1.5 Years In: What No One Tells You About Running a Virtual Nutrition Practice

1.5 years in: What no one tells you about running a virtual nutrition practice (solo episode)
Diabetes Digital Podcast by Food Heaven
0:00
Hey everyone, it’s Jess and it’s just going to be me today.
I was actually planning on recording an episode with a guest, but they had an emergency and I figured why not just do a solo episode on the fly and give you guys an update on what’s been happening inside our group practice.
0:20
Now that we’ve been running Diabetes digital for the past year and a half.
I know there’s a lot of you who are with us from the very beginning, from the Food Heaven days.
And I thought it would be fun to just do an update.
And I got this idea because my husband, he works at a startup and his Co founder CEO did an update.
0:39
I think they’re like 3 or 4 years in.
But he did like a kind of behind the scenes, what’s going on update.
And I read the whole thing and thought it was really cool and insightful.
So I’m like, let me do a podcast version of that.
Welcome to the Diabetes Digital Podcast.
I’m Wendy.
And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.
0:58
Through our telehealth platform, diabetesdigital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.
Visit diabetesdigital.co that’s Co to book your first appointment.
We accept insurance and offer affordable self pay options.
1:15
Now let’s get into today’s episode.
So I want to rewind for a quick second for all of you who are here new and you’re like, what is going on?
What do you mean?
Diabetes Digital?
That is our company that we started at the beginning of last year.
1:33
And so just to rewind for a second, before that I worked for years as a clinical dietitian.
So I worked at places like UCSF, Eastmont Wellness Center in Oakland, Kings County Hospital Center.
I saw thousands of patients and learned about medical nutrition therapy, kind of the insurance and outs of that and really worked with every condition under the sun.
1:56
I saw a lot of people with diabetes.
I saw a lot of people with pre diabetes.
I saw a lot of people with eating disorders, disordered eating.
I saw people with cardiovascular disease.
I saw a lot of GI patients, people with IBS, things like that.
So I’ve seen so many patients probably work, like I said, with thousands of patients.
2:15
And also along this same time, me and Wendy, who is my BFF and also fellow dietitian, we started Food Heaven.
And Food Heaven was our kind of online platform that we like to say it’s really the intersection of Wellness meets social justice.
2:32
So we would do a lot of different things, whether it’s speaking engagements, we had retreats, we had a podcast since 2015.
So a really long time to have a pod.
It’s almost been 10 years, which is insane.
And we would do a lot of recipe development, trying to, you know, do content creation from recipes from diverse cultures and just, you know, speaking out about some of the healthcare injustices that we see in providing a platform for people to talk about all these different intersections as well as body image, body respect, things like that.
3:06
So I had been doing that also had been working as a clinical dietitian and had a private practice.
This is actually my first time in life, I think having just one job.
So even during the food heaven days, I always had something else going on.
And while I was working at these different systems, I saw that there were some issues.
3:28
Number one, they were very much focused on weight loss at any cost.
And I used to be like that too.
And then as I have learned more, and if you listen to this podcast, you know that we take a weight inclusive approach.
As I learned more about Health at Every Size and being weight inclusive, I stopped practicing from a weight normative point of view, meaning this idea that everybody will be at their healthiest when they get to, you know, their quote, goal weight or ideal body weight.
3:57
So I noticed that a lot of people, especially with diabetes, were also blamed or dismissed or thrown into rigid meal plans that didn’t really reflect their lives or culture.
And this was really frustrating and I remember like Wendy and I would always say like, we don’t really have anywhere to refer people to who do have diabetes or pre diabetes that fits within our values of weight inclusivity, cultural inclusivity, also accessibility because you know, it’s that time, especially like many dietitians didn’t take insurance.
4:31
It really was the pandemic that opened up doors for more dietitians to take insurance.
So we had noticed like kind of the void as well as we wanted to do something that was more directly helping people kind of getting back in touch with our dietitian roots because we were doing a lot of stuff online and we’re like, OK, we want to do more stuff like directly with patients so that we can have more of a one-on-one impact.
4:58
And that’s kind of what created Diabetes Digital, which is our virtual nutrition counseling platform for people with diabetes, pre diabetes, PCOS, any kind of condition that involves blood sugar dysregulation or metabolic issues.
5:15
We started Diabetes Digital in January 2024, so about a year and a half ago when this comes out, we thought we’d be perfect for it, not only because we were dietitians, but also we were certified diabetes educators.
