Allied Health Business Models: Lived Experience, Risk & Growth with Ben Gold

Craig: Hello everybody, and welcome to the Healthy Business Lab podcast. We interview amazing allied health practice owners and business owners who are doing great things in the space, learning from all the insights and gold nuggets they have to share.

Today, I’m super excited to have Ben Gold from Hub and Spoke Health on the call. Ben, welcome.

Ben: Thanks, Craig. How are you going? Thanks for having me.

Craig: I’m tremendous. I’m super excited about our chat. Obviously, we had a pre-call conversation about your background and what you’ve done.

How about I hand over to you to share your background in the allied health space and what you’ve created there, and then we’ll evolve the conversation from there?

Ben: No worries. I’m a physio by trade. I did a Bachelor of Science before completing my physiotherapy degree. Then I moved to Queensland for a year with my then-girlfriend, who is now my wife, just to have a different experience.

We were there for a couple of years and then decided to move to New York, probably after about three or four years of practice. We lived there for seven years.

I initially started working for someone else and then started my own business over there, which is somehow still going, thirteen or fourteen years later. That business involved doing home visits in Manhattan and Brooklyn.

While I was there, I did some more study, including a Mastery Certification in Manual Therapy and a post-professional Doctorate of Physical Therapy, or PP-DPT, which is a bit of a mouthful.

We were having our second child, our daughter, and thought it was time to move back, get a bit of help, and have a bit more space. So we landed back in Melbourne.

I started a business called Home Physio Melbourne. It was just me, a car, a backpack, and a massage table, driving around Melbourne.

Then things started to grow. I became too busy to see all the patients myself, so I needed to hire some contractors.

We then grew from physiotherapy into many other services, which we currently offer today. Our business is now called Hub and Spoke Health because we’re not just physio; we offer many different services.

We have this hub-and-spoke model, where we have a central hub that is about to expand, along with spokes, which are satellite services that we deliver out into the community.

Craig: That’s a great summary of what we discussed in our pre-interview chat. I’m sure our listeners have already started to pick up on the many experiments you’ve undertaken: moving to New York and back again, working with different business models and delivery models, and learning across different countries and locations.

I’d love to explore that more in a moment. But I also want to circle back to how, while building and growing a business, you have looked after yourself and drawn on your background knowledge in health and the human body.

As you’ve grown your business and gone about your business life, are there particular things you’ve consciously leaned into?

Ben: From a mental health or physical health perspective, or both?

Craig: Both. You’ve learned so much in this space and help people in this space. What do you lean into and tap into for yourself from all that knowledge and learning?

Ben: It probably started earlier in my career, when I was younger, as “Do as I say, not as I do.”

As I’ve gotten older, I’ve recognised how important exercise is for both physical and mental health. It’s an old cliché, but it’s true.

I’m probably in better shape than I’ve been for ten years, simply because I’m doing more exercise. That helps. It’s good to feel strong, and as a result, you also get the side effect of supporting your general mental health and anxiety.

It has been a challenge to stay focused, grounded, and able to manage risk because every time there has been a new experiment, you’re essentially putting a lot on the line.

That’s always challenging. It helps to have a supportive partner. My partner, Nicole, also works in the business, so that is very easy on some days and very challenging on others.

But mostly, it’s very good. It’s great to have a partner who supports you, supports the business, and helps.

Craig: I love that. It’s something I’m working on as well: getting back into looking after myself better physically.

I’ve been doing more work on mindset, which has also been beneficial, but I’m now focusing more on the physical side and strength training.

That leads nicely into the experiments of business. I’d love to unpack the move to New York, what you learned while you were there, what you saw, and how that helped shape your business model and the experiments you undertook at the time.

Ben: The whole thing was a big experiment, to be honest.

I needed to study for a five-hour multiple-choice exam, which all physical therapists in the United States need to complete when they graduate. That involved about six months of study, followed by sitting the exam. Luckily, I passed.

Without passing, I couldn’t have practised. That was a big risk and a big experiment because we had already moved across before I passed the exam. I had faith in myself that I would eventually pass it.

The healthcare system over there was different, and the insurance system was more like car insurance than health insurance.

