Tea Nguyen, DPM (00:54)

Today, we're talking about something that can completely change the revenue stability of your practice. It's when you should offer an annual membership and when you should offer a high ticket package. I'm going to clarify what those two things offer and how to apply it into your practice. If you own a private practice or you're thinking about starting one and you're going to offer cash services, things that are not covered by insurance, things like PRP for pain relief, shockwave, laser, maybe functional rehab or functional medicine, longevity medicine, integrative medicine, any other cash-based program, you'll need to understand this distinction because they are two models that are often interchanged, but they solve very different problems. If you use the wrong one at the wrong time, patients hesitate or they get information overwhelmed and the confused mind never buys. So you don't want to do that.

Tea Nguyen, DPM (01:52)

to your patients or your client. Let's first define these two models. When I say a high ticket package, what I mean is you're charging them a lot more if they purchased a set of things. Now this high ticket package is something that has an outcome. It is very problem specific and it has a timeline. You have evidence that you've helped people in their situation. An example of that is If you treat foot pain or any body pain, for example, and you can get them out of pain, then now you have a recovery program. If you take care of people who have neuropathy, for example, maybe you now offer a reversal program. So whatever specialty you're in, if there is something that you know has an endpoint for them, but it requires a strategy, kind of like your recipe for that perfect cake that only you have the recipe to, That's when you want to think about a high ticket package because the person is paying for the end solution. They're not paying for how many visits it's going to take to get there necessarily. They're not thinking that because oftentimes the patient or the client, they don't know how long it takes to get better. Only you know that as the doctor. So they're seeking your guidance. And if you do a one-off payment model where you come as often as you need, they may not commit to the plan.

or they may not feel like they're on the right path, they have hesitation, they don't feel fully committed, and that's when they kind of plateau in their healing process. And you want to be able to create a package that acts like a no-brainer for them because once somebody commits to a high ticket package, once they're trading you money to solve that problem, you are now providing them a transformation. So they are buying for the end result. They are buying the transformation.

Tea Nguyen, DPM (03:50)

They're not buying the time it takes for you to talk to them. So it's a different pathway. Now let's move into the annual membership type of model. We see this in the DPC model often, or maybe think about a gym membership where this has a lower level of urgency and that's going to take an individual a lot longer, a lot more convincing to decide if this is for them. So you have to go through a nurture sequence where you're educating them as to the value of your membership. so an annual membership is more of ongoing care. It's preventive based or maintenance based. It is focused on the access you provide the individual. So if they want access to you as the doctor more frequently than what they currently have, that's what they're paying for. This is more of a relationship centered type of relationship type of membership that they're buying into when it applies to a medical practice.

And you might have heard of these types of programs. They might fall in line of longevity and performance membership, for example, or an active aging program, or a priority access, right, kind of club. So the question that this type of membership answers is, can you help me stay well? So this is more of a continuity purchase. So the psychology of a membership when you sell it comes from a different place, it's maintenance, it's preventive, it's long term. So in summary, the simplest way to understand a high ticket package is that it's something that solves a problem in a finite time period. It could be considered more of an acute management or solution, for example. It can also be for somebody who's dealing with chronic pain that just takes a few more visits than an acute pain problem to be resolved. And membership is something that maintains something.

So it offers long-term access, long-term care, kind of like the gym, but instead the person's buying the membership to the doctor. And many times patients will have insurance. They'll have their insurance options for the episodic stuff, things that need immediate attention. And many will choose to have a direct primary care doctor who focuses on more preventive care and easier access. How does this apply to specialty care? It really depends on the type of specialty that you have. For me as a podiatrist, because I don't do any medical management long term, most of what I offer ends up being a high ticket package and sometimes they get converted into a membership which allows me to have sustainable revenue. So high ticket packages, you're selling in the thousands of dollars. This is about urgency and the ideal

Tea Nguyen, DPM (06:39)

high ticket patient is somebody who has tried the easy things. They have tried their insurance stuff. They're frustrated and they don't like the idea of another steroid injection or they've had it and it didn't give them long term solutions. They didn't get better. It came back or they had rebound pain for example. They don't want that temporary relief. They really want somebody to lead them to give them a decisive proven plan. These are individuals who are buying certainty because they're fed up.

