the American employers and taxpayers, basically we are the consumers as patients of healthcare, we pay for it. It’s really businesses that will stand up to say, “Hey look, we’re coming out of a pandemic economic crisis, we can’t afford these runaway costs and healthcare. No more!” Small business and medium-sized businesses over the past several years have seen increases in premiums, nearly 14 to 20%. Larger businesses that have more negotiating leverage, 5 to 8% increases a year. Well, when these actual innovators went out and went with a price transparent model, do you know what happened in the marketplace where they actually knew their costs and they removed all the layers of middlemen? Dr. Keith Smith, at Oklahoma Surgical Center has told us, since the 11 years when he started posting their prices online for all of their procedures, they’ve only lowered their prices. Four times they’ve changed them, and each time they’ve lowered them because they get more and more control over their costs and they’re able to pass those savings on to the patients. The same should be with any major hospital system anywhere in our country. That discipline, as an entrepreneur would know, comes from a market economy. The only way you can have a market-based economy is if it’s functional and you get to see prices and you put the consumer in control, in the driver’s seat.
We have gone a long way from market in the last month, though. We have government bailing out hospitals to the tune of nearly $200 million billion. The insurance companies, they should be like the car insurance companies that are actually handing checks back for us not driving our cars during COVID. Because hospitals have shut down elective surgeries and emergency rooms other than COVID, so patients are down by 35 to 40%. You actually used your heart, liver and lungs, but they were actually really prepaid medical, they’re not really insuring that hard. So let’s be real, they only have to pay out. I’m hoping that we all get checks at the end of the year from our health insurance companies, from the premiums that they’ve been able to invest over this time.
Let’s talk business about where policy is going to change. The only place it’s really going to change is in Washington. We’ve been doing market research and polling with the nonprofit I founded. Having come from the healthcare system, I’m actually fighting my own industry. Why? Because it’s run amok. We can put these trends in reverse by putting the consumer in control, and the consumer doesn’t have a voice in Washington. So I decided to put my own money and time and invest it in fighting that fight. I will tell you that there is the opportunity forward, because in the Harvard Harris Poll, 88% of Americans across; whether they were Republican or Democrats or Independents, 88% supported government mandates of the healthcare industry, hospitals and insurers, and pharmaceutical companies to reveal their secret or hidden negotiated prices, so that we can know them before we get care. So now’s this moment in time for all that bailout by government to actually provide accountability and transparency in the system and reward the consumer and the taxpayer. God willing they do it, Congress does it in the Phase 4 Stimulus next month.
People are skeptical that that sort of accountability will be built in by the least accountable people on earth, but what we do have is the American consumer. I will tell you, I’m not Pollyanna, I’m not too much of a crazy optimist, but I do see some light. As horrible as this COVID-19 pandemic is, and God bless the families that have lost loved ones or who are fighting the ill themselves and all the healthcare workers; the doctors and nurses on the frontlines, the light that I see in this pandemic and disastrous time putting great strain on the individual families, our society, our country, our world at that matter, this is the light that I see, it is entrepreneurship and innovation.
Why? What do we see with COVID-19? We are staying home and we have to secure our physical and mental health and our financial health; all from our smartphones, our televisions, our computers. That has changed medicine to quickly break down the barriers and the silos that the healthcare industrial cartel has put up to keep these charades and status quo going, and has placed them down to create a new world of telemedicine and virtual care which, by its way, is price-transparent. You know the price in most cases before you go on a telemedicine visit. Not only that, you don’t have to get in the car, you can do it from your FaceTime or your GoToMeetings or your Zoom call. Think about the difference that does for eldercare, 24/7 care, rural care, urban care. It’s going to enable patients and the consumers to have broad access at an affordable price and get quality care across our nation. That’s a really big deal. So I think its innovation and entrepreneurship that now out of this crisis will rise to create the American healthcare system that we can trust again.
You can go online and go to our website “PatientRightsAdvocate.org”. Then we are also on Twitter, so feel free to follow us. We encourage you to look at the videos online that tell, not only patient stories, but these incredible successful business stories of where they’ve saved on their healthcare so substantially. So we’re really optimistic about the future. We’re still working in Washington because we do believe that there’s an opportunity for demanding price-transparency system wide, and transparency across the system, even supply chain. It’s a great thing to have accountability and transparency in Washington DC, but especially in healthcare. So I’m not giving up hope there, I’m going to still pound the pavement. I’m doing it virtually now, but I was pounding the pavement in Washington. I packed my suitcase to bring the voice of the American consumer, and that’s the patient, the worker, the employer and the taxpayer. We’re the consumers of healthcare to Washington.
Highlights from Alex’s Interview
Let’s start with my story and what I doing and why did I quit all that stuff. Back in the day, I was a personal trainer in Dallas, Texas. I was running around, waking up at 5am, teaching people how to work out; people who didn’t want to work out, and try and convince them to stop eating things, and really not enjoying my life and what I was doing. So at the time, me and my business partner decided to start a website, essentially a blog. After a few months of working at that website, one failed, but then we started another one and started to get some traction, we started to get some visitors online. So we came to this crossroad decision of “Well, what if we quit our jobs, sold all our things and just try to go all-in with our business and with making money online?” That’s what we did. We made this crazy decision after this hike in Seattle, moved into my dad’s house, and we started working. Once we burned all the bridges and we started working at it, we started slow, we made our first $100 per month. We weren’t making any money when we quit, by the way. We made our $100 in a month right afterwards, and then the second month, we made $200 and then it just kept doubling. So we did $400, then $800, $1,600, $3,200, $9,000, then $18,000, then $40,000 in a single month. That’s how it all got started. For us, it was just an absolute just frustration with what we were doing, was what led to us moving towards blogging and our success.