One of the first companies I worked for, New York Sports Med and Physical Therapy, was amazing. They had a gym model that is now much more prevalent in Australia.

When I left Australia, most physiotherapy clinics were windowless offices. You would be hurried out with a bit of Theraband and given a handwritten sheet with some exercises.

The model in New York flipped that on its head and gave me a different perspective on value for money.

After you finished in the treatment room, you went out into a full rehabilitation gym and either worked with the physio or a physio aide to complete your exercises. You might then lie on a bed for heat or ice, although it’s questionable how much that helped, but it was part of the experience.

You may have been there for an hour to 75 minutes. That was the rehabilitation experience, and it was very social, with patients working in an open gym setting.

That part wasn’t risky. It was more about learning different models, and it probably ignited some of my ideas about what I thought would be a good business model. A lot of my ideas stemmed from that experience.

Craig: I love that exposure to somewhere new and different. I had a similar experience working in London and the UK, seeing different models and approaches.

It’s not necessarily about one model being good or bad. Sometimes the difference simply sparks your thinking and makes you ask, “What is possible?”
It sounds like that was very much how things evolved for you.

Ben: Exactly. I think life teaches you that you might not appreciate it at the time, but your lived experience moulds many of the decisions you make later in life, whether you’re conscious of it or not.

Craig: When you came back to Australia and started setting yourself up again, you were still managing and operating a separate location on the other side of the world. What experiments do you remember from that time?

Ben: Dealing with different time zones was a big experiment.

One thing we definitely failed with was trying to take calls. I was still trying to take calls from new patients, so we got a Google phone number at the time. I don’t think you can get them anymore, but I ported that to my US phone number.

The phone would obviously ring at 3 a.m. I would miss the call and try to call the patient back, but that often didn’t work.

Another failed experiment was getting an answering service that knew nothing about my business. I got them to take the calls, but it wasn’t personable and they didn’t understand our business. That was a big waste of time and money.

I became resigned to the fact that I wasn’t going to get all the new patients because, in Manhattan and Brooklyn, everyone wants everything yesterday.
If they didn’t get a response, they would move on to the next clinic. So I eventually let that business run in the background.

Craig: Has that idea — that everybody wants something yesterday — and your experience of the customer journey shaped how you now do things?

Ben: Absolutely. One of the things we say in the company is, “Referrals come first. Drop everything and referrals come first.”

I come from a long line of impatient people, but I also put myself in the shoes of someone who needs care today. If I’ve had pain, I’ll ring around until I find someone who is available.

We pride ourselves on having very speedy communication, even if it means we can’t help someone. We still get back to them.

I don’t know whether that comes from personality, lived experience, or a combination of both.

Craig: I love that. You tried a few things, they didn’t work, but you then developed a structure and process around how you wanted to operate. Even if you don’t have capacity to fulfil the request, you can still help somebody by communicating with them. There’s someone on the other end of the line who wants help, or simply wants to be heard.

Craig: What other experiences evolved from those initial learnings?

Ben: Everything back in Melbourne has been one big experiment. You want the experiments to work well, but some haven’t. You learn from them and keep moving.

The first experiment was starting a home-visit practice. I thought, “What’s the point of becoming a run-of-the-mill physio in a practice?”

I knew I couldn’t work for anyone else again after having my own business. I learned that pretty quickly.

Rather than putting myself in a windowless office, paying rent, and hoping patients would come over time, I wanted to do something that was low-risk.
That meant starting a home-visit business. I set up the website because I knew how to start a business. I wasn’t aware of everything involved, but once you get through that initial stage, you have to have faith in yourself.

At first, it was physiotherapy. I reached out to referrers, doctors, GPs, and surgeons and hoped for the best. That worked.

Then, as we added new services, each new service became a large experiment. We went from physiotherapy to exercise physiology, which became busy quite quickly.

From there, we added art therapy, which was a hit, and then music therapy.
We now have a bit of a formula for rolling out new services in the mobile space. That’s what we’ve done, although some services have not been successful. We learn from those experiences and move on.

Craig: Having a mobile service isn’t necessarily mainstream, so that in itself was an experiment. But it made logical sense to you.

