Building Strategic Investment Foundations

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, Cardinals experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Ashley: Hi there. Welcome to the Ignite Healthcare Marketing Podcast. My name is Ashley Petrochenko, and I’m the VP of Brand Marketing here at Cardinal. I have a special episode for you today. Instead of welcoming a new guest, we’re going to feature one of the best episodes from Scaling Up this year. It’s a panel discussion between Cardinal’s media experts, where they discuss how to build strategic investment validation to scale growth. They’re going to walk through their planning process, how to align investment and budgeting operational capacity and business goals, and how they use forecasting models to predict outcomes. And lastly, this session will touch on how they measure marketing impact and how they approach attribution in a privacy-first world. So, enjoy the conversation, and I hope that it helps you plan for 2026. Thanks.   

Rich Briddock: Big topic. We’ve got some great panelists here today. We’re going to be talking about building strategic investment foundations. Something that we spend a lot of time noodling on at Cardinal. We’ve got some great minds here with us today on both the media and the analytics side. I’m going to let them introduce themselves here in a second. My name is Rich Briddock. I’m chief strategy officer at Cardinal. I will be performing the role as host today and asking these guys some great questions. Hopefully, we’ll have a great discussion. Alex, do you want to intro yourself?

Alex Kemp: How’s it going? My name’s Alex Kemp. I’m the senior director of analytics here at Cardinal. Ready to get started. Happy to be here.

Rich: Evan?

Evan Ilgenfritz: Yes, I am Evan Ilgenfritz. Glad to be here. I’m the VP of Paid Media here at Cardinal. Really look at all paid media strategy. Also, very excited to be here.

Brandon Wilhelm: I’m Brandon Wilhelm, group media director. Always like talking with these guys about some of these topics.

Rich: Excellent. Well, this is a big topic, so let’s jump straight in. I guess this is one of the most foundational pieces in terms of driving performance up and to the right is knowing where and how to invest the budget. If you’re spending in the wrong places, the results are not going to be great. One of the prerequisites seems to really be to understand what’s working as part of the marketing mix. Kemp, as the analytics guru on the panel, what do you see typically prevents healthcare marketers from understanding what’s working? What are some of the challenges that we come across on the measurement side that really have to be fixed in order for us to put a strong investment strategy in place?

Alex: I think with healthcare marketing, it’s a story of all these different and disparate systems that are often very difficult to get them to be talking to one another. I think that’s one of the biggest challenges that healthcare marketers face is when you have a CRM that’s not informing your ad platform bidding algorithm, your entire tech stack needs to be talking to one another so you can basically understand what’s actually working, and being able to affect change on the ground level, i.e., the actual ad platform. I think that’s one of the bigger gaps that we see is having your tech stack not really be working together for you.

Rich: You might be tracking relatively shallow conversions in platform. The thing that’s actually supposed to be driving the leads is forms and calls, but what really moves the business is new patient bookings or kept appointments, and there’s a big disconnect between the two often.

Alex: Right. Exactly.

Rich: From a paid media perspective, Evan, how do you help a client understand the difference between, again, what’s coming from our efforts versus what might be coming from other digital channels, what’s coming from traditional? How do you help the clients that we work with isolate the impact of paid media?

Evan: It’s a great question. It ties directly into the previous one, which is, it’s informational organization. As Alex was just talking about, making sure that you have the setup usually in a CRM to at least understand from the business side of things, what your leads in patient acquisition, where they’re coming from, even from a high-level bucketing system of saying, this is from paid media, this is from organic traffic, this is from referral sources, et cetera. That organization is essential.

With that organization, you will, of course, when you talk about direct lead driving with paid search or bottom-of-the-funnel work and paid social, you’re going to want to see those attributed in your CRM. This lead, someone clicked it, they turned into a lead, that’s where it was driven from. It gets a little bit more complicated when you’re looking at brand awareness or inorganic search and word of mouth. I think from that stance, you’re really going to be looking at, if you’re running brand awareness paid media, trying to determine, looking at what do we believe that’s contributing itself.

To determine that, you often might need to do some holdout tests if you’re running brand awareness video or display assets. You’ve been running it for, say, a year, and you want to see what it’s driving or what it’s supporting versus what is organic, you might have to pause it in some markets and see if there’s a decline. Again, organizational bucketing in your CRM, making sure those are connected to your platform metrics on the other end, and then starting to isolate those buckets. We’ve got organic is here, paid search and conversion driving efforts are here, how do we connect them in the middle? That’s usually how you’re going about it.

