How to se­cure full en­roll­ment and a 30x ROI: A con­ver­sa­tion with the CEO of the bou­tique en­roll­ment agency do­ing just that

KEY TAKE­AWAYS:

• CEO Bryan Man­ning of bou­tique en­roll­ment agency Clin­i­cal En­roll­ment has met or ex­ceed­ed re­cruit­ment mile­stones since the com­pa­ny’s in­cep­tion.
• In a Q&A, Man­ning ex­plains how his com­pa­ny se­cured 3 of the glob­al lead­ers in phar­ma on­to its client ros­ter and ex­pand­ed in­to new treat­ment ar­eas, all while ex­celling in di­ver­si­ty re­cruit­ment.
• Man­ning out­lines the 5 es­sen­tial el­e­ments of his busi­ness mod­el to which he at­trib­ut­es Clin­i­cal En­roll­ment’s suc­cess-dri­ven re­sults.
• The Forbes “30 Un­der 30”-rec­og­nized CEO talks about the biggest mis­take that spon­sors need to look out for in 2025.

The surest sign that a com­pa­ny’s busi­ness mod­el is ex­celling is when oth­ers study it to repli­cate its suc­cess. Such is the case with up and com­ing bou­tique en­roll­ment agency Clin­i­cal En­roll­ment (CE), whose stratos­pher­ic rise in 2024 is wor­thy of the “How I Built This”-es­que at­ten­tion it has re­ceived, as well as piquing the cu­rios­i­ty of its peers. If land­ing three of the world’s lead­ing phar­ma spon­sors on­to their client ros­ter in 2024, of­fer­ing a suc­cess-based pric­ing mod­el, and ex­pand­ing in­to new treat­ment ar­eas like on­col­o­gy, neu­rol­o­gy, oph­thal­mol­o­gy and der­ma­tol­ogy wasn’t enough to elic­it awe from a no­to­ri­ous­ly sto­ic biotech in­dus­try, then the rel­a­tive­ly young age of the agency (launched in 2022) is. Still, for Forbes “30 Un­der 30” list-earn­ing Founder and CEO Bryan Man­ning, there’s noth­ing cu­ri­ous about the suc­cess of the com­pa­ny he launched in his home­town of Char­lottesville, VA — ex­cept why every­one else isn’t do­ing it, too.

Q: From what I un­der­stand of your busi­ness ap­proach, you make a lot of bold state­ments. Can you back them up?

BM: (laugh­ing) In our vi­sion, pure­ly look­ing at the da­ta, we think it’s re­al­ly sim­ple. There are cur­rent­ly 4x more clin­i­cal tri­als re­cruit­ing than there were in 2019, but from a pa­tient pool whose size hasn’t grown along with it. In a world where 84% of in­ter­ven­tion­al clin­i­cal tri­als are miss­ing mile­stones by at least a month, and be­cause of what we call the RFP “over­promise gap” that sits some­where around 47%, we re­al­ized that you just can’t re­ly on 10-year-old data­bas­es to find pa­tients, be­cause best case sce­nario you’ll get 25% of peo­ple you need. These pa­tients are out there liv­ing lives on so­cial me­dia, look­ing for com­mu­ni­ty, and en­gag­ing with what in­ter­ests them. So why wouldn’t we go to where they are, in­stead of ex­pect­ing them to come to us? This is why we’ve been able to re­main in high de­mand, be­cause we’re work­ing with­in the land­scape that is, not what was.

Q: That all makes sense. But then, why share this in­for­ma­tion so your com­peti­tors can see it? Wouldn’t it be bet­ter to have a “keep your eyes on your own pa­per” ap­proach?

BM: Be­cause ul­ti­mate­ly shar­ing it im­proves peo­ple’s lives. As a pa­tient with an or­phan con­di­tion my­self, it’s a trav­es­ty that drugs fail be­cause clin­i­cal tri­als can’t find the right peo­ple. In the tri­als that we work on that are the most suc­cess­ful, a col­lec­tive align­ment around them is what makes them work. The goal for every­one in­volved isn’t just to run the tri­al, the goal is to com­plete the tri­al. That’s what gets mean­ing­ful treat­ments over the fin­ish line to hope­ful­ly help peo­ple, but al­so for Clin­i­cal En­roll­ment on a more mi­cro lev­el, we’re on­ly paid on en­roll­ments. We need to get signed In­formed Con­sent Forms and pa­tients in­to seats, or else we’re work­ing for free. That’s high­ly mo­ti­vat­ing! And if we can get all of the sites, spon­sors, and stake­hold­ers aligned to have the same get-it-over-the-fin­ish-line men­tal­i­ty, that’s when mag­ic hap­pens.

Q: I’m sor­ry, say that again — you’re on­ly paid on en­roll­ments?