And so we really wanted to create a space where people could get that accessible, culturally relevant, weight inclusive care.
5:35
It started with just Wendy and myself, and we actually spent about six months prepping everything, getting it all together.
Actually, I lied.
It wasn’t just Wendy and myself.
We had other people to shout out to Chelsea Schaefer, who she was with us during the Food Heaven days and we were kind of closing the doors on food Heaven and we’re like, oh, we don’t know what we’re going to do.
6:00
And she’s like, I’m down for the ride.
So she was part of the early days.
And also shout out to Jen, our admin manager now.
She was part of the early days.
So I think it was really us 3 or 4 kind of figuring all this out, how to build this practice and flash forward.
6:20
So I’ll just give you a little overview of where we are now.
We have now completed over 6000 patient visits.
We have 11 dietitians and we’re onboarding 3 more.
6:36
And all of our dietitians are employees.
About half of them, I would say are full time.
So people have the option if they want to be full time or part time.
Sometimes they have another job.
But even part time dietitians with us see at least like 21 patients per week and have a caseload.
6:52
We also have built up to about 80 referring providers.
So providers who are actively referring and sending us patients and we’ve built a full team.
So we have a tech coordinator because you would be surprised the amount of technology that goes on behind the scenes.
7:08
We honestly could have two full time tech people.
We also have two full time admin staff, including Jen who’s a day one.
We have our web developer who is amazing.
The amount of people who I meet with who are just like, I love your website.
7:23
Shout out to Jennifer and Angela who created our website and you can find everyone’s information, information names on our About Us page.
Jennifer and Angela also do SEO for diabetes digital.
So they’re really growing our organic search.
And then this month and actually right after I finished recording this podcast episode, we’re on boarding with a Google Ads team who’s going to help us, you know, get ads going.
7:46
We’ve tried ads in the past, have not been that successful, but we’re open to trying it again.
And this Google Ads team has been referred to us by another group practice.
So that is kind of our team.
What’s going on now, who we’re working with on the day-to-day and some other cool updates are we launched group visits this year.
8:07
So Jenny, our incredible dietitian, she was promoted to outreach manager and now leads group visits and our community partnerships.
She also does, you know, all the work behind the scenes on the podcast and she sees patients too.
8:26
We also promoted Nikki to our clinical manager.
And by the way, both Nikki and Jenny have been on this podcast before.
So if you just search the name Nikki or Jenny on the Diabetes Digital podcast, you’ll find them.
But Nikki has been an incredible clinical manager.
She’s supporting the RDS, she’s managing hiring and supervision and clinical questions.
8:47
And honestly, that’s one of my favorite parts of my job.
Actually, I think that is my favorite part of the week is our team meeting with all of the dietitians where we talk about cases, we do different presentations and different team members who have various expertise will lead different presentations.
9:06
So for example, yesterday we had a presentation that was so amazing by our dietitian, Anna, and she has expertise in nervous system regulation as well as breathing.
She has like all these certifications and she talked about how we can stay within our window of tolerance and help patients learn what that is.
9:27
So we’re always learning.
That’s my favorite part.
And another highlight for this year is we’re going to have our very first ever team retreat in Palm Springs, which is a huge milestone for us because we were imagining not being able to have a retreat for years and years.
9:45
So the fact that we’re able to do it this year and bring all the dietitians out to Palm Springs, we bought out a whole hotel.
It’s a mini one, but it’s so cute.
It has like a pool and it’s all pink and all the rooms are adorable, and we’re all just going to hang out and check out Palm Springs.
10:04
So that’s going to be so fun.
I cannot wait.
And it’ll be a nice chance to get to connect with the dietitians in person because all of us work virtually and even though we meet multiple times per week, we’ve never met in person.
So those are some of our highlights and what’s been kind of happening behind the scenes up until now.
10:23
And I also want to talk about some of the things that you don’t see.
Like I’m sure everyone knows that yes, we see patients and we’re dietitians and we have dietitians on our team.
But here’s some things that you just don’t really think about that kind of are a lot of what we do.
So number one is getting credentialing and insurance contracting that in and of itself when I tell you, you spend months just waiting for the different insurance payers to process your applications, half the time they’ll deny it or you know, even with the claims like once you are in network, we spend so much time like fighting different denials, trying to negotiate rates, explaining what an Rd. does.
