Marketing, specifically patient acquisition, is among the most important tactical areas for virtual clinics. This is an especially rich subject, so I’ll dig into different pieces of virtual clinics’ marketing stacks and tactics in future issues of this newsletter. This week I focused on what is likely to become a contentious area of patient acquisition: “Abandoned cart” strategies.

If you’re not at all a student of ecommerce and have never heard of the term “abandoned cart,” then this new advertisement created by Ryan Reynolds’ ad agency for ecommerce company Bolt is a helpful and funny watch:

As part of Issue 0001’s dive into mental health virtual clinic Cerebral, I began the sign-up process for the company’s services. The first step in the process is a form that includes name, email, and phone number. It also requires that you tick a box that grants the company the right to market to you via text, email, and even robo-caller.

If you don’t click the box granting them permission to market to you via those channels, then you can’t take the free quiz to see if Cerebral is right for you:

On January 19th around 1:30 pm, I ticked the box and clicked the Get Started button, but I never completed the Cerebral onboarding. In ecommerce that’s an abandoned cart. Seeing an email from that online shop within a day or two would not be unusual. What about in the world of DTC virtual clinics? Here’s what happened with Cerebral:

As you can see from the emails from Cerebral below, I received 16 emails in the 19 days since I clicked “Get Started.” I’ve also received 12 text messages from Cerebral during that time. (Actually, while I’m editing this on February 9th, I’ve received yet another email and yet another text.)

The first four emails and the first two texts all came in within the first 24 hours. The discounted offers for $7 a week began in those first few emails and texts. You can also see from the subject lines below that the first few emails included one from the CEO and Founder of Cerebral Kyle Robertson. It’s all pretty clear that Cerebral’s subject lines follow a certain pattern after a while. TODAY ONLY –> LAST CHANCE–> FINAL HOURS. First, it was for a “January flash sale” then for a “Self-care sale” and most recently for a “Winter Olympics Sale”.

(It kind of reminded me of the carpet stores in suburban strip malls that are forever touting going out of business sales.)

The text messages from Cerebral hewed pretty closely to the emails. Often they echoed the same “last chance” or “final hours” FOMO copy.

Here’s a look at the first four emails I received from Cerebral. Each of these arrived within 24 hours of abandoning the sign-up process on Cerebral’s site. The fourth email — ostensibly from Cerebral’s CEO — arrived just shy of the 24-hour mark.

I continued to receive follow-up emails on days 3, 4, 5, and 6 as shown below. The themed flash sales started on day 6.

Daily emails stopped on day 7 and then Cerebral skipped two days before sending another email. Then they skipped three days before sending another. Then they hit me with daily emails with a Self-Care theme from January 31 through February 2.

After a four-day reprieve, Cerebral started up a Winter Olympics-themed regimen of daily emails over the past three days.

50,000 new signups in three weeks? One of the subtle things I noticed in these emails was the number of Cerebral users ticked up considerably during this courtship, according to the emails’ copywriters. Two days ago the company wrote that “Over 400,000 people have signed up for Cerebral.” And on January 31, the email copy stated that 375,000 had. The January Flash sale-themed emails all stated that 350,000 people had signed up for Cerebral, and those started at the beginning of the last week of January.

How does Cerebral’s abandoned cart strategy compare to other virtual clinics? 

I don’t have enough data yet to come to any firm conclusions, but after going through a similar process with a number of other virtual clinics, Cerebral seems to be on the aggressive side in terms of outreach attempts with abandoned carts. Remember: It sent me 16 follow-up emails since the confirmation email on January 19th.

Thirty Madison’s GI clinic Evens: For example, a gastrointestinal health-focused virtual clinic named Evens, which is owned and operated by online pharmacy Thirty Madison, sent me a confirmation email when I started to fill out the quiz is hosts on its site as a way to onboard new potential users. I did not complete the quiz. Almost exactly 24 hours later I received my first follow-up email, which informed me that my treatment plan was waiting. In total, I’ve received seven follow-up emails since the confirmation email 12 days ago.

Weight loss clinic Calibrate: Much like Evens, Calibrate sent me a confirmation email when I gave it my email address as part of an eligibility form sequence that I did not complete. About 28 hours later I received my first follow-up email that said my metabolic reset is waiting for me. In all, I have received six follow-up emails since my confirmation email 12 days ago.

Three follow-up email templates in the virtual clinic abandoned cart playbook

I plan to go through this process with a much longer list of virtual clinics in the future, but even from this small set, I can see a few email templates and tactics emerging as typical of virtual clinics’ abandoned cart strategies.

• Email from the founder. Cerebral, Evens, and Calibrate all sent me emails that aim to look like they were from the founder/CEO of the company. “Steve here, CEO of Evens. As someone with a history of acid reflux, I know how debilitating GI symptoms can be. That’s why I started Evens…” Cerebral sends this one out at the 24-hour mark. Calibrate uses it as its welcome email. Evens sent out an email from the CEO Steve on Day 5.
• Your plan is waiting. Both Evens and Calibrate use an email like at the 24-hour mark. Cerebral’s spin on this focuses on the care team instead and uses the subject line: “Meet your care team” as shown above.
• Flash sales. Cerebral sent these types of emails in succession. As one flash sale ends another with a new theme begins. Evens sent me a special offer after waiting me out for about 10 days — 60 percent off my first order plus free shipping.

One of the more out-of-the-box tactics came from Calibrate, which invited me to a webinar focused on how insurance works with Calibrates services and medications. The subject line was “You’re Invited: Insurance 101 tonight.” I didn’t attend but Calibrate promised that it would be a “live virtual event” and not a pre-recorded Zoom discussion (like I assumed when I first saw the email). Do things that don’t scale at first, I guess?

How will abandoned cart strategies evolve for virtual clinics?

Sorting through this reminded me of enrollment tactics employed by B2B2C-focused digital health companies like Omada Health, Livongo, and Hinge Health. Pre-Teladoc acquisition, anyway, Livongo had a reputation for sending more emails to drive enrollment than its competitors. Financially, anyway, you might argue that worked out for them.

In the virtual clinic model, however, there are no third parties to negotiate a set of ground rules around marketing. And that’s a big part of the appeal of this go-to-market for digital health entrepreneurs.

But how much is too much? Curious what you think.