In the past five years, there has been tremendous growth in the world of digital advertising. Machine learning and algorithms continuously improve to help digital advertisers reach and engage the right audience. The key is finding the perfect balance between artificial intelligence and marketers’ ingenuity. They each have their unique strengths and role in developing effective digital advertising campaigns.

Hosted By:

Lauren Leone, SVP Healthcare Marketing
Nicholas Van Winkle, Director of Paid Media
Alex Kemp, Director of PPC

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Quotes From the Episode:

Nick: “You have to bring a certain channel mix more ready-made for a particular type of client. What we’ve seen over the last two years, maybe five, more generally is that everything is becoming paid search. What do I mean by that? The hard and fast lines between channels are really beginning to blur.”

Alex: “With healthcare in Google, more often than not, your marketing audiences are disabled. Another route we take to do the same thing is essentially use a third-party display network. What that allows us to do is still get a pixel placement on the website, collect an audience, but we’re not doing it through Google, and we’re doing it in a compliant way.”


Related Resources:

3 Proven Ways to Improve Digital Advertising Performance

How 3 DSOs Are Accelerating Growth with Digital Advertising

How Medical Practices Can Drive Growth with PPC and SEO


Read the Transcript:

Announcer: Welcome to the Ignite podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Lauren Leone: Thanks, everyone for joining us on the latest and greatest episode of the Ignite Podcast. My first time hosting our CEO, Alex is presenting out in Vegas at a conference this week.

I get to stand in his place. My name’s Lauren Leone I’m the SVP of Client Services and Healthcare Marketing here at Cardinal. I have two really amazing guests joining us today.

If you all think I sound smart in our podcast really all I’m doing is repeating the smart things that Nick and Alex have told me. This is who you really want to be hearing it from. We have Nicholas Van Winkle.

He is the director of Paid Media here at Cardinal overseeing all Paid Media channels, search, social, display, and everything else that we’re going to talk about. His goal is to bring it all together for you and for our clients. We have Alex Kemp who is our five-plus year resident paid search director, all things Google ads. If you need to know something about what’s going on in the Google world, Alex is your guy. Thanks for joining us guys.

Nick Van Winkle: Oh, such a pleasure to be here.

Alex Kemp: Yes, happy to be here.

Lauren: One of the first things we want to dive in, I want to get your perspectives. I get asked this a lot, but I want to hear what you guys have noticed as the experts in your fields. At a very high level, what has changed? What have been some of the biggest changes in the digital space in the last five years?

Nick: How about I take the opening crack.

Lauren: Yes, Nick let’s get you– yes, we’ll get Nick started on that one.

Nick: First, these are big questions. I love big questions.

Lauren: They’re big questions. Yes, pick one or two things that feel good.

Nick: What’s changed? About five years ago I was essentially designing keyword-level bids within paid search. I was manually bidding which it’s almost laughable today, that’s how quickly things have changed. Why is that? The biggest most overarching view here is the level of data that we have access to within our platforms has become far more fine-grain.

At one point it was age, gender, household, income, and location, maybe some behavioral, maybe some site-specific.

Essentially, over the years that categorization has become finer and finer and more predictive of what the user, the human being at the end is ultimately going to do next. We can become more and more sophisticated with when we place our bets, how we place them, why we placed the whole thing. It’s all rather impressive at this point. Five years ago we just didn’t have that level of granularity. It was much more, broad.

What you had then was broad-based audience categorization within a manual keyword-bidding situation. Those are two rather blunted instruments as compared to what we have today which is fine grain, sand grain level of granularity in terms of audience segmentation and categorization. Machine learning has to predict exactly what the user– where they are in their journey and how to speak to them.

In the last five years, it’s just become so much more sophisticated. That’s what I would say.

Lauren: Alex, I’ll ask you to answer the same question and then I have a follow-up already in my mind that I want to ask you. Let me get your thought first on just what you’ve seen as the biggest changes.

Alex: I would– first of all, I agree with everything Nick was saying there about the level of detail we have now, and our reliance on machine learning, and algorithms, and all that. The other perspective I would add-in is around how much digital media people consume nowadays. I would say COVID in 2020 pushed us maybe 5 to 10 years in the future of what digital media consumption would look like on a normal timeline where COVID didn’t happen.