They've wasted a lot of money, they've wasted a lot of time. And they're not somebody who is really thinking, do I need access to my doctor for 12, four months, right? They just wanna know, can this person fix my problem so that I can walk without pain? And that's the mindset that these individuals are in. Those who are willing to pay a lot more for their problem have a higher urgency. It's daily problems that they're dealing with, that they're trying to get rid of.

that they can't resolve on their own and now they're looking for the expert. Whereas a membership is more about the patient's thinking, I need somebody who can help me invest in my health so that I can stay active. It's a little bit of a different urgency, right? It's not as urgent. They're not gonna go looking, knocking on people's door asking, do you sell a membership so that I can have access to you? It's not necessarily that, but they are people who are acutely aware of the limitations of either their insurance options or they don't have insurance and they just want to make sure they have access to somebody. So memberships are people who feel like they have a higher agency over their health. They're extremely aware of the value of having a doctor ready on speed dial practically. Now, caveat, you don't have to be on speed dial, but that's the idea is that level of attention that you would get in a direct care practice.

Which is different than the insurance option because sometimes patients who call the insurance options get hung up on a phone tree, right? They're being passed through an operator after hours, they're being passed through a medical assistant, and then eventually the doctor gets the message a day or two later, right? There's a longer process in connecting the patient to the doctor. Now, it's not right or wrong, it's just the system, it's just the way it's built.

But when the person has a direct care doctor, most of the time you'll hear direct care doctors say they are happy to be accessible by text, by email, or a simple phone call. And they're not being abused for that time. Because they have a smaller patient panel, they have to accommodate fewer people. And that's the luxury of direct care. You need less to make this work, but you also got to price appropriately and not have a bunch of expenses in between to deliver that care.

Tea Nguyen, DPM (09:23)

So you might be wondering when to offer a high ticket package. Offer it when the patient has something that can be measured and can be resolved within a certain timeframe. So we're not talking about curing something that is incurable, right? Cancer, ALS, MS, you know, not that kind of stuff quite yet here. The high ticket package has the potential of having an endpoint. So if the individual is suffering from a certain kind of pain,

And let's say you provide a regenerative solution and you know at 12 weeks point, they should get 50 % better. For example, you have a defined protocol that is the person that would have a higher success rate in that high ticket package than the longevity membership based type of model or offering I should say. So we know that there's some level of predictability of success. There's an outcome and there's urgency. So If you're doing body part pain, you know, for me it's heel pain, ankle pain, Achilles tendonitis, Morton's neuroma. ⁓ For others, it may be degenerative knee pain, hip pain, spine pain. You might be in functional medicine. You might be giving hormone replacement therapy. You might be offering weight loss services. Those are things that have a finite problem that can be solved within a certain time period. And the way that you would structure a package for me is I like to explain it as it's kind of the no-brainer option so that it's packaged in a way that makes it easy for them to say yes to. And what makes it easy for them to say yes to is saying that it comes with the evaluation, we have imaging on site, it includes six treatment sessions, this is the rehab protocol, and X number of follow-ups. So that's what I call the tech specs. It's what's included in the package. And how you want to package your stuff depends on your medical experience.

Tea Nguyen, DPM (11:18)

So if you've dealt with this one condition for a long, long time and you know on average most people, not everybody, but most people can get better after five visits or so, something like that, then you know you have a high ticket package. So here's how you would present the package. You would say to the patient, based on your findings, the most predictable way to get back to be pain free is in our 12 week functional recovery program.

You decide what you want to call it. You can even trademark it, make it your thing. And now you're no longer selling your visits, you're selling a plan that works. And that in itself is highly valuable because how often are people just piecemealing together the solution, but they don't see the big picture. They don't have the experience to know what works in what order. That's what you do. Now, if you're a specialist, you're wondering, how do I offer an annual membership?