So the first blog was just a health and wellness website and it was called Avocadu. It is called Avocadu.com, we still run it today. What we sold on there is primarily a few fitness programs; so one for yoga and one for losing weight. We also run ads on the website as well with a company called AdDrive. The health programs we have are very cheap, they are $47 and $27. We sold a lot of those back in the day. In terms of driving all of the sales, we tried to sell through Pinterest. So we are a very popular blog on the Pinterest platform. For those of you that aren’t familiar with blogging, Pinterest can be a very dynamic place to drive organic traffic to your website. So we drive most of our traffic from Pinterest. We drive them to specific articles, teaching them about certain topics they want to learn about. So let’s say you want to learn a new yoga exercise, we’ll teach them that on the blog. While they’re on the blog or on the webpage, we lead them to an email opt-in. When they opt-in to the email, they are then sold and pitched on our programs. So in that case, they’d be pitched for Yoga Fat Loss Bible.
Right now, Avocadu is just doing one per week. There was a time when we were growing at the beginning, where we were at three per week. But now, we’ve throttled that down a lot and realized that there’s not as much benefit to posting more, but to posting higher quality content. So we just do once per week, and about 1,200 words long is where we ended up, that’s two and a half or three pages typed. Quantity is almost as important as quality, which is the word count in terms of the Google algorithm. So it’s more like a sliding scale. If you’re under 500, you can forget about any Google traffic. But there’s also too much that you can do. Google is starting to recognize that people can try to fake it and write a 10,000 word topic about some healthy brownie recipes or something like that and Google recognizes that that is not going to best serve the viewer. But right in the 1,200 to 3,000 word range is where you want your articles.
Pinterest is a visual platform, so primarily what we do is we go on shutterstock.com and we will use images of either the ideal target markets and results or where they are at currently. So one way to do it is you find a woman doing some yoga and you create a pin for a yoga article, and you do write a little text on the Pinterest pin as well so people know what the article is about. In that circumstance, you are marketing the ideal image that somebody is trying to achieve, they see that somebody’s professional is doing yoga, so they recognize that this is about yoga. The other way to do it and another effective marketing technique that we have found is also to post about where someone is at currently. So if they are overweight and they’re on the couch right now and are feeling a little bit lazy, posting a pin like that and then writing something about how to get motivated to exercise is also an effective marketing tactic. That’s kind of the image focuses for us.
In terms of producing the articles, me and my partner are not doing it anymore. At the beginning, we were absolutely doing it. I would wake up at 4am before my personal training clients, and I would wander my way to Starbucks, and write articles. Then I’d write in the middle of the day, then afterwards. That was how we began. So I wrote all the articles at the beginning because I had a lot of health and wellness knowledge at the time. I had played college football for a brief time and I had been personal training for a while at that point, so I was pretty familiar with the science of everything, as well as how to make a marketable article. So that was a big key. I would say that creation ends up being about 30% of the time while promotion is the lion’s share.
That’s the big mistake that a lot of people think, “Now I’ve written the blog, I’m done.” But you’re not even close. You need to email it out to your audience, you need to post it on Pinterest, and you need to spread the word about it. I believe Derek Halpern was one of the first marketers to recognize this, and this goes back to the quality over quantity approach, is that when you’re posting something very high quality, you then can focus more on promotion. Then when people find that piece of content, they go, “Oh, wow, this is really high quality. This is really great!” But if you were just pumping out quantity, the promotion wouldn’t matter as much. So that’s kind of our focus right now.
We have other blogs as well, I own four of them now. So we have a health and wellness blog, we have a coffee blog, we have a blog that teaches other people how to make an income blogging, which was started after our health and wellness blog, and then I also have a web development website, just teaching people how to build your own website from scratch and monetize it. So a lot of different things but they’re all very different in nature. The web development company primarily hinges on a very strong YouTube presence, because that’s where a lot of people look for web development information. While, the coffee blog hinges a lot on what I just talked about, where it’s all about the article development, structuring, creating great posts, and SEO marketing them. But even that website is a little bit different from Avocadu as it’s not focused on Pinterest, it’s more focused on Google SEO. So each website needs a different marketing channel, if you will, because that is a little bit more effective.
The vast majority of customers we get from Pinterest are females. That’s again another reason. We tried our web development company, we tried creating articles and doing Pinterest, but people were much less interested than the health and wellness topics. So it’s about 80% female audience on Pinterest. To get the men, YouTube and Google are two good places. Google users are female as well, but YouTube is primarily a male user base. Obviously, it does have a large female audience but significantly less than men.
The blogging industry is always changing, it’s always moving, but it’s not moving as quick as people think. So there’s not some sort of rapid change happening, it’s just slowly evolving. Google will come out with an algorithm update that will change a lot. But really the core principles and concepts that it takes to make any successful business remain true if you have the highest quality articles and the best content on the subject. Google algorithms really won’t affect you as much typically. So there is some change, it’s always evolving, always a moving target, but it’s not like a Pokémon evolving, from one to a completely new one. It’s just a slow evolution.
If someone is doing it right, they can take their blog to a good modest degree in about three months to six months to a year and a half for full-time, and two years or three years to get to extraordinary income. It would take a good amount of time per week to get to the first level, but it would only take you working nights and weekends, so it would take like 20 hours a week, somewhere in there. Again, 70% of that is promotion.
So if you are interested in blogging, “CreateandGo.com” is the spot to learn. I’m doing a lot of projects right now, but I’m also building a media company. If you want to follow along for that journey, “AlexNerney.com”, my YouTube channel, Instagram are all personal branded on my name. We’re going to build something big out here in Austin, Texas. Just signed for a space, signing it today. I’m really pumped about that. If you want to follow along for the journey, we’d love to have you.