Lifetime Customer Value

The lifetime value of a customer is a commonly used marketing metric that is rarely used by health clinics. It calculates the value of the likely revenue from a customer and is used to determine the return on investment for a particular form of marketing and to set limits on the maximum amount to spend per customer acquisition.

Taking the logic of lifetime value to its extreme allows some businesses to deliberately make a loss on their initial sale in order to win the lifetime business. The logic is that the profit made from all future transactions with the customer will compensate for the loss and provide a profit at some later date.

On the whole we have found that health clinics typically don’t take lifetime value of a customer into account when analyzing their marketing activity. On the face of it one might think that this degree of conservatism is prudent, but there are two problems with this:

  1. It under estimates the potential revenue that a customer will likely bring to the business. For example, you may be judging a Botox enquiry as being worth a potential €500 in revenue, but if you look at the likely revenue over the lifetime of the customer it might be worth more like €2,000. This ultimately results in the business under valuing the effect that marketing has on its business.
  2. It encourages short term thinking which leads to clinics maximising initial revenue from a customer instead of focusing on customer care and retention. If you start to look at your customers in terms of having a lifetime value you soon come to the realization that your retention rate is a critical business metric. A ten percent increase in your retention rate will have a dramatic affect on the long term profitability of your business.

Factors That Affect The Lifetime Value Of A Customer

There are five factors to take into account when calculating the lifetime value of a customer:

  1. Initial Purchase. In our experience this is typically the only figure that clinics take into consideration when valuing a customer.
  2. Likely Ongoing Annual Purchases. This should take into consideration both routine maintenance and other large scale procedures. For example, you might say that a customer will typically have check-ups worth €100 annually and one procedure worth €4,000 every ten years. This would make the likely ongoing annual purchase worth €500 (€4,000 divided by ten plus €100).
  3. Gross Profit. Some procedures are going to provide you with very little profit but others will be much better. This is one of the reasons that it is best to segment the marketing efforts of your business as much as possible.
  4. Retention Rate. This is a critical figure and represents the percentage of your customers that will still be with you in one year’s time. Remember that although customers will primarily leave you due to dissatisfaction, they will also stop coming back for other reasons: they move city or country, their money situation changes, they even die. Also, bear in mind that your retention rate is cumulative so that if you currently have 100 customers with a retention rate of 50%, then you will have 50 customers after one year and 25 customers after two years.
  5. Number of years. Typically businesses run the model over 3 or 7 years. Unless you have very high levels of retention it simply doesn’t make any sense to run it any longer than this.

Worked Example One – Dental Implants

In this example, Philip needs two implants with crowns. The initial price for these is €8,000 and routine checkups and maintenance typically results in €100 per year. Also an additional €2,000 every five years in major work is typical. This averages at €500 annually. The Dentist has a retention rate of 85% and a gross profit of 50%. Because the dentist has such a high retention rate she runs her models over 7 years.

7 Year Lifetime Customer Value

7 Year Lifetime Customer Value

In this example you can see that the value of Philip to the business reduces each year. This reduction reflects the probability of Philip not being retained by the business. The overall lifetime value of Philip is €4,807, compared to €4,000 if the clinic had only been looking at the value of the initial treatment. This difference may seem small but it could easily allow for additional marketing activities to be explored.

Worked Example Two – Botox

Linda wants Botox treatment to address some lines in her face. The initial treatment cost is €500. However, treatment is typically provided 3 times a year. Retention rates with these ongoing elective treatments are low (60%), however gross profit is high (80%). The cosmetic clinic runs their models over 3 years.

3 Year Lifetime Customer Value

3 Year Lifetime Customer Value

Even thought the model is only run over three year the lifetime value of the customer is radically different to the value of the first treatment. In this example the clinic would be well advised to do a root and branch analysis of all of their marketing activities in an effort to increase business and profitability. It would also be worthwhile to look at ways of improving rentention.

Calculating the lifetime value of your customers may well differ a little if you’re not operating a health clinic. Tell us your experiences with measuring and acting on on customer retention in the comments below.

Tagged with:  

Site Hierarchies Now Included In Google Search Results

Google Search Result For Cosmetic Surgery Ireland

Google Search Result For Cosmetic Surgery Ireland

Google have started to add extra information to their search results in order to give users a better idea about what section of a website they’re about to click through to. This makes more sense in some situations than others. For example, in the search result pictured above the new site hierarchy link “Plastic Surgery Clinics” which appears after the “www.revahealth.com >” in green doesn’t really add any information, seeing as the same text is included in the main link to the page.

However, imagine if the page title (and Google’s main link text) was “Dr. Michael Smith, 4 Main Street, Crosstown”. In this case the site hierarchy link would probably be something like “Dentists”, which would give you a good context about the type of page you were going to click through to, telling you Dr Michael Smith is a dentist rather than a GP or a surgeon for instance.