And I think this is where a lot of people get caught up. They don't realize that a high ticket package even exists in the direct specialty care model, but it certainly does. But depending on the type of medicine you want to practice, you might also be offering something that's more of an annual membership. So this doesn't work for all specialty practices, especially if you're a surgical type where you know the surgery will fix their problem and it should be done with the problem once the surgery.

The healing process is over, right? This is more along the lines of if somebody has already completed that successful package program. So this is like the back end of continuing care. If I provided a surgery, they would have a higher level of care, meaning I would extend that to six months or more. Sometimes that or more gets converted to a lower monthly membership.

Tea Nguyen, DPM (13:09)

So for example, if I provided a surgery, let's just say $5,000, I say, for me to do the surgery, you will also get six months of aftercare. Once you're done there and you need monthly ongoing preventive foot care, because oftentimes I get older people who for one reason or another just need a little bit more help in their feet, then I would downgrade them to this membership, this maintenance program instead. And so if you have something like that, that's when you wanna think about

providing more value in that relationship. So this is not a crisis mode type of membership. If they have a crisis, if they have pain that's debilitating, the annual membership doesn't always make sense. It's after you get them through the hump of that crisis mode that now they're stable, then you downgrade them for something where they pay a couple hundred a month for continued access and ongoing monitoring.

Other things that fall in line with the annual membership, your biohacking, which is not one of my favorite terms, but hey, some people are using it. So maybe you understand what I mean when I say that. You're providing functional medicine, regenerative medicine, stuff, post-recovery things, things that just is maintenance. It doesn't require a quick intervention, but if you stay on top of it, if the person stays on top of the treatment plan, they will avoid chronicity. That's it.

So you can tell the patient after they purchase the high ticket program or the surgery or whatever that is, at the completion of that, where they reached a high point, most of their issues have been resolved, you can then introduce them, because they will ask, what's next? You can then say, you would do really well to prevent this from happening again in a crisis mode and therefore here is the maintenance program or the prevention program.

so that we stay ahead of the curve, right? And now this is offered in an annual membership. So now you're shifting from the problem into I am the person who takes care of myself and I wanna stay ahead of the game. This is an identity in a sense where the person says I'm that type of person to have a gym membership. I'm that type of person who wants the VIP aftercare or I'm that person who says I know I can't predict the future, I just want something just in case.

Tea Nguyen, DPM (15:35)

That's the membership option. Here's where you don't want to create more confusion. Now that you know there's two types of things to sell, you've got the high ticket package and now you've got the membership option, sometimes I find doctors offering the wrong thing at the wrong time. If they came in for a problem that does have an endpoint, for example, they have chronic pain and you know that your PRP protocol will get them out of that pain,

You provide too much information all at once and you say, okay, we can do the PRP. Once you get better, then we'll enroll you into our wellness plan. And you kind of just like ramble on. And sometimes we accidentally do that because we're either excited or you want to prove our value or give them all the things, right? What happens in this instance is if you give too much all at once too soon, they get confused. They're like, wait a minute, what am I coming in for? What are you providing? And that's something you want to avoid.

So patients won't understand the extra stuff, the upsell, until they understand the actual plan. And then you walk them through that plan with those frequent visits, you build that relationship and trust with them. And at the end, when they ask, what else can I do to prevent this? That's when you offer the wellness plan. Anytime you give too much, too many options, you confuse them, they look confused, maybe they're even quiet because they don't want to raise their hand and say, I'm confused, that's when they don't purchase. So you want to make sure that you offer a clear plan so that they can have confidence in you and in themselves so they can follow through. So here's what that looks like in a clinical setting. The patient comes in and the first thing you do is you work them up and you get them a proper diagnosis. And then at that point, you offer them a prescription of some sort.

Tea Nguyen, DPM (17:30)

The prescription can be a medication, it could be a treatment plan, your high ticket plan, for example, is the prescription, which is a transformation. And that's what gets you towards that high ticket solution or high ticket package. And then you do a great job. You deliver that outcome. And at that point, at the end of their treatment plan, if they're asking for a continuity or if they're asking things like, how do I prevent this from ever happening again? Then you offer the membership.