11:08
Because I think for a lot of insurance companies like yes, they contract RDS, but a lot of their even staff don’t even know like what RDS do or what that discipline falls under, Especially when we call them to verify patients benefits.
Like so often times we have to call multiple times and our admin team can be on the on hold for an hour verifying one patient’s benefits, which sometimes I don’t think the patients understand what a great courtesy it is for us to verify their benefits because a lot of practices don’t do that.
11:40
They’ll just start seeing you.
And if it’s not in network, then you just have to pay or they’ll make you verify yourself.
So it does take us hours a day to verify people’s benefits.
And also just with the insurances, it’s, it’s also super expensive because we do license our dietitians in multiple states, which is how we are in 41 states, but all those states have fees.
12:05
So we have a budget, I can’t remember what it is, but it’s like thousands of dollars per year per dietitian to like make sure they’re licensed.
And and that’s just the licensing fees, not all that labor that goes behind kind of making sure that happens.
OK.
Another thing behind the scenes, what people don’t see in a virtual group practice is our tech, the tech stack as, as they call it, I’m learning a lot.
12:28
It’s very expensive to have technology.
So for us, again, we have a team of 11 dietitians, myself, Wendy, and then like 15-16 people.
We pay $5000 a month just for software.
12:47
So that includes things like practice Better, which we need to see patients and then RingCentral which we need to call patients in HubSpot, which we need to manage patient records and then Carragon, which we need to connect HubSpot to RingCentral and Practice Better.
13:04
And we also use Featherly, which we use as a HIPAA compliant, like form, so that when you’re trying to work with us, you can fill out all your information.
That then goes into our HubSpot, which is a customer relationship management platform.
13:21
We also use Canva.
We use Slack, there’s website hosting, there’s analytics.
I mean, those are just some of the tools.
There’s like a list of so many.
And a lot of what I do is also just making sure that things fall into the budget and that, you know, we are not overspending, which we are for that text.
13:41
So yeah, there’s just a lot of work to be done there.
Another thing that you don’t see is managing.
So I think for a lot of people, they wonder, OK, what goes into, you know, diabetes, digital or group practice.
And honestly, like 70, sixty, 70% of my job is just managing.
14:00
So it’s not just the clinical supervision, which Nikki has been doing that and doing a great job, but it’s like the whole team.
And I almost look at it as a conductor to make sure everything is and organize smoothly, working cohesively, figuring out what needs to be done and who’s the best person to do it.
14:19
Also giving a most emotional support when needed, trying to prevent burnout.
So much trainings like this week where we have two dietitians who actually are moving from part time to full time and they’re going to be doing a lot of cool stuff like a hybrid position for each of them.
14:37
And so this week it’s a lot of training on some of these intricate things that they’ll be doing because I just mentioned like 10 tech platforms that like when you come on to doing that side of things, you have to learn how all these platforms work and it can be a lot.
14:53
And also just making sure that things don’t get lost because that’s one thing that I want to make diabetes digital stand out is like having the loop closed on all patients.
So if you’re referred, your referral doesn’t just go into the ether where you never hear back, like we want to get back to you within 24 hours.
15:15
So you know, when you have a large volume of patients, we mentioned 6000 visits since we started.
Like that’s a lot that you have to keep track of manage and we’re such a small team that we all are pretty much all hands on deck making sure that things are running smoothly.
Okay.
15:30
Another thing behind the scenes is marketing and visibility, which is also a lot of what I do.
So again, the SEO, the ads, the podcast episodes, we get most of our patients from this podcast.
Thank you all.
Well, yes, it, it varies every month, but I would say like on any given month, like a good percentage come from this podcast.
15:53
Also this past month, I’m so grateful that the majority came from friends and family recommendation.
So people who are working with this, who share diabetes digital with their loved ones, that’s incredible.
That’s you couldn’t ask for more.
And now that we’re building up our referral network, like you don’t go from zero to 80 referring providers from doing nothing.
16:14
You have to meet with them.
So that’s what I’ve been doing a lot of every week is meeting with providers.
Our team will reach out to like 250 providers per week, connecting with them, letting them know about diabetes digital.
I have a whole presentation.
By the way, if you’re a provider and you want to meet and you think that you might have patients who are a good fit and want to learn more, hit me up at je*****@*************al.co.
