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Getting to the Heart of the App User Journey With Stacy Earl From Cardiogram

Subharun Mukherjee 18+ years of experience leading product strategy, Go-To-Market (GTM), new market entry, value-based sales, analyst relations, and customer experience programs. Expertise in Financial Services, eCommerce, on-demand services, and the SaaS industry.
Getting to the Heart of the App User Journey With Stacy Earl From Cardiogram

Health: what could be more important? It’s an area that everyone has an interest in, and whether that’s monitoring your fitness routine or checking vital statistics, it’s one that’s rich in measurable, actionable data points.

While the target market for any B2C health app is wide, the challenges are also magnified: with data so intimate, how can brands get users to first of all sign-up, up and eventually grow to really trust the app they’re using?

Enter Stacy Earl. A passionate health tech user, she’s spent her 15-year career shaping growth marketing in the governmental, health tech, and B2C healthcare space. Until most recently, she was the VP of marketing at Cardiogram, an app for users with heart concerns.

Tune in to this edition of the Big Leap with host Peggy Anne Salz to hear how Earl develops that mutually beneficial relationship with users while promoting the importance of early diagnosis and, ultimately, peace of mind.

Education and Differentiation

It’s fair to say that there’s a wealth of health app options available, with some coming built into your personal tech straight out of the box. So Earl sees the first step as that differentiation, the second as education: “We do that with really detailed information. But we also really have to earn their trust. And so we make sure we stay rooted in science. Our machine learning data scientists work with clinicians as they develop and refine our algorithms.”

This information goes way beyond standard research; it’s backed by universities or the American Heart Institute, making sure that users start their Cardiogram journey with peace of mind regarding their health. But while personal health is one thing, a healthy bank balance is another. Earl knows that health is a competitive marketplace: “You’ve got to show the value of the product early on and especially as the economy’s tightening down. That’s differentiating it from the free options out there.”

The Value of Authenticity

Earl does this by using real use cases and testimonials to promote the app. At a time when marketing strives for authenticity, these true stories and video demonstrations of the product are ideally placed to make sure Cardiogram’s value hits home. For her, it’s about community: “So, we really focus on educating people on how to use the existing features to manage their conditions. And in addition to that, we really keep people involved in new algorithms that we’re developing. So, we ask our users to participate in that development.”

While building trust is essential, there’s one instinct that helps Cardiogram as they look to involve their users: “It goes back to that feeling that they are participating in that greater good of developing better healthcare for all. There’s so much value in data, and having access to that data is just crucial to healthcare, I believe, in this day and age.”

Designing for Retention and Personalization

With health apps, it’s especially important that the data the user has consented to share is used in a productive: “Every time we’re building in a feature, we’re thinking about personalization, we’re thinking about the events that they’re passing along to us, and how we can use those events and that data in our marketing and in our journey to ultimately retain users and also make sure that they’re getting as much value as they can out of the app.”

But with a wide range of users — from those simply keeping an eye on their cardio health to those with critical heart illnesses — the importance of different messaging for different personas becomes even more essential. Earl believes this is key to helping Cardiogram craft the right messages for the right user: “Our push notifications etc. are not one-size-fits-all. We can use that information that we’re getting to help tailor those better.”

To hear the full story from Earl, and how CleverTap helps Cardiogram keep serving health-conscious users, listen to the latest episode of The Big Leap below.


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Full Transcript

Peggy: Hello, and welcome to “The Big Leap,” presented by CleverTap. It is the series where we shine a light on the pioneers, the marketers, the companies, the growth leaders, all achieving growth through retention. And our guests don’t do just that. They talk about the strategies and stories that took them from good to great, in other words, the success of their company, but also their personal growth and strategies. And our guests also reveal the steps, the strategies, the stories that took them from good to great. It’s about success, company growth, and also personal growth.

And my guest today brings them all together because she works at a company that looks at all of this together. Cardiogram, a company that organises your mobile health data, making it meaningful, useful, and above all, actionable. And speaking of action, well, she’s had 15 years of experience in the industry, making and shaping growth marketing. A growth marketer for most of her career. She’s been focused on B2C healthcare, technology, health plans, and government agencies. And at present, well, she combines her enthusiasm for all of this with her interest in wearable health technology as well, mobile healthcare and personalised medicine above all, all part of her mission to build high-functioning teams and better-functioning people, helping us with our health. Hey, Stacy Earl, welcome to “The Big Leap.”

Stacy: Thank you so much for having me. I really appreciate it. It’s always a pleasure to connect with you.