We’ve seen on our end for several different industries and verticals where search volume has just gone through the roof on paid search. If people weren’t already to turning to the internet to solve their problems when it comes to finding solutions they’re doing it at even a greater rate now. Like I said, I really think that 2020 pushed us into the future a little bit and the way people consume media now is so different.

It’s at a level that is so much higher than five years ago and even in 2019. That’s another shift in the landscape I think I would add in terms of how digital marketing has changed.

Lauren: I do a lot of the intake of our prospective clients who want to work with Cardinal, and most of what they’re saying is, “My old provider referral source has dried up. It’s not as strong as it used to be. I can’t rely on it anymore. I don’t know where my patients are finding me, but somehow I need them to find me.”

You’re absolutely right. We’ve heard that in the field quite a bit over the past year and a half. When we are exploring those new partnerships one of the most important things for Cardinal in scoping those is auditing what’s currently going on. Alex does a lot of our audits here at Cardinal. If you’ve ever sat in on a presentation with me where we’re going through an audit most of that information has actually been dug up and uncovered by Alex.

Alex, what are some of the outdated strategies that people are clinging to? What do you see in those accounts that people just can’t seem to break the habit of doing even though the engines have evolved so much?

Alex: I think piggybacking on what Nick was saying about how bidding has changed and how we use the platforms to our advantage. Back in the day, we had very granular campaign structures where we were saying every service that a client has gets its own campaign. Because was as the humans know better in terms of how to allocate budget to that service or to those keywords. We were breaking campaigns out by match type and maybe even device.

Things were just very granular and that’s some of the things I see sometimes where I look at an account and it might be for a single location. Or if it’s for a multi-location but I’ll see way too many campaigns for what they’re spending and what their objective is. That’s one of the biggest things we see is how is the account organized? Is it organized in a very granular way to maximize control? Which is to answer your question I think that’s eventually what it comes back to for people who go with that route is I want to maintain control because I think I know where that budget should go, and I know how I should bid for each of these keywords.

You suggested really the platforms have evolved so much that there are things that we should be delegating to humans. There are things that we should be delegating to the platforms. I think that has just shifted where we’re giving away more– we’re giving the platforms more rein to make changes and optimize the campaigns where humans play a slightly different role compared to maybe five years ago.

Lauren: Maybe red flag number one becomes if you’re not discussing on a regular basis with your agency, or your team, or your contractor whomever you’re using. What the AI is doing, and how we can lean into it, how we can take advantage of it while still deploying our human marketing thoughts. That maybe that’s a red flag or something you want to bring to the attention of your team and say, “What could we be doing better?”

Nick: Can I toss one in?

Lauren: Yes, I would love to Nick, and you’ve got a global perspective here of multiple channels. I want to hear what you have to say.

Nick: Something that I might suggest is outdated is anchoring yourself too much to the keyword at this point. Keyword does give you a high level of information. It will tell you the intent of the user, but there are so many other signals that are in play at this point. Essentially, all the other behavioral and audience-based signals that can tell you where that particular user is in their journey. The keyword is blind to all of that.

What you essentially find is the old-fashioned way is– and what you still see marketers doing today is putting too much emphasis on keyword-level bids. Not using all of the audience-level information next to the keyword level intention to make a more sophisticated bet on what the user is going to do next. You got to get out of the keyword game and expand into the audience game as audience now trumps keyword in terms of even intentionality.

Lauren: I think that’s a great segue because a lot in the user experience space has changed too. Nick what is your suggestion to people listening to this on how to do that? What’s one step they can take in their campaigns to be more user and audience-centric and less keyword-centric?

Nick: There’s so many ways into that. The first way is the structure of the account itself. No longer can as Alex was suggesting hyper segment these things. You have to build the thing in a way that accords to the bidding technology. There are right ways to do that and wrong ways to do that. If you do it wrong you essentially hobble the algorithm. When you do it correctly which is to say give the algorithm as much information as is possible to find the patterns that you want it to find, then you set it up for success.

Frankly, the structure so much is born just the right structure. Beyond that you really have to get the conversion right. Now there’s a lot– I wonder if I’m going to start grinding an axe here. In the digital marketing space we make a lot of hay about efficiency and we should, but often we can set up systems that find efficiency. Which is to say more and more cheaper and cheaper clicks or cheaper and cheaper phone calls or cheaper and cheaper form fills.