BM: Cor­rect. But frankly, we’re not even paid on most of our oth­er suc­cess­es at all. Things like sig­nif­i­cant­ly de­creas­ing screen fail rates, in­creas­ing en­roll­ment speed by around 440% — even hav­ing an un­heard of di­ver­si­ty re­cruit­ment rate of close to 30% that’s ac­tu­al­ly in line with the new FDA guide­lines. It’s fine with us, though, be­cause it isn’t just Clin­i­cal En­roll­ment’s suc­cess. We view it as a full tri­al suc­cess.

Q: So you find these pa­tients, then what? What hap­pens next?

BM: We speak to them in a way that makes them feel seen, in­formed, and mir­rors how peo­ple ac­tu­al­ly be­have — both on­line, and in re­al life. It’s emo­tion-dri­ven, hope­ful mes­sag­ing that en­cour­ages pa­tients to know their op­tions, while not over­whelm­ing them with ster­ile, over­ly tech­ni­cal lan­guage. And then on the oth­er side of the process, we even make our stake­hold­ers feel seen. We have a ded­i­cat­ed clin­i­cal site re­la­tions de­part­ment who al­so makes sure the sites feel sup­port­ed. We know them well enough to know when mem­bers of their team are on va­ca­tion so that we can slow re­fer­rals dur­ing that time and not over­whelm them. We un­der­stand our spon­sors’ needs, like when they need us to tight­en screen­ing to re­duce screen fail rates, ac­cel­er­ate ad spends to meet dead­lines, etc. We tai­lor our­selves to your needs, which is the core tenet of every­thing we do.

Q: Are there spe­cif­ic treat­ment ar­eas Clin­i­cal En­roll­ment spe­cial­izes in?

BM: We’ve worked in a lot of ar­eas, like on­col­o­gy, neu­rol­o­gy, oph­thal­mol­o­gy, au­toim­mune dis­eases, der­ma­tol­ogy, res­pi­ra­to­ry dis­or­ders, and a host of oth­ers. As much as we love go­ing out and find­ing net new clin­i­cal tri­al par­tic­i­pants — it’s the back­bone of our busi­ness — our abil­i­ty to launch from first par­ty da­ta is a huge as­set. We have pa­tient pop­u­la­tion lists with con­firmed di­ag­noses who have ex­pressed in­ter­est in clin­i­cal tri­als that we con­sis­tent­ly keep en­gaged and ac­ti­vat­ed. So while new pa­tients are typ­i­cal­ly the high­est con­vert­ers, it’s nice to have an 8- or 10,000-per­son list to help jump­start the be­gin­ning of a tri­al.

Q: OK so we’ve talked about sur­mount­ing the “over­promise gap”, align­ing to ac­tu­al­ly com­plete the tri­al, di­ver­si­ty re­cruit­ment, and bold­er moves like suc­cess-based pric­ing and a so­cial-first ap­proach. You’re giv­ing a lot of ad­vice to oth­ers, but I’m cu­ri­ous, what’s CE’s plan for the com­ing year?

BM: It’s sim­ple. Spon­sors were up­set about fork­ing over a ton of mon­ey up­front for no re­al guar­an­tee, so we in­tro­duced suc­cess-based pric­ing. Sites were up­set at in­dus­try-lev­el poor pa­tient qual­i­ty, so we dou­ble-screen every­one and be­gan col­lect­ing elec­tron­ic med­ical records, which is some­thing we just start­ed do­ing. Every­one was re­ly­ing on data­bas­es to find pa­tients, so we put our en­er­gy in­to so­cial out­reach. Be­cause of all of this, our pa­tient qual­i­ty has nev­er been bet­ter. We take a bet­ter­ment ap­proach to each facet of this in­dus­try, and that’s the place we try to keep evolv­ing fur­ther in­to.

Q: To close things out here, what’s the biggest dan­ger to spon­sors in 2025?

BM: Not re­al­iz­ing that min­utes mat­ter. When you’re the av­er­age Phase 2 in­ter­ven­tion­al clin­i­cal tri­al spend­ing rough­ly $330,000 per day, that breaks down to $33,000 per work­ing hour if we’re as­sum­ing a 10-hour day, or $550 per minute. So every minute is crit­i­cal. Re­lat­ed­ly, the av­er­age cost of en­list­ing our ser­vices equates to about two or three days, but when we ac­cel­er­ate tri­als by an av­er­age of around 60 days… that’s a 30x re­turn on in­vest­ment. Sud­den­ly we’ve be­come the best in­vest­ment the spon­sor ever made.

To learn about Clin­i­cal En­roll­ment, their re­cruit­ment prac­tices, or how to con­nect with Bryan, read more here.