Peggy: And it is, it’s a second time, we had a webinar earlier, talking about your work, your VP of Marketing at Cardiogram, and looking also at what you’ve done to growth retention, because, of course, your chief responsibilities, your business is all about making users more, first of all, use the app frequently, but also trust it. And that’s important for any healthcare app. It’s a bit difficult to balance sometimes. And you’re expanding very much from what you were doing in your lines of business to app marketing. What are you bringing with you in your own talent to make that connection?

Stacy: So, yeah, I’ve been involved in growth and marketing of healthcare tech for over 15 years now. But, you know, I think from a personal, I am very much into mobile health. If you can see both of my wearables here, I have my Garmin on one wrist and my WHOOP on the other.

Peggy: Oh, cool.

Stacy: Yeah, I have a real passion for mobile health data. I think that we can use mobile health to really reduce the cost of healthcare overall, help equalise, you know, access to care and use this technology for, you know, prediction and early diagnosis of healthcare. So, it’s a real passion for me. And so it was a joy when I was, you know, asked to join Ilumivu, who’s the parent company of Cardiogram, and really see what we could do to help people who have heart health concerns, use Cardiogram and its pre-diagnosis capabilities to give them some peace of mind so that they don’t have to worry as much.

Peggy: And the predictive aspect, when I think about it, Stacy, so very important, not only because it’s going to help, you know, entire systems and organisations give everyone healthcare, if we’re watching it and taking care of it, we can be more effective not only in how healthcare is provided, but how we’re taking care of ourselves.

Stacy: Yes, yes, absolutely. You know, so many of our users have heart concerns, and maybe it’s atrial fibrillation or long-haul COVID, or, PoTS, or maybe they just, you know, have a family background and they want to make sure that their heart stays healthy as long as possible. But we’re also able to use heart rate data and other background data to actually predict your risk of other related metabolic conditions like diabetes, hypertension, and sleep apnea. So, it’s really fascinating what machine learning can do these days.

Peggy: Yeah. And we’re really at the cusp of that. You said machine learning, and that’s bringing it all together. The value proposition of your app is about service, but it’s also very complex. You know, it’s a complex product to market. It’s a product that you need to… The more you educate me, the more I’m going to understand, appreciate, and use it. How do you approach customer education, user education about all the different options, all the different advantages?

Stacy: Well, one of the first things we have to do is we have to make sure that we differentiate ourselves from the data that’s freely available, right? So, anyone can have an Apple Watch and they can have Apple Health, and they can see generally, you know, what was my average resting heart rate for the day? We have to first differentiate ourselves from those, you know, free apps that are out there. And, you know, we do that with, you know, really detailed information. But we also really have to earn their trust. And so, you know, we make sure we stay rooted in science. Our machine learning data scientists work with clinicians as they develop and refine our algorithms. And our content always comes with receipts, as they say. We provide links to the studies that we’re basing our content on, and those studies are trusted institutions like universities or the American Heart Institute, not just a recycled listicle.

Peggy: So, the interesting thing about user education is that it’s also a way to engage. It is a way to build trust, to your point. And that is all about ultimately getting people through the funnel, getting them through onboarding, turning them from free to fee and payers. But tell me a little bit about what you’re doing to get people to register and even commit to a trial.

Stacy: So, part of that starts with our app marketing, you know, within the App Stores, both, you know, App, and the Play Store. And that means, you know, we have to start with that kind of differentiation again, you know, and showing people really what the features are that are going to help them. You just can’t say enough about video, right? Picture’s worth a thousand words. But we also use user testimonials. So, work very closely with our customer service team, and they pass along those emails to me that are user testimonials that say, you know, here’s how Cardiogram helped me. And so then we reach out to those people and we ask them, you know, if they would work with us on video content or if we can use their quote. And so we really want people explaining to other people how to use Cardiogram as well. You’ve got to show the value of the product early on, and especially as, you know, the economy’s tightening down. That’s differentiating it from the free options out there.

Peggy: And also extremely smart. I’m thinking, Stacy, you’ve gone for, you know, not even… I wouldn’t even say micro-influencers. You’ve gone for real people at a time when everyone says you have to be authentic in your marketing. So, smart move, smart move. What about the approaches that you are employing? Okay, I am using the app, I’m excited, I’m in my trial, but you also want to keep me motivated because the more I use it, the more I’m going to appreciate it. What are you doing to keep excitement levels, interest levels high?