Then you evolved into a multimodal approach that was also mobile. How has that evolved over time?

Has it been demand-driven, or have you looked at how complementary services could help existing clients?

Ben: In Manhattan, everyone has their person. They have their berry person, their bread person, their massage person — and “person” applies to all genders.

They often have people who come to them. Home visits have been occurring in Manhattan for years, probably much longer than in Melbourne, partly because of the proximity and the ease of getting around.

The idea really solidified when my wife was pregnant with our first child. She had terrible sacroiliac joint pain and couldn’t walk.

I thought, “Wouldn’t it be great to have someone come to us?” But I couldn’t find anyone.

We had to put her in a taxi and take her to a doctor who gave her an injection into the joint, which helped a lot. That experience solidified my belief that there was a real need for home-based care.

It also led to another business we started, called Physio to Mums. The idea was to bring physiotherapy to pregnant and postpartum mothers to help with getting fit, mastitis, aches, and pains.

That business didn’t really go anywhere. I think some of the obstetricians thought I was a bit unusual for wanting to work in women’s health, although there’s nothing strange about male health professionals working in that area.
Meanwhile, Home Physio Melbourne was growing. I didn’t know whether there was demand, but I thought the model made sense. It makes sense when you’re in pain to have someone come to you.

If you’ve had a knee replacement, it makes sense to practise going up and down the stairs in your own home rather than using pretend stairs in a clinic. It makes sense to train to get out of your own bed rather than a plinth in a clinic. All of those things made practical sense to me. Then, along the way, the NDIS started, and that became a big part of our business. We also worked with what were then called home care packages, now called Support at Home, for people over 65 with chronic conditions.

The need has always been there. I also looked at it from a government perspective. What costs the government more: having people in nursing homes, or treating them at home?

Treating people at home saves the government a significant amount of money. I had faith that the business model would work, and now the home-visit sector is thriving. I only wish we had become a bit bigger — although I don’t really mean that.

Craig: I love how you’ve explained the thought process behind it.
What I’m hearing is that you use a logic filter. You ask, “Surely this should work in a certain way?” Then you test it practically and work out how to build it into a wider business model.

That applies not only at the business level, but also at the macroeconomic level. What is happening in the wider space? If you look at government policy logically, what are they trying to achieve? I haven’t worked in public health for a long time, but it makes sense to keep people out of emergency departments and prevent hospitals from becoming overloaded.

It makes economic and practical sense to provide care in the home where possible. If you can build a strong model around that, it should create a great business model.

Ben: You would hope so. But it’s still challenging.

A friend made me aware of the term “pen stroke risk.” When you work with government money or government schemes, your business could disappear at the stroke of a pen because of a policy change.

We have experienced that with the NDIS. They decided to reduce the reimbursement for physiotherapy when everyone had been expecting an increase after seven or eight years.

They also cut travel reimbursements by 50% overnight. That was an existential threat to our business. We lost around $100,000 overnight and needed to rethink how we operated.

Those risks occur all the time when you’re dealing with government institutions.

Craig: How do you manage that risk now, having experienced the impact of that policy change? How do you approach decision-making and planning as a result?

Ben: No two situations are the same, but the first thing is not to panic. You need to think about things logically.

I see business as a game that you want to win. That doesn’t mean it’s free from huge amounts of stress, but I think you need to be creative and have a good team around you to bounce ideas off.

That includes the management team, the admin team, and colleagues in the sector.

In the home-visit space, there are new providers appearing every day, but there are also several core groups that I speak with. We share ideas and learn how each other is responding to changes.

I wish there were an exact formula, but we’ve experienced similar changes before.

For example, dietetics and exercise physiology both had reductions in reimbursement rates recently. We emailed all the support coordinators and explained how we were changing things and what we proposed to do.
Obviously, everything had to be legal and ethical.

We explained that the proposed changes were existential. If we weren’t around, participants and patients wouldn’t get seen, and practitioners would lose their jobs.

It’s stressful to have that responsibility when these changes occur. Not everyone understands the situation from the perspective of a practitioner, staff member, or patient. Sometimes, though, you have to make difficult choices.

