Dr.Bill is on a mission to modernize medical billing so doctors have more time to focus on patient care. Sarah Wilkinson, CEO at Dr.Bill, breaks down the business journey from startup to scale-up.

Canadians truly value their doctors. We entrust them with our health and turn to them in times of great need. Whether for a sore throat or a broken rib, we’re fortunate to not have to worry about the cost of each visit. As we exit the doctor’s office on crutches or with a prescription in hand, few of us think about how our doctor will get paid. The assumption is they’re compensated quickly and easily so they can focus on what they do best—caring for us.

Here’s a reality check. For each service they provide a patient, physicians must submit a claim to the government, referencing a thick book (there’s one per province) filled with codes for every type of care covered under the provincial health plan. Each submission requires the proper code and paperwork; and, even if it’s error-free, doctors often receive only partial payment for the claimed amount. The balance may be paid after an appeals process that requires even more documentation. It’s a far cry from what most of us are accustomed to—a pay cheque that appears like magic in your bank account exactly when you expect it to.

“Medical billing is like all the pain of tax time, combined with the drama of a small business owner with a shoebox of receipts,” says Sarah Wilkinson, CEO of Dr.Bill. For doctors—whose job description is to focus on patient care, not accounting—the effort to get paid can be cumbersome, if not downright frustrating. Dr.Bill is on a mission to change that.

Dr.Bill now services more than 10,000 physicians (of the 90,000 physicians in Canada) with its modernized medical billing software that eliminates time-consuming paperwork, code lookups, and manual data entry. Behind the scenes of the RBCx Venture is a team of more than 100 people offering one-on-one support, including managing the dreaded appeals process so doctors are paid faster and can concentrate on patients, not payments. “End to end, we are vital to a physician’s payroll,” says Wilkinson. “That’s what we do.”

Navigating a regulated industry

When RBC purchased Dr.Bill, the company was a scrappy startup that hustled hard to land each and every customer. Although it had achieved product market fit, the customer acquisition process could be painstaking, and was in need of some surgery.

“They were in seed-slash-beta mode, trying to acquire each customer one by one,” says Wilkinson. Not exactly conducive to the rapid scaling plans for the venture which had become an RBCx Venture and subsidiary of RBC.

“The founders were zero-to-one people,” says Wilkinson admiringly. “They created something out of nothing, however didn’t have the experience scaling to the next level in the health care industry.” Operating in a highly regulated space like health care makes the barriers to rapid growth that much more challenging.

A regulated industry, by definition, has a rulebook. Health care companies navigating this space must learn to work creatively within regulations. The disruption mentality of a typical startup may not be the right way to go in this environment.

“I feel like many startups view themselves as cowboy disruptors,” says Wilkinson. “I would argue that Dr.Bill is here to be like, oh no, we are a part of this health care system.” To get a seat at the table, however, Dr.Bill needed to prove its worth. Gaining a much larger portion of the market was key. Wilkinson was recruited to fulfill that task when she joined Dr.Bill, initially as chief operating officer, following RBC’s acquisition of the startup. Using her extensive background in payments at RBC, she laid the groundwork to scale.

Prepping Dr.Bill to scale

First on the list was to raise Dr.Bill to RBC standards of privacy and security. Many startups may not have the resources to meet the privacy standards demanded by a space as regulated as health care. While a small pilot program may be able to squeak through the tight regulations initially, startups that try to land larger contracts are apt to hit regulatory walls. Meeting the security standards required to handle people’s health care data can, understandably, be prohibitive. Not so for RBC. “Dr.Bill actually has bank grade security,” says Wilkinson—a feature that made the venture that much more attractive to work with.

At the time of acquisition, Dr.Bill was servicing more than 1000 customers and predominantly operating off spreadsheets and emails—fine for the early days of getting off the ground, but not ideal for targeting a 10,000-plus customer base. “We had to lift and shift and replace all the manual ways of doing things,” says Wilkinson.

The company also established a more conventional software lifecycle to quickly produce high-quality, well-tested products ready for use. This included the introduction of a product roadmap and a process to make enhancement decisions based on learning gathered from the physician audience.

Bringing in staff that knew the anatomy of a scaled business was key to retooling Dr. Bill’s processes. While the employees at early-stage startups have the hustle to make things happen, “they faced some barriers to operating at scale, and mitigating those barriers with the right experience was critical to where we wanted to go with Dr.Bill,” says Wilkinson.

An acquisition boosts customers and influence

Wilkinson also wanted to replace the startup’s “hand-to-hand combat”—the intense one-to-one effort to acquire just a single customer—with a one-to-many approach. “We still want the individual physician, but we also had to go after bigger fish,” says Wilkinson. “Not just sign on one physician at a time, but sign on complete hospital divisions, and repeatedly.”

Sales and marketing was overhauled to reduce its reliance on SEO-led acquisition which wasn’t aligned with Dr.Bill’s new customer acquisition approach. The focus became building meaningful connections with the physician community through partnerships, advocacy, and relevant content.

Along with its organic growth strategy, Dr.Bill sought an inorganic means to boost its customer base and influence across all levels of the health care space. This led to the purchase of MDBilling.ca—the largest medical billing company in Ontario. The instant expansion reinforced its presence in B.C. (where Dr.Bill originated) and Ontario, and provided the scale to land larger deals.

Dr.Bill is a collaborator, not a disruptor

Dr.Bill’s access to knowledge, capital, and skills has played an important role in developing a product that helps physicians manage the complex billing environment in which they operate. Dr.Bill’s efficiencies benefit all stakeholders in the space—doctors, administrators, hospitals, and ministries—and positions Dr.Bill as a collaborator, more than a disruptor, in a system heavily dependent on rules to function.

“Dr.Bill exists because our founders saw an opportunity to help physicians navigate a really complex system,” says Wilkinson. As it turns out, the relationship that has developed between Dr.Bill and the doctors it serves goes far beyond just billing. Dr.Bill’s staff witness, first-hand, the real and personal struggles Canadian physicians face post-pandemic. That sparked Dr.Bill’s current campaign to spread awareness of physician burnout and a donation to the Ontario Medical Foundation (OMF) to support research into burnout solutions.

“Hospitals and, by extension, physicians are incented to deliver care to patients,” says Wilkinson. “Our job is to make sure that’s what they can focus on.”

RBCx is a valuable resource for startups

Like most startups, Dr.Bill has a tight, nimble team to deliver on key milestones. As such, gaps in knowledge and resources are unavoidable. Its reliance on RBCx to fill those gaps has been instrumental in helping Dr.Bill successfully execute its ambitious strategy.

“RBCx is stuffed to the gills with people who understand modern software development and know design, user research, scaling, and marketing,” says Wilkinson. Dr.Bill’s experience navigating the regulated health care system has now armed RBCx with industry-specific knowledge that’s hard to come by. RBCx clients facing similar challenges in regulated industries can also leverage this unique and expanding knowledge base.

To learn more about Dr.Bill, visit dr-bill.ca.

RBCx backs some of Canada’s most daring tech companies and idea generators. We turn our experience, networks, and capital into your competitive advantage to help drive lasting change. Speak with a RBCx Technology Advisor to learn more about how we can help your business grow.

This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or its affiliates.


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