Stacy: You know, of course, nothing beats rolling out a new feature. But that’s just not possible on, you know, kind of a weekly basis. So, we really focus on educating people on how to use the existing features to manage their conditions. And in addition to that, we really keep people involved on new algorithms that we’re developing. So, we ask our users to participate in that development. For instance, right now we have two programs going on, one for early prediction of migraines, and the other one for atrial fibrillation.

Peggy: I’m just thinking through what you’re doing is you are allowing, empowering, enabling, I don’t know the word for it, but the idea is be a part of the community, work with the app, and you can contribute to the greater good of algorithms that are going to help us help you, but help everybody else.

Stacy: Exactly, yes. So, it really does start to feel more like a community.

Peggy: One North Star is always going to be, you know, sessions and sessions within a certain period or, you know, session length. But again, you are part of my routine, you’re part of my life, you’re my life coach. And I love what some people say about health apps is that they’re also part of a personal operating system. You know, I’m giving you my data and you’re helping me manage my life. So, what other metrics do you have to look at to say, yes, this is the way we direct our efforts or our resources to deliver on that really important promise, which is really you are my assistant?

Stacy: So, it’s interesting because, in gaming apps, you might be looking for users that have really long session times, right? They get in there and they just can’t put it down. But in our app, I’m looking for users, they’re coming to the app multiple times a day for probably very short periods of time. Maybe they’re looking to see how their heart rate recovered after a workout, or maybe they’re tagging a symptom that they experience so that they can share it with their doctor later on. So, for me, I’m looking at how much time in-app per day, so per daily user, and how many sessions per daily user. Those are kind of two really good metrics for us. And so we’re always constantly tweaking our onboarding and our outgoing messaging to see what impacts those metrics.

Peggy: Yeah. I’m wondering, what does impact those metrics? Maybe just a little peak under the hood.

Stacy: Yes. Well, we talked about it a little bit early on, but one of those was participation in those new programs that we’re working on. That’s worked so well for us. Oh, wow, it’s been a year ago now where we asked people to participate in a survey about long-haul COVID. And, of course, you know, this is pretty late in the game. There’s been a lot of information about COVID out there. So, we really weren’t sure how interested people would be in participating in that survey. But, within a week, we had 30,000 responses to that survey. And what we saw was the people who responded to that survey also, you know, had more time in-app, more sessions daily. So, those metrics kind of went up for them. And so it goes back to that feeling I think that they are participating in that greater good of developing, you know, better healthcare for all. There’s so much value in data, and having access to that data is just crucial to healthcare, I believe, in this day and age.

Peggy: And it’s also a hook for your app because what I’m also doing is, unlike a free app, which will give me snapshots, I’m able to see patterns, I’m able to see not just patterns, but some logic, something is going on in my health, and I can see what triggers it and how I can improve it or whatever needs to be done. I’ve just got more of those insights. Tell me a little bit about some of the hooks, triggers that work for your app. We know it works for your users. What works for your app to make it habit-forming to improve that engagement?

Stacy: So, we really have to work really closely with our engineering team and our product manager to make sure that every time we’re building in a feature we’re thinking about personalisation, we’re thinking about the events that they’re passing along to us, and how we can use those events and that data in our marketing and in our journey to ultimately retain users and also make sure that they’re getting as much value as they can out of the app. So, that’s a huge challenge. So, Cardiogram has been around almost seven years now, and it wasn’t designed with that in mind. So, as a marketer speaking to another, you know, marketer or maybe, you know, someone who’s just starting to develop an app, I would say, “You know, make sure that you think about marketing and you think about that personalisation right upfront from the beginning as you’re building the app in, because it’s harder to do later on down the line.”

Peggy: So, I have to ask you, I know what designing for retention looks like, what does designing for personalisation look like?

Stacy: So, for personalisation, it’s thinking about… You know, we started off with, I think, you know, kind of for user personas. And so you have to really kind of put yourself in their shoes and think about, you know, what information is personal to them. And it’s different for someone who is…we call them the worried well, right? So, they’re well, but they want to make sure that they stay that way. You know, what personalisation is for them looks different than personalisation for that PoTS person, you know, that I talked about. The worried well doesn’t want to be spoken to as if they’re ill, as if they’re sick. But the PoTS person needs, you know, compassion. And so the more data we have like that, it helps us, you know, even personalise our emails and our tone, or our messages, you know. So, our push notifications are not one-size-fits-all. We can use that information that we’re getting to help tailor those better.

Peggy: As you said it yourself, personalisation permeates every aspect of messaging. You understand your segment and then you adapt your messaging accordingly. Worried well wants to be treated a different way than, for example, those with PoTS. Now to do this requires talent and a tech stack. Tell me a little bit about both over at Cardiogram.