This looks great on our end, and looks at the system overall is becoming more efficient. However, none of that efficiency ultimately is connecting to the effectiveness. It’s not actually connecting to your business in the same way, or it’s much more tenuous in the way it’s connected to your actual business goals. Connecting the conversion from the business to the actual levers of the digital is probably about the most important thing you can do after you set the thing up correctly.

I wonder if I’m wandering around at this point, but does that answer you question?

Lauren: That’s a fantastic tip. I think a lot of people are looking for how do I get my CPA down, and they’re wondering why is my CPA3 X on Facebook I just need it to go back down when in reality they should potentially be focusing on how do I get the highest quality out of what’s now available from these platforms. Whether that’s through messaging, through the ad assets, through the learning pages, or through the ability to bring this data back into the engines, so that we can actually inform them on KPIs that really matter to the business. I think you summed it up perfectly.

Nick: Yes. I ultimately want to make some of these digital efficiency touchpoints. I want to expose them as the superficial metrics that they are. The useful and directional, but ultimately not the ground floor. That’s what we have to do.

Lauren: Yes. Segueing but keeping in with the data conversation one thing that Alex doesn’t get a lot of credit for is the fact that he essentially built our analytics team here at Cardinal when it was in its infancy. I know he is also our resident data analyst. Alex, what do we have available to us in terms of first party data today, and how can we use that in HIPAA compliant way? What do you have going on with some of your more sophisticated clients where we’re actually utilizing some of this patient outcome data to get smarter and smarter in our bidding?

Alex: Yes. The original idea there is that like Nick was saying a lot of times we have a misalignment between what we’re telling the system or the algorithm that we want versus what we actually want which is business outcomes with our patient, with our customers. When you have that misalignment the machine will naturally go after what you told it to go after which was calls and forms. The way the offline first-party data comes into play is let’s not only feed the system calls and forms to track and measure those first touchpoints, but also let’s feed them what happened to those calls and forms.

Really those users behind those calls and forms. What happened to those contacts once we got in touch with them, once they entered our CRM what actually happened to them? If we can feed the algorithm, “Hey, I know you drove this call and you drove this form, but that form also ended up being a patient and drove a lot of revenue, so I want more of those.”

What you end up getting is you’re getting closer and closer to a perfect alignment between your actual business outcomes and your bidding technology.

The way we do that like you were saying is really leveraging that first-party data where we can get from our CRMs and say, “Okay, here are all the GCLIDs.” Not to get too technical, but here are all the users that actually turn into a patient let’s feed that back into the system. Now we’re not only optimizing towards efficiency like Nick was saying, but we’re also optimizing towards effectiveness or quality whatever word you want to use there.

The idea is how can we leverage our first-party data that’s already available and use that to better inform our efforts on digital? Is this kind of how that comes into play.

Lauren: Alex, a quick three bullets on what a Tech Stack needs to look like to make that happen. Just give some tips here to people listening who are saying, “Wait a minute, I don’t want to give patient information back to the engines that doesn’t seem compliant.” We know it can be done in that way. What tools do they need to make that happen?

Alex: It comes down to what’s called the Google click ID which I’ll refer to as the a GCLID. The GCLID is essentially the identifying string of letters and numbers that are associated with every single ad click that has ever happened essentially. The way this works is if you can get this GCLID to be passed into your CRM system as someone converts you can track that GCLID throughout the process of becoming a lead and an opportunity.

Then from there you can strategically import those GCLID into the system. In terms of Tech Stack having any CRM is going to be beneficial, because you can have the ability to import that GCLID into the CRM. Then you can actually track it throughout the process. There’s a couple of different ways you can get this GCLID from the CRM into the platform.

You can use tools like Zapier.

You can just use scheduled exports into a Google sheet or you can actually set up a full on integration with Google ads where it is on 24 hours. Salesforce is automatically or on CRM is automatically putting that those GCLID into the system and the system is matching those GCLID to the clicks and really feeding in that revenue data. It’s a complicated process, but it’s very important and it’s the way the industry is moving, and how Cardinals moving definitely.