Google Search Result For Dentists Ireland

Google Search Result For Dentists Ireland

These site hierarchy links have only started to appear in the last week, and so far only for some of our search results. It will be interesting to see how common these become and how they’ll evolve. Have you seen these for your site yet, and are they any help?

[Additional information direct from Google here: Site Hierarchy Links]

Tagged with:  

Online Business And Revenue Models

I’ve been meaning to write up the presentation I gave at BizCamp Dublin for some time so when Kevin Noonan asked to borrow one of the slides it gave me the incentive that I needed to start typing.

One of the great aspects of the Internet is how easy and inexpensive it has made setting up a business. In a lot of ways it is similar to the software industry; there is effectively no capital investment needed (you don’t need to build a factory) and there is close to a zero cost of sale (each additional sale adds nothing to your overall costs).

What is unique to Internet businesses is that they can frequently dispense with the cost of distribution. Even software companies have massive sales and marketing costs that are either borne by themselves or by a distributor. A web based business presents the opportunity of dramatically lowering or eliminating these costs.

This means setting up a web based business is cheap – cheaper in fact than it has ever been to set up a business. We all moan and complain about how difficult it is to get start up capital, but think how difficult it would be if you needed tens of millions to build a factory before you even made a single sale!

The web is also democratizing business, and it still has a long way to go, but for the first time almost anyone can think about setting up an international business without major backers.

This is a good thing but it doesn’t come without its own share of risks. If you were building a factory on the basis of tens of millions investment there would be a team of ‘grey suits’ analysing you business plans and doing the due diligence to make sure you weren’t sinking their money into a sure-fire loser.

Seeing as web start-ups don’t have this level of investment, this level of due diligence is absent. This is a problem because you are still investing the most valuable asset you have – your own time.

Think about it. If you are thirty years old now and are thinking about starting an online business, realize that you will only be thirty once; you never get to relive that year. You owe it to yourself to ensure that you have done the necessary checks and balances to help ensure you aren’t pissing your life away.

Four Business Questions

There are four questions I always ask whenever I look at a new business. Good answers to these questions help me figure out if there is a viable business there.

  1. Who will pay? Are you delivering value and are you delivering it to someone that can pay? There is no point in building super cars for teenage boys – sure you’re delivering value but they can’t pay. Seems obvious but this is something that a lot of start-ups have problems with. One of the reasons for this is the proliferation of Silicon Valley web starts up that have no obvious route to monetization. A full 10% of the Webware top 100 companies have no revenue model. This may be a viable model for companies that are awash with start up capital, but it is not a reasonable approach for small start-ups on the edge of Europe.
  2. How much will they pay? A lot of business plans make the assumption that the value their products deliver is equal to the benefits they bring when compared to the customer taking no action. This is not true. The value of a product equals the difference between the benefits of your product versus the customer’s next best option. For example, if you are providing a financial planning application the value that you provide is not the value of financial planning. Before you came along businesses still did financial plans. The value that you offer is something different. It is the time that you save or the improvements in the plans or the cost reduction in the price of what you offer versus what they currently use.
  3. How will they pay? This is not so much the payment mechanism as the structure of payments. This should ideally model the way in which the customers derives value as closely as possible. For example in RevaHealth.com we provide health clinics with patient enquiries which they subsequently convert into patients. If we closely tied the revenue model to the value that we provide we would charge our customers a commission on each patient enquiry that converted into an actual patient.
  4. Can revenues be reconciled to costs? If you can’t reconcile revenue to costs then you don’t have a business. This isn’t just a matter of making sure that revenues exceed costs, it is also a matter of making sure that revenues come in quickly enough to cover costs. If we examine the above example where we would ideally charge our customers on a commission basis, it turns out that revenue would take 6 months on average to come in and would prove very difficult to collect. We wouldn’t have a viable business using this model.

Five Web Business Types

I categorize most web businesses into one of five core types. I am sure that there are more but this gives me a basic model that fits just about everything that I have come across.

Five Online Business Types

Five Online Business Types

  • Merchant – This is the simplest model. You buy something and then sell it on for a higher price. Examples are Amazon, iTunes, Woot, etc.
  • Operating A Market – You bring buyers and sellers together into a market place and enable transactions to take place. The different here between operating a market and being a merchant is that you enable the transaction but are not actually party to the transition. Good examples of online market places are amazon.com, eBay, Google AdSense and Etsy.
  • Application Provider – Here you typically provide software as a service. Good examples are Basecamp, Gmail, Mint and Zoho.
  • Utility – You provide an Internet service that in isolation provides no value; however, when combined with other applications you provide measurable benefits. PayPal is a great example – by itself it has limited value, but when combined with market places and merchants it provides great value. Other examples include; Amazon Web Services, Open DNS, YouSendtIt, OpenID and AlertSite.
  • Publisher or Broadcaster – You could be dealing with commercial content or end user content; it really doesn’t make much of a difference. Essentially the role of a publisher or broadcaster is to distribute content. Examples include last.fm, craigslist, flickr, youtube, etc.