Stacy: Yes. So, we use CleverTap. We initially were on Leanplum. We’ve transitioned over to CleverTap. And so it’s really critical to have a MarTech solution that is built for apps. I just can’t emphasise that enough. I mean, as someone who transitioned into app marketing about almost two years ago now, it’s a whole different world, you know, because I can actually see how people are interacting within the app, the actions that they’re taking, the events, right, and then market to them accordingly. So, that means that you have to have a very analytical mindset. You have to create these trees, these ever-branching trees.

So, instead of just having one message pathway, you’re building a tree out with nodes, depending on the personalisation. You might start with one path and then you say, “Okay, now, if this person is a worried well, we’re going to take them in this direction, and if this person has a healthcare concern they’re trying to manage, then we’re going to take them in this direction.” And then you keep branching from there. So, you end up with very complex marketing, which means that you need a content developer who thinks about that and can develop, you know, the content accordingly. And you need a very patient, creative person who will then go in and develop, you know, this entire campaign that branches in all of these different ways.

Peggy: You talk about the content there, I mean, it has to be empathetic. You have to understand the user. You have to make it count, because, of course, it is app marketing, it’s about getting someone through a funnel. How do you show that you care, share their concerns, share their values? How do you speak to them in a way that resonates?

Stacy: All my credit goes to my team. So, yes, I really can’t give them enough credit. So, they are Alexa Kurtz, who is our content developer, and J.D. Dolly is creative, and they are just an unstoppable team together. So, they somehow managed to get just the perfect blend of compassion and empathy while still presenting what sometimes is dry scientific data, in a kind of lighthearted way. And I think that one of the things that I had to do as a leader was allow Alexa to develop that voice, and give her the leeway, you know, and not micromanage what she was writing. So, I think it all started when she developed a closing tagline that we use on all of our emails, which is cheering you on from behind the screens. And it was just that great blend of humour and, you know, support that worked so well. And so from there on, now I don’t edit what Alexa writes. I might tweak a word here or there, but I really let that team, you know, perform, do their thing.

Peggy: I love the humour. She’s a keeper, Alexa?

Stacy: Yes.

Peggy: It’s really not easy to do that, and it’s actually quite hard work to match that with the channels. I’m just curious if we could, like, take a trip through the journey that you’re building, let’s say a channel that works best when you want someone to subscribe.

Stacy: In the early stages of engagement, push works really well, right? And when people are just discovering the app, I definitely have to say push works super well. But I can’t discount email. I know it’s old school, but we have an average of 41% open rates for our email. And maybe that’s just the age of our users, which tend to skew older, but you can’t forget that. We implemented an in-app mailbox only about three or four months ago. And so our users are still getting used to that. But really what I think about is which channels are they subscribed to? And so I make sure that I… We start with a long-form piece of content every time. So, we always start off with a blog post, and we put that on our web so we have SEO, etc. But the other reason why that’s important is because then that blog post can be used to create an email message, and then it can also be used to create a push message and an in-app mailbox message. And so for those, right, I can’t push someone to an email, but what I can do is push them to blog content. And so it’s important that I have all three of those to get users exactly in the channel that they want to use, not just the channel I want to use.

Peggy: Good point. Because it’s really not up to you, it’s up to them. They will come where they want to. Next question for you, a good engagement experience or journey, what does it look like?

Stacy: Something that causes them to want to learn more, right? So, it causes them to take action, whether it is to open the app, whether it is to go read a blog post, or whether it is to participate in development of a new algorithm. And so I’m ultimately looking for them to take action, which, of course, then I can use CleverTap to measure how many people took an action out of that. How many people, you know, did I convert? Whether conversion meant clicking on something and going somewhere and taking an action, or conversion meant subscribing.

Peggy: Good question here then. It’s all about figuring out that journey. But, of course, you have a personal journey as well. And it’s all about trial and error. Tell me about the biggest personal mistake you’ve made that turned out to be the biggest personal win, because, of course, we always learn from our mistakes, Stacy.

Stacy: Yes. Not testing, learning, knowing, you know, working in new technology. And so, yeah, when we were first, you know, using this MarTech stack and then the first time we decided to send users out to ask them to do this survey, and then we found out that we didn’t quite have everything linked up correctly. So, we were trying to push their user ID over to the survey so we could match up data with their survey responses. And, yeah, it didn’t quite go as planned, but we got phenomenal response. And so then very quickly, I had to turn around with all this egg on my face and we had to write this email in, like, minutes, right, that says, “Oops, you know, we messed up, and please…” And I think every marketer does this at some point in their career, right? But, yeah, beta testing. Also, don’t roll it out to, you know, 500,000 people at once, you know. Just roll that out to, you know, 1,000 people and test it out first to make sure it’s working right. So, that was a great lesson for us. We learned a lot in doing that. And so now we have much better testing protocols and we roll things out a little bit slower than we did before.