Lauren: Some things that help that things like call tracking software, if 65% of your activity comes through a phone call, and we don’t have the ability to track that phone call and capture a GCLID then we’re in a tough spot. Maybe some things for people to start thinking about is do I have a call tracking solution? Am I using CRM if I’m not how am I collecting and tracking this information? What capabilities do I have to push it back to my agency?

Just some tips there for everyone. I think a lot of what we’ve been talking about primarily has been within the view of Google, but I know there’s a lot of diversifying of the mix going on within our clients in particular, and hopefully, a lot of other healthcare organizations are thinking about going beyond just existing demand. Nick this is where I’d love to get your opinion. What have you notice change in the past 12 to 24 months with regard to channel mix as a whole?

Nick: Our customers, they meet certain criteria most of them anyway which are multi-local healthcare lead generation. Which means you have to bring a certain channel mix more ready-made for this particular type of client. What we’ve seen over the last two years maybe five more generally is that everything is becoming paid search. What do I mean by that? The hard and fast lines between channels are really beginning to blur.

Before essentially within this particular categorization of clients there’s a lot of ready-made demand. People are actively looking for these solutions already, and essentially we just put paid-search in market and collect them. Now we’re finding that a lot of that lower funnel demand can live, and what is conventionally thought of as middle and upper funnel channels, and why is that? It’s all the sophistication. That’s all harkens back to sophistication. What we’re doing, what we’re seeing, especially within the Google stack, is sharing of data between all of their channel solutions, be it discovery or smart display, or Google Local, or YouTube, any of them.

If you have a paid search channel in the market, what you can essentially do is share all of the insight from paid search into those other channels. What you can do then is essentially, you can, frankly in smart display, you can serve someone a smart display ad before they even know they’re ready to search for your solution. You really can get out in front of paid search. That’s how sophisticated some of these solutions are. All that’s to say your channel mix is everything has within the channel mix has the potential to be a lower funnel, given the capacity for data sharing.

It behooves the marketer, it behooves us, to not just stand up paid search anymore, we’re now obligated to stand up a whole host of channels given the high intention lower-funnel capacity that now lives is nestled into each one of these channels. The mix is changing, and the mix is actually going up the funnel. It’s not for the reason you suspect, it’s because high intention lives now all over the place, and we have to go find it.

Lauren: What about remarketing? There’s the age-old you can’t remarket in health care. Alex, what are you guys doing to kind of get– I want to say get around that but in a compliant way, not violating any rules, but to be able to stay engaged with a prospective patient once they’ve touched the brand in one way or another, whether it’s through an impression of a display ad, an impression of a social video, or even a search?

Alex: You’re saying, with health care in Google more often than not your marketing audiences are disabled. Another route we take to do the same thing is essentially use a third-party display network. What that allows us to do is still get a pixel placement on the website, collect an audience, but we’re not doing it through Google, and we’re doing it in a compliant way.

That still allows us to like you’re saying, reengage with people when they’ve gone to the website, when they’ve interacted a different way with the website, maybe they’re staying on a website longer and visiting multiple pages. That’s how we think about remarketing because oftentimes like you’re saying, you really don’t have that option available to you within the Google Display Network. There are other display networks that are available to you that don’t have the same policies and the same restrictions as Google ads.

That’s how we think about– Because remarketing is another huge part in that entire funnel and journey. It’s still something that we definitely want to focus on to how we’re adapting to the changing world that Google’s giving us.

Lauren: Google put those in place for good reason, to not exploit what you know about someone’s personal healthcare situation. What are the ways that you can do that in a compliant manner, Nick? How do you respect that information without crossing the line? I know that the line is something very important to you. I know that we’ve talked about it a lot. What are your thoughts on it?

Nick: Eventually, we’re not going to be able to do it really at all, given those inevitable cookieless future. It’s not even a HIPAA compliance issue, it’s just a digital marketing writ large, how do we navigate in this space when we can no longer remarket? Alex and I talk a lot about this. [laughs] It’s tricky to know– Let me just speculate for you? Especially in the healthcare space, if someone visits your sites, essentially, how do you get that particular user to interact with you in a way that they can give you some level of information about themselves voluntarily?