Five Revenue Models

There are five basic revenue models I can think of that cover these five business types.

Five Online Revenue Models

Five Online Revenue Models

  • Mark up – This is old school business. Simply charge more for something than it costs you to buy. This model is particularly suited to online merchants like amazon.com.
  • Commission – Charge a percentage or fee on each transaction. This is the obvious model if you are setting up an online market place. eBay would be a classic example.
  • Subscription – Charge a recurring fee. There is great flexibility to the subscription model and if you are going to monetize your business through subscriptions it behoves you to spend time working out the ideal structure. Business types that commonly take advantage of the subscription model are application providers and utilities.
  • Pay per use – Charge every time someone uses your service. Utilities tend to uniquely take advantage of this model.
  • 3rd party sponsorship – This normally takes the form of advertising but can also be acting as an affiliate. This is particularly suitable for publishers & broadcasters due to their large audience base. It can be effectively used by application providers as well in certain niches.

This is only the first half of my talk at BizCamp Dublin. Watch out for the second half with a more in depth look at how things like customer churn and on-site advertising can affect your business. In the meantime, we’d love to hear your business model stories, good and bad!

Tagged with:  

The Results Of Our Local Domain Search Experiment

A few months ago, in the post Using Country Specific Domains For SEO we introduced you to the idea of redirecting half of our Irish and UK pages from RevaHealth’s .com domain to our local .ie and .co.uk domains. In this follow up post we describe how the experiment turned out to be successful, but with a very disappointing result.

The main goal of all search engines is to return results from the sites that are the most useful and relevant to a user query. Sites with country-coded top-level domains, such as .ie, are associated with a geographic region, in this case Ireland. By default, and all other things being equal, sites with a .ie domain are interpreted as more relevant for users in Ireland. For generic top-level domains such as .com Google allows site owners to manually assign a preferred country in their Webmaster Tools.

As our .com domain’s content covers many countries we can’t use this particular feature to optimize the site for a particular region. Instead, we were hoping that by redirecting our Irish and UK pages to their local domains that those pages would benefit from a boost in search results positioning on Google.ie and Google.co.uk as being targeted at their local audiences.

The initial results were terrible. The redirected pages dropped in the SERPs by about 3 positions. As our Irish pages previously ranked better than our UK ones they suffered even more. (Ireland was our first local area of interest and those pages were in the index much earlier.)

After a few weeks our results moved slightly in the right direction but were still behind the control group. We decided to let the experiment run for longer, almost four months in total, to be sure that the conclusion drawn was correct. In the end we turned off the redirections, just last week in fact. The experiment was successful in terms of achieving measurable and unambiguous results, but unfortunately they were very disappointing.

Our redirected .com pages disappeared from the index and over time their corresponding .ie and .co.uk pages were indexed instead. However, they never reached the search results positions we had had before with our .com pages. We speculated that our .com domain had more trust and authority than our country specific domains and that’s why pages from RevaHealth.com ranked better even in Google’s country specific search engines.

Now, just one week after undoing the redirects, most of the .com pages have regained their positions from before the experiment, which we think goes some way to validating our speculation. Our generic .com domain, which is crawled much more frequently than our local domains are, does seem to be a more trusted site, not only by Google.com but also by Google.ie and Google.co.uk.

Have you run any similar experiments that you can share with us?

Tagged with:  

Email is notoriously open to fraud. It’s built upon old protocols which tell the user very little that is definitely true about its content and source. The most basic thing about an email, the “from” address, can easily be spoofed by a sender who wants to pretend to be someone else, especially spammers.

SPF (Sender Policy Framework) is a protocol that is built on top of email. When a message arrives at the server receiving your email (Google, Yahoo, or your own company’s email server) the email claims to be from person@domain.com, but it might not really. All we know for sure is that it definitely comes from some IP address.

Using SPF, your email server can check with the domain that the email purports to be from to see if the IP address you got the email from is one that they use to send email. If domain.com says no, they don’t send emails from that IP address, then the email may be spam. If the domain says yes, then it’s probably not.

Probably; however, this isn’t certain. Not all email senders support SPF. It is voluntary but very widely used. So, just because the sender doesn’t support it doesn’t mean all emails from that domain are spam. Conversely, people send spam from perfectly respectable domain names all the time, so just because you do get a valid SPF record back that matches the “from” domain, doesn’t mean it’s definitely not spam. Still, it is a good indication, and some email servers and ISPs will mark your email as spam if the SPF record doesn’t match, or isn’t present.