16:36
That’s dot CEO because I will meet with them and now like I said, some of our dietitians are coming on to help with some of that process so we can just be doing more meetings.
There’s also the newsletters.
I was meeting with one of our dietitians yesterday and she was like how many newsletters do we have?
16:53
Actually 2.
So one of them asked how many and I was going through it and then another one didn’t even know we had newsletters.
So we have so many different like newsletters for different types of people within our database.
So if you’re someone who has booked an appointment and you’re current patient, you might get, you know, a monthly newsletter versus if you’re someone who hasn’t booked an appointment yet and you are eligible to book, you might get a different newsletter.
17:20
Just a little bit more about our business.
So there’s that.
We also have social media, we post most days and try to put good content out there.
And so the goal is really to get in front of potential potential patients and providers every single week.
17:38
And also even with providers, there’s so much behind the scenes that happens too, where we try to really stay in the loop with them.
We fax all of our patients like their providers, so just let them know we’re working with them, things like that.
So it’s a lot behind the scenes.
17:54
And then last but not least I’ll mention is the admin.
Our admin is incredible.
Shout out to Jen.
They handle so much eligibility.
They handle all the patient communication.
Again, with hundreds of patients, it’s a lot of communication all day, every day.
18:12
And they will communicate with us via text, via call, via e-mail, via practice Better, which is our platform for patients.
So it’s always kind of being on.
We get a lot of faxes, a lot of scans.
We also keep track of all of our patients lab values to make sure that they, you know, they’re, they’re reaching the goals that they want to reach.
18:34
And it can be a lot.
So there’s so much behind the scenes and just a typical day for myself and I’m going to guess a typical day for Wendy, I’ll say yesterday.
So I did our admin meeting that was about 45 minutes.
18:54
So that’s the admin team.
Then we have our leadership meeting, which is the kind of some of the R DS I mentioned who were doing more leadership roles.
We had that.
Then we had an SEO meeting after that where we had updates on what’s going on with SEO.
19:09
Then I had a tech meeting after that where it’s like just working on the website and technology.
Then we had our weekly Rd. meeting after that.
Then I had a one-on-one with one of our dietitians to start with training and I was supposed to have another one-on-one with a tech person, but I actually couldn’t make that.
19:27
I had to reschedule because I had to call about like 8 patients so that I could, you know, let them know about their benefits information.
So it’s, it’s very different every single day and that’s what I love so much about it.
19:43
I think Wendy’s day is honestly similar.
It’s a lot of meetings and she’s managing all of the operations, the admin, the credentialing, the quality assurance, so many different things.
And I think one of the biggest things for both of us is how can we make things better?
20:00
That’s my favorite phrase to ask myself is like, OK, what with this thing?
Like how can we systematize this to make it better, to make it more efficient, to make it easier for our dietitians?
And our goal is to like take feedback because I hated when I worked at companies and.
20:19
You would give feedback or you do like these feedback surveys and it’s nothing ever changed.
So I’m like, what is the point of this?
So for us, of course, we can’t do every single thing every time, but as much as we can, we love to take that feedback.
And because we’re such a small team, we can incorporate it the next day, you know, So if people ask for, you know, this type of handout or they want this amount of admin time per week and they want it to just be set admin time versus having to track their hours, we can make those changes to help make people happier, our providers especially, which in turn leads to happier patients.
21:00
OK.
Now in terms of financially, our goal this year is to just break even.
Like that would be an incredible goal.
And it’s still not necessarily 100% breaking even because Wendy and I still have to pay ourselves back for our initial investment in the company, which was very significant.
21:18
So breaking even and then hopefully being able to pay ourselves back is really our goal.
So just to give you a little bit of perspective, at about 11 to 12 dietitians, that’s where we hover around break even just because we have a really high overhead and we have to make sure that we have all the components that make the business work.
21:42
And also for us, it’s like I would rather give back and have our team and dietitians happy and do special things for them, then have more profit, if that makes sense.
So like for example, the team trip, I would rather spend the money on that so we can all connect and have a good time, then take that money for profit.
22:03
So maybe that’s not the best business point of view, but that is my point of view for Diabetes Digital.
And then in order to have an actual profit, we need about 20 dietitians.
And so that’s we’re going to kind of get to 20, see how we feel.
We’re not trying to be the biggest company.
22:20
We just want to be stable and impactful.