Be it email, or signing up for a newsletter, or some sort of content, there’s actually some level of exchange. That’s what healthcare marketers essentially need to do is understand what is this right exchange that can be made with the potential healthcare customer? From there, you can actually remarket to them given that they’ve given away this information voluntarily. Then you can even perhaps produce look-alikes that look like this user as well.

There’s some ways around it. We’re not there yet, we can still rely on some more traditional or conventional remarketing in some capacity, but we won’t be able to for much longer. Look, we’re all trying to crack collectively in the marketing space. We’re definitely thinking through it here. You’re listening to me think through it out loud at you. Thanks for that.


Lauren: I love it. That’s why we’ve got you here. We just want to know where it’s going? What kind of things do we need to be thinking about? There’s no perfect solution yet, but it’s something that everyone’s thinking about. That’s what’s most important. I get this question a lot. Alex, I think we actually got this in a meeting last week, it was a very interesting question.

With everything we’ve talked about at the beginning of this call around AI and algorithms and the fact that machines can, they can decision quicker than a human can, that’s just a fact. What do agencies or humans still have to contribute to the buying of digital media? Why are we needed? What can we do that they can’t? What is your idea of the perfect marriage between AI and marketing?

Alex: I think the role of the agency and the role of the media manager has changed in that like I was saying going back earlier, we’re starting to delegate things to humans and delegate things to machines based on what those things are good at. What are the strengths and weaknesses with humans? Probably not setting keyword bids for thousands of keywords based on tons of different data points.

It’s probably not finding out the perfect combination of headlines and descriptions in the ad, but what humans are good at or in the actual assets that we use in the ad, for example. What are the headlines? What are the descriptions? What is our messaging strategy, even higher level than headlines and descriptions? How are we even trying to speak to the user? Then, on the other end of it, what are machines good at? Probably not necessarily syntax and combining words in a way that kind of reads very well.

That’s where they kind of, I think, rely more so on humans. The idea there is, again, just how do we make best use of machines and best use of humans? I look at it as a synergistic relationship there where you can’t have one work without the other. You have to be able to guide the machine in the right way. That’s how I look at agencies is, it’s almost like new-age marketing, we went from– Full circle almost.

We went from old school marketing, madmen era, to much more technical, much more data focus when Google Ads came out. Now it’s making a full circle, again, where the marketers aren’t really doing the super detailed analysis or optimizations, they’re really doing the overarching strategy and the marketing itself. Like I said, I think it’s almost kind of a new era. Marketing is even more important now.

Whereas before, you could lean on things like keyword bids and ad copy. That’s how I think it’s shifting. It’s much more of an old-school marketing world.

Lauren: Nick, I want to pose the same question to you before we close out this episode. You have visibility over other channels like social networks, Facebook, Instagram, LinkedIn, what are your thoughts on how we can best, let’s say, contribute to the algorithms of those platforms?

Nick: We absolutely have to use them, but it’s, I don’t know how to put it, it’s– A calculator is a supercomputer. No human can perform as well as a calculator, but no calculator can then do anything other than calculate. It has no general knowledge. It’s not multi-discipline. It can’t go then cook me dinner. It just has no ability to do the thing that it was pre-programmed to do. It’s very good at the thing it’s designed to do, but nothing else. The problem with algorithms is the lack of context.

Human beings have to continually set the context right for the algorithm, the machine to go do that thing that’s ultimately trying to do, and we can set it up wrong, and it can go find the wrong thing of it, wrong thing for us. Very efficiently, no context. The relationship is human beings are very great or great with general knowledge context. Well, the machines are great. They just dig deep Wells, but they’ve got no ability to jump from well to?

We have to use our strategic minds to deploy these machines, to ultimately do the thing that we’re trying to do, which is, in many cases, drive more appointments or conversions or anything like that. It is as Alex suggested a very symbiotic relationship. If you lean too much into one direction, there are trade-offs here. If it’s all human, no algorithm, you essentially get none of the pattern detection, and you can’t find the conversions.

If it’s all algorithm, no human. This is, you’re just making a mess for yourself. You have essentially a machine that has all the potential to run rampant and there’s no context and there’s no safety, there’s no control. There’s no one driving the thing. There’s no one pointing in the right direction. It’s finding this perfect middle between the two that we’re trying to essentially in stand shape for every one of our digital channels.