So how can you avoid this fate?

First check if you already have a valid SPF record. Go to http://www.kitterman.com/spf/validate.html and enter the domain where you send email from. If your domain returns a valid SPF record, everything is fine. If not, you may find some email servers you send emails to may block them as spam.

Here’s what Gmail was showing for us:

Received-SPF: neutral (google.com: XX.XXX.XX.XXX is neither permitted nor denied by best guess record for domain of info@revahealth.com) client-ip= XX.XXX.XX.XXX;

Authentication-Results: mx.google.com; spf=neutral (google.com: XX.XXX.XX.XXX is neither permitted nor denied by best guess record for domain of info@revahealth.com) smtp.mail=info@revahealth.com

(To see this, simply send email to a Gmail account, and then select ‘See Original’ in the little menu at the top of the email message. You get to see all the headers for the email.)

What this is saying is that when they check the IP address we’re sending from, they get back neither a “confirm” nor a “deny” message. That is, there is no SPF record at all.

We used to have our SPF record for RevaHealth.com set correctly. I know, because I did it. I also could tell when it stopped working – when we moved our front end box from one server to another a few months ago. Of course, I couldn’t remember just what I’d done to set it correctly nearly three years ago.

The key to the answer is not who or what sends your email, but who owns the domain. The email receiver doesn’t check with the domain, but with the DNS (Domain Name Server). In the example above, Google GMail isn’t checking with RevaHealth.com, but with the Domain Name Server for RevaHealth.com. In our case, that’s Go Daddy.

Of course, I didn’t remember that at first. Thinking our own front end box would have the SPF record I looked in its own DNS entries and added it there. There’s a very handy SPF setup wizard here to help you to create your SPF record and save it in your DNS. However since our DNS is Go Daddy, this did me no good at all.

So, after going back and reading the very helpful SPF FAQ again, I realised that I should use our DNS to create the SPF record. And that’s when I realised what had gone wrong. When we moved our servers, we updated our DNS entry for RevaHealth.com and lost the SPF record in the process.

Editing your SPF record on a domain register depends on their interface. Thankfully for us, there is a helpful guide to creating  SPF records for domains hosted with Go Daddy.

I quickly added the SPF record to our RevaHealth.com domain entry, but this wasn’t the end of the story.  We send email from our hosting server. This looks like mail.si-svXXXX.com and that’s what an IP address lookup returns. When I entered this domain as an allowed domain to send email, I got nothing. Running the validation check failed.  However, this was because the SPF record should return only the domains it supports, not the sub-domains. Dropping the “mail.” and changing the record to just si-svXXXX.com brought our SPF records back to normal.

Now, Google reports itself happy with us again.

Received-SPF: pass (google.com: domain of support@revahealth.com designates XX.XXX.XX.XXX as permitted sender) client-ip=XX.XXX.XX.XXX;

Authentication-Results: mx.google.com; spf=pass (google.com: domain of support@revahealth.com designates XX.XXX.XX.XXX as permitted sender) smtp.mail=support@revahealth.com

Did it make a difference? Is this worth bothering about?

Yes. Several of our customers had not been receiving emails from us because their ISP was blocking anything without a valid SPF record, and these emails are now getting through okay. It probably reduces the overall spam score for emails we’re sending too, but that was always very low anyway. It’s definitely worth doing, it costs nothing, and the business cost of emails not arriving where they are supposed to can be massive.

Tagged with:  

Sample Sizes for A/B Testing

A/B testing is great for iteratively improving web applications. I have had loads of conversations with startups who are using it to test. However, they all seem to be making one fatal mistake – their sample sizes are too small.

An A/B test that uses a sample size that is too small is worse than no test at all. The figures just aren’t statistically significant, and if you had run the test longer the results may have reversed. This means that not only might you have the wrong result but you feel that you have proof in that wrong result. This results in in you defending your position later on despite contradictory evidence.

So how big does your sample size need to be? Unfortunately the answer is – ‘it depends’. Luckily it doesn’t get very complicated. The only thing it depends on is the gap between the winner and the loser. In general the smaller the gap the bigger of a sample size that you need.

Specifically divide the gap between your winner and loser in half and then square the result. The result needs to be bigger than your sample size to be statistically significant?

Below is a worked example where there is a 10% difference between A and B

a-b-testing-sample-sizes-10-percent-difference

So with a 10% difference between A and B you need a sample size of about 1500 to be statistically significant.

Let’s see how this works with a 2% difference between A & B

a-b-testing-sample-sizes-2-percent-difference

Now you can see that you need a sample size that is around 25 times bigger.

Tip: If you find your test needs a very high sample size (above about 20,000) then your users don’t really care much about your changes. Give up and test something more significant.

© 2010 WhatClinic.com Blog