Peggy: Slow and steady winning the race. But a good point is also, Stacy, I’ve been reading it in a lot of research as well is that once you’ve built up a relationship with your user base and you do make a mistake, they’re much more forgiving.

Stacy: Yes.

Peggy: So, it’s like, yeah, we get it, but you probably have users that are saying, “You know what? As long as you keep on involving us in your programs and your projects, and that, and we’re helping everybody, you know, make a couple of mistakes along the way…” There’s that saying, right, that people who do a lot can also make a few mistakes.

Stacy: Yes.

Peggy: The more you do, the more mistakes you may make.

Stacy: Yeah. And we’re at an interesting point in our journey now. So, we are making a change to our revenue model, right? For the first six years that Cardiogram was around, it was a freemium model. And so, you know, we had free users who then we were trying to convert to premium. And in December of last year, we changed that model and we said, “Okay, now we have a 30-day free trial,” which is quite lengthy, but after that, there is no free version anymore. And, of course, we needed to do that really for revenue. We had 250,000 monthly active users, but out of those, we had about 50,000 subscribers. So, we had all these people who were using the app but weren’t paying for anything. And so we really had to take a look at that.

And, okay, so that’s easy enough to do for new users coming in. The real challenge now is doing that with old users who have been members for a while. And so we really had to… You know, as we’ve started converting those users over to paid and eliminating the free, we’ve had to personalise again, you know, and we’ve had to rely on that relationship that we’ve built. You know, part of our messaging was using personalisation again. You’ve been a member for X amount of time, you’ve been a member since December 1st, 2018, and really helping them understand we’ve been giving them free for a very long time. And then also relying on that relationship for them to understand the position that we’re in, that we can’t continue to provide free for forever. There are data costs associated with it, there are personnel resources associated with it. It’s a hard decision to make for a marketer, or for a company, you know, and hard to implement as a marketer.

Peggy: But I think it’s the same approach because of your content because you’re so up-front about it. You know, you’re stating why. It’s not out of the blue. There’s a reason for this. And also the model itself, you know, you simply have to explain it. And as you said, you’re using personalisation to do it. Can you give me some idea of how that’s working out? I mean, is it possible if you’re upfront and honest to say, “Look, yeah, you’re going to have to open up your wallet for me, but I’m giving you value?”

Stacy: So, we’re still working on that data. We’ve been rolling this out for about three or four weeks now, but we’re pretty happy with the results so far. I do have some more lessons learned about that as well, you know, like pitfalls you don’t think about, you know, where we are telling people that they have seven days left when they open the app. And so that starts the email journey, the personalised journey. But I need to make sure they open the app. So, I really needed a trigger, you know, to make sure that they went in and opened the app when maybe they haven’t been in for a month or so. So, there were some lessons learned around that too. It’s been a very interesting journey to go from a freemium model to, you know, a trial, subscription.

Peggy: Well, now you’ve got me going, because that is a very, very important and relevant journey, as a lot of companies rethink this and say, “You know, we have to change the paywalls completely. You know, freemium is out.” I will look forward to continuing the journey with you actually, Stacy, maybe having you back again to tell that, because there’s nothing better than practical advice from a practitioner. And if you have said you have seen the pitfalls, experienced them and can warn us about them, then that is valuable in and of itself.

Stacy: I certainly will be happy to do that.

Peggy: Thanks again for sharing and for being so candid because that’s it. We want to know what works and what doesn’t. And some people don’t want to share that journey, but you have done exactly that. So, it’s been a perfect, perfect match to have you on “The Big Leap.” Thanks again, Stacy.

Stacy: Thank you, Peggy.

Peggy: And this has been “The Big Leap.” For our audience, we also publish this video as a podcast, which is easy for you to consume on the go, on the train, on the plane, wherever you may be. And if you’re listening to the audio version, you can also see the video, just search for The Big Leap on YouTube. This show is all about shining a light on amazing marketers who took the big leap to achieve growth through retention. So, if you have a story to tell, hook up with me on LinkedIn and we may get you set up with a show of your own. Until then, this is Peggy Anne Salz, for CleverTap and “The Big Leap.”

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Last updated on March 26, 2024