Lauren: It would only be fair to close out a discussion on the evolution of digital by talking about maybe what’s to come. Nick, you eluded a little bit to this, what some challenges may be when it comes to cookieless world. I would love a closing for, from each of you, Nick, I’ll start with you on anything that you see coming down the pipeline. Good, bad, ugly that you think marketers in the healthcare world need to be aware of?

Nick: Two ends of a spectrum. Let’s call all this on one side of a spectrum. You have essentially really almost perfect consolidation for all of your channels. You in Google’s, in many ways, standing this up right now with a product called performance max, which essentially collapses the difference between paid search oh all the channels that your disposal within Google, essentially you just give it a budget, a problem statement.

It goes, in many ways, creates customer journeys through all of their channels to produce whatever you’re trying to produce. Usually, again, appointments and conversions. There’s this model where it’s essentially really an impressively automated, and marketers are going to have to grapple with that. It’s like we’re going to have to figure out how we most effectively play within this space. There’s for the reasons I’ve just specified, or this thing has all the potential to not have the necessary context.

There’s plenty of human intervention that has to live within this even very consolidated product. On the other end of that, you have hyper fragmentation of the channels, and this is usually born of antitrust. Let’s see what happens here in the next five years. If Google and Facebook are split apart by the channel level and essentially don’t, and those channels no longer have the ability to communicate with each other, like they currently do, the system’s fractured again.

What we have is a bunch of siloed products that as marketers then have to figure out how to tie. We have to therefore fall back in what is to more of an old school funnel approach where we just like, this is your upper funnel channels. These are your middle funnel. This is lower. We start, we nurture people down in much in, let’s say, an older fashion way. Those are probably the two ends, maybe dramatic ends of a spectrum. What the future holds.

Usually, the future holds something in the middle. I would expect something between those two extreme statements to be the true– to be the actual case in the next three to five. Alex did anything I said makes sense.

Alex: No, I would agree with some of them, I think to answer the question for maybe a little bit of a different perspective, I think with all the changes that we’ve seen with match types in the past year with close variance and how broad and phrase and exact, how they all match to the search term. I think right now we’re watching like the deterioration, the deterioration of the keyword, like in front of our eyes. If you can’t already say it now, the keyword is almost not a thing anymore because when you say I want to target exactly Dennis near me, that doesn’t necessarily mean you’re going to be on that search term.

Is the keyword even really an effective tool anymore? I think it is, but what I’m thinking is that in the next five years as keywords are not going to be the way you target. They’re going to take keywords away, and it’s going to be more around like loose signals that you can give the system, which is what we’re seeing right now, performance max, where there are no keywords. It’s saying these audiences are likely to have a higher conversion rate.

That’s where first-party data and all this other stuff comes into play. I think it’s going to be a keyless world, any minute now, and it’s going to be even more important to get the creative right. To get your first-party data right. To get really that relationship between you as a manager and Google as a machine and getting that in a right place to continue to drive the same performance that you’re typically driving with the keyword. That’s my hot take for our case.

Lauren: Sounds like a scary world. We’re imagining here. Scary in the sense that it’s just, it’s going to be different than what we’re used to, and we’re going to have to think about how to best live within it. Appreciate you both joining us today. This is your episode of Ignite digital marketing, and we’ll see you next time.

Alex: Thank you so much, Lauren.

Announcer: Thanks for listening to this episode of Ignite. Interested in keeping up with the latest trends in healthcare marketing? Subscribe to our podcast, leave a rating and a review. For more healthcare marketing tips, visit our blog at

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Alex Membrillo Cardinal CEO

Alex Membrillo

Founder and CEO

Some say Alex Membrillo was born to be CEO of Cardinal Digital Marketing. Others say the Flock chose him. Together with his team of high-flyers, Alex has led Cardinal to exponential growth thanks to an innovative approach to digital marketing. Team awards proudly include A Best Place to Work designation and the Inc. 5000 list of fastest-growing privately-held US companies.

A Digital Marketer of the Year by the Technology Association of Georgia (TAG), Alex also contributes to the Forbes Agency Council, with placements in national publications including Entrepreneur, Search Engine Journal, Physicians Practice, and The Wall Street Journal. He’s served as an expert speaker for the American Marketing Association, HCIC, SMASH Senior Care Marketing & Sales Summit, and SHSMD (among others).