Like I actually, I don’t know, I have a lot of problems with like these companies where they’re just trying to completely disrupt and take over.
And I just don’t find it ethical.
And I think that you can have a great business and it doesn’t have to take over everything else within the whole industry.
22:41
And I also am a big fan of businesses that are clinician owned and operated.
So that is something that’s really important to me because also within our field, there’s a lot of, you know, venture tech capital bro type of people coming in.
And I don’t know, I just, I don’t like it.
22:59
I like clinicians running clinician businesses and clinicians who have worked in the field and know what it’s like and, and know what makes your job easier and better and all those things.
What is coming up for Diabetes Digital so #1 is just keep on keeping on.
23:17
Try to get better at what it is we’re doing.
The second thing is more group classes.
I’m going to be teaching a group class.
It’s going to be on perimenopause.
Cannot wait.
But we’ve had already quite a few and we’re having next week 1 on PCOS.
23:35
By the time you listen to this, it’ll already be over.
But we’ll do another one, don’t worry.
But PCOS, we just started a women of color with diabetes and pre diabetes support group, the which is going really, really well.
So it’s it’s been good.
We also want to do more work within the community, more community talks.
23:53
If you have a company or work at a company and you want us to come and do a class for you or even provide nutrition services, let us know.
You can e-mail me at je*****@*************al.co.
That’s Diabetes digital.co, and we want to continue our referral partnership.
24:12
So again, if you’re a provider and you want to connect with us and learn more about how we help your patients, also hit me up jessicadiabetesdigital.co.
We’ll have more podcast episodes as well.
We have some incredible podcast episodes, a really good lineup coming up.
24:30
I think you guys are going to love it and that’s it.
I’ll end by saying this.
So if you have been with us from day one where me and Wendy like tracked our burnout where we were just talking about how with doing food heaven and also doing private practice and so many things, we were completely burnt out and ready for something new and also like potentially going to walk away from nutrition.
24:55
I’m so happy that we did that and changed our direction because I’ve never been happier in like life.
I think in general, but also especially in business like this is this job is perfect for me.
25:12
It uses all the different parts of my brain and I just feel like we have the most amazing team and it’s just like a dream.
It’s literally a dream job for me.
So yeah, I’m just very grateful, very happy and for all of you guys have been rooting for us from day one.
25:30
I appreciate it.
Or day 2 or day 20 or day year 10, whatever.
I appreciate that so much and it means the world.
And also, if any of our team members are listening, thank you all for all that you do.
You guys are incredible and I’m just so proud of Diabetes Digital and what we have been able to accomplish.
25:50
And I think our patients also have been really happy that we’re here and doing this work because they may have not otherwise felt like they had a place to go.
And last but not least, if you are a current patient, thank you again for taking a chance on us and riding with us.
26:10
Many of our patients have been with us from day one, which is insane.
And so many of us them stay with our dietitians long term just because they love having the support.
So thank you to all of our patients and if you have worked with one of our dietitians, one thing I will ask you is leave us a review, please on Google, just Google Diabetes Digital will come up.
26:30
Those reviews help us because people like I know me, I’m looking for reviews first and foremost.
So if you have, you know, a good experience with your dietitian, please share it with other people because there’s no way for them to know.
26:46
And so many will say like to us like, Oh my God, it’s been great because especially when I call the patients, but it’s even more amazing if you say to us and you say it to everybody else so that they can learn and see who they want to work with and all of that.
And if you are someone who is wanting to be a patient, you have diabetes, pre diabetes, PCOS or menopause, perimenopause, definitely go to diabetesdigital.co.
27:11
Take our get started quiz.
We will do a complimentary verification of your insurance benefits.
And most people don’t pay anything out of pocket.
Some people do, but most don’t.
But either way, we’ll let you know.
We’ll call you.
If you don’t book direct, we’ll call you and like go over your benefits.
27:27
Sometimes I call people so you might talk to me.
And yeah, thank you guys so much for listening, for riding with us.
I think this is a perfect kind of mid year episode and I’ll catch you next time.
Bye.
Thanks for joining us for today’s episode.
If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.
27:51
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.
You can also connect with us on Instagram at Diabetes Digital dot.
Co and TuneIn every Wednesday for practical, inclusive and culturally humble diabetes.
28:10
These insights.
We’ll catch you later.
Bye.
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