Craig: I appreciate you bringing that up because people don’t always understand that side of being a business owner.

If someone is thinking about starting a business, they may not consider the broader picture, the impacts, or the stepping-stone effects of certain decisions.
What I hear is that communication is a major part of your approach. You paint the picture for all the stakeholders involved and explain how they are affected by a decision, funding change, or change in the environment. Because of your model — multiple services, locations, and delivery methods — communication must have become central to what you do. Is that fair?

Ben: I think so. Whenever a major change takes place, we need to look at change management. That involves all the stakeholders, starting with staff, so we can let them know what we’re doing.

Then we communicate with referrers and patients across the platforms we use and explain why we’re making changes.

There is always an explanation, along with a healthy dose of guilt about why we’re doing it. Physios and allied health professionals generally don’t enter the industry to become millionaires. We hope we go into it because we want to care for and help people.

It can be challenging to talk about things from a financial perspective because there can be an underlying feeling that financial matters are dirty or that we shouldn’t care about them. But without financial sustainability, we have no business and can’t help people.

Craig: You’re speaking directly to my heart and to why I do what I do in this space. The purpose of this podcast is to explore how allied health businesses can be healthy and sustainable because we want them to have an impact.
People enter allied health because they want to help others and improve people’s lives. The business side can feel like a necessary evil, and money, systems, and structure can all feel uncomfortable.

That’s why I appreciate you sharing what you’ve done, the different evolutions, and the thoughts behind your decisions.

You also mentioned your network and the people in the space with whom you share ideas. There is so much value in sharing both the good experiences and the challenges because everyone can learn from them.

With that in mind, the idea of this podcast is to share the transformations we see and the results people achieve.

When I say the word “transformation,” what comes to mind? It could be from a client perspective or a team perspective. What have you seen over the years that makes you think, “That’s why I keep doing this”?

Ben: I’m mostly off the tools now, but when I was working directly with patients every day in New York, I remember one particular patient.
I was treating her husband, who was a concert pianist. They were in Miami for a concert when she was hit by an electric bus because she didn’t hear it coming.

She was flown back to New York and had to be put back together. She had a fractured pelvis, fractured skull, and fractured femur. She had literally been hit by a bus and was lucky to be alive.

Over time, she transformed and learned to walk again with my help.
That reminded me why I do what I do and made me feel good about helping someone. That’s the patient side of transformation.

I’m not sure whether transformation is the right word for the next part, but we’re embarking on a new journey in our business.

We’re developing a physical location — a large hub with treatment rooms and a rehabilitation gym. It’s challenging, but I hope it will be transformative in how we deliver care by giving patients both hub and spoke options.

If they live close to the hub, they can access that location. If they start as a spoke because they can’t get to us or are in too much pain, they may eventually become part of the hub model and join our rehabilitation gym. That could be transformative for the business model because it would vertically integrate different parts of care.

We could support people through mobile care when their needs are more acute, then help them move through subacute care and eventually into longer-term rehabilitation in a gym.

Craig: I love that as a transformative approach to business design and business modelling, but also in terms of outcomes for clients. It provides flexible ways for people to access therapy and care, which is at the heart of what you’re describing.

Craig: I really appreciate you sharing everything today. If people want to reach out, connect, network, learn from your experience, or access your services, what is the best way for them to contact you?

Ben: People are welcome to email me at ben@hubandspoke.health.
It’s not .com.au — it’s .health. I’m happy to help anyone who has questions and would be more than happy to connect.

Craig: Excellent. We’ll share those details in the show notes, along with the website and some of the social media accounts you’ve shared.

Ben and I connected through LinkedIn, so if you’re on that platform, I highly recommend reaching out. He has a great deal of knowledge and broad experience with different approaches to business models and impact.

We want to see businesses like yours growing and evolving, giving people different access points to care. I really appreciate what you’re doing and everything you’ve shared today, Ben.

Ben: No problem. It’s been a pleasure, Craig. Thanks so much.

Craig: That’s a wrap for the Healthy Business Lab podcast. Once again, like, subscribe, and do all the things you like to do to keep following amazing stories and gathering gold nugget insights. Over and out from us. See you on the next episode.