That tends to be the best way, the best order of things to offer patients your solutions. You don't really want to lead with just join my membership, right? It's a backend offer. It's because they've done the hard work, they've shown their commitment, and now they want ongoing care. And because you've already established that relationship, it then makes sense for them to buy into that. So that membership offers the patient lifetime value, because now you are their doctor for life, which I think is really powerful for direct care. So a quick summary, a high ticket gives you quick cash injections, it increases your revenue, it makes more money per case. A membership offers predictable monthly revenue if you're offering those monthly payments. Also patient retention, stability, and less pressure to market because if you provide care on a more episodic basis, they get better after one visit, then you have to market to fill up the space that was just released, right? You just healed somebody. So it's more effort to market to new people compared to having the same people come over and over again. And the reality is in your cash practice, in your direct care practice, you will need variations of both. Having high ticket services gives you quick money, gives the patient a commitment to stick to the plan, right? That's a good thing.

and then the membership offers you cashflow with less effort. So it's important to know who not to offer the membership to. Usually if you're early in your practice and you don't have consistent outcomes, you don't really know how to package your stuff yet, right? You don't have clear protocols or there really isn't a patient demand for that membership, or you simply don't have the staff support to support you. Meaning if you have a membership that offers, let's say laser therapy, ongoing care and you don't have the staff support to sell a lot of these then you're limited by you doing the service. So first thing you want to do is build something that is repeatable, that is a high ticket offer first, that doesn't require a whole lot from you and then later on offer the lower end the membership. Now I want you to keep in mind that a high ticket is not about charging more money necessarily.

It's really about bundling the correct things so that the patient has a successful outcome. And if they have a successful outcome, your revenue should reflect your expertise. So it goes hand in hand. And once you get those numbers coming in, you're able to charge more. And a membership is not like those sneaky membership offers where you can't get out of a contract that you didn't realize you didn't like until like months in.

A membership really is about supporting that individual to make sure that there is a spot for them. Membership allows access because you limit the number of people you see in a day, in a week, in a year, and that secures their space in your medical practice. So don't want you to think that having a membership is intended to lock people in against their will. It's really about them asking, what else can I do to prevent this from happening? And then you saying, well, the next obvious solution is my membership. Okay.

So if you're in a place right now and you're wondering which one of these to build first, you want to ask yourself these four questions. The first is, are my patients mostly in pain or are they more proactive? The second question is, do I have predictable outcomes? The third question, am I solving problems or am I just making myself accessible for emergencies or urgent care types of things? Or just the nice to have, right? There's not a high level of urgency.

Tea Nguyen, DPM (21:54)

in the membership. And number four, do I want revenue stability? Because if so, then you really don't want to offer your stuff as a one-off procedure. Those one-off visits, meaning each time they come to the office, you charge them the one price, which ends up making you comparable to the insurance option. You haven't done anything to make yourself unique. And that model requires a lot more effort.

it becomes more expensive to market for each new patient because you're just giving them those one-off visits, which is of great value still, but if you're looking for financial stability with less effort, you really want to design your direct specialty care practice with these high value, high ticket packages, plus or minus a membership, depending on what your specialty is. When I help doctors start their direct specialty care practice, this is exactly what I'm teaching them. I'm teaching them to create one high ticket package that they love to offer, that patients are asking for, so that they don't lead with mental confusion of all of the things they're offering. Create one high ticket package, make it simple for the patient to say yes to, and hit your first 100K with that first, rather than having 20 plus different services with 20 different price points, which then makes you comparable to insurance, and therefore makes it harder for you to stand out.

Tea Nguyen, DPM (23:18)

If you're somebody who wants to surpass your revenue plateaus, you want to reclaim your energy, you want to make more money with less effort, and you want to get expert feedback without the overwhelm of doing it all yourself, I want to invite you to join the Direct Care Society. We start our growth strategy calls in March. The link is down in the show notes, and I hope you do join us to expand your potential. Wishing you lots of peace and profits in your direct specialty care practice. Take care, talk soon.