Rich: We know for some of our clients, especially the referral-driven ones, the patient journey can be pretty complex. There’s also field teams who are working with providers. Was it really driven by DTC? Was it driven by an HCP referral? How do you detangle that? I agree. I think some of the holdout test stuff and some of the correlation stuff that I know your team works on, Alex, is really critical in this environment.

Brandon, not to leave you out, once we’ve got our measurement stuff in place, once we have joined the dots up on Alex’s side, and once we’ve done the categorization and got the channel attribution correct that Evan was talking about, how does that inform the foundational elements of the investment strategy? We’re now in this place where we know what paid is driving. What do we do next?

Brandon: It really sets the foundation for where you can start to double down on your investment as a whole. You’re able to see more of that full landscape and determine where the dollars that you’re investing are going to be effective because now you’ve got those pieces in place to give you some idea. You’re not looking at a generalized assumption. You’re actually getting down to where it’s going to drive impact, whether that’s from direct attribution or from that broader testing where we’re doing holdouts or whatever. We’re seeing what we actually get back from the spend that we’re doing.

It’s important to be doing that in a way that allows us to look at what does that incremental investment actually get me as I invest into a new channel, not only in totality, but across different sources, like we just mentioned? Really determining where you’re going to drive the biggest impact is the end goal as you’re putting all these pieces in place.

Rich: I think his market is right. We love to lean on the data to have some level of confidence in the decisions that we’re making. We can’t emphasize this element of the investment piece enough. You have to be able to join the dots up. Oftentimes, attribution will never be perfect, but it’s really critical that you have strong data that supports the investment decisions that you’re making.

Let’s move on and talk about another big topic that comes up frequently with this group, which is often capacity and control versus performance. We have clients that really lean into needing to meet certain capacity goals at a very granular location level. We have other clients that want us to spend where the fish is biting. Let’s jump into this topic. Alex, I’m going to ask you first. Capacity is something that lives on the client side often, and it’s not necessarily information or data that’s often readily available to us. How do you go about factoring capacity in as an element that drives your investment strategy?

Alex: Like you said, I think it’s inherently a little bit challenging because it’s not data that you own or that’s in a marketing platform or anything like that. There is that level of needing to connect the dots, as you say, and get your hands on that data from the client, whether that’s just in a spreadsheet or a file that they send to you. Really, what we’re looking for here is just start simple. You don’t need this fancy platform or solution that will do this for you. Once you have your hands on that data, you basically have what you need to marry that data with your marketing data, which is going to give you a sense of how efficient and effective a given campaign or channel or location is.

Once you actually have that data together, that’s where you can actually make some decisions. Essentially, like I said, starting simple. You really just want to look at the relationship between performance and capacity. Where do I have high-performing clinics or locations, and I have headroom for capacity? Or, maybe the reverse, where I have very inefficient clinics and also no headroom, or the opposite. There’s a matrix there that you can be looking at.

Rich: Some combination thereof of performance capacity, yes.

Alex: Exactly. That’s how we will eventually look at is once we get our hands on that data, where does a given location fall in that matrix? Then, looking at how we been potentially miss budgeting this location. Because maybe on paper, it’s very efficient from a performance standpoint, but there was no appointments available.

Rich: Driving thousands of leads that no one can ever possibly see.

Alex: Those leads could have gone somewhere else.

Rich: Right. They could have been redistributed across other locations inside of the system. In terms of this capacity data, is that something that we need daily, weekly, monthly? What suffices there from a need perspective?

Alex: We were just talking about this. I think it definitely depends, I think, on each individual business and how the operations works. Is capacity changing at a weekly rate? If so, then we would want that data on a weekly basis. It’s most likely not changing on a daily basis. Again, it depends on everyone’s situation. I think weekly is a good place to start. Again, if capacity and operational metrics like that change really only on a month-to-month basis, then you don’t really need to be doing it more than that. Again, trying to start simple of like, we don’t need to be doing it every day or anything like that. Let’s just get it out there and iterate.

Rich: Yes, start leveraging it. Once we have a sense of capacity needs, Evan, how do we balance that, especially for multi-local clients, that location-level control with the need to drive performance and have enough conversion volume for algorithms to effectively optimize and drive lead volume?

Evan: That’s a good question. What we just talked about was the plan, and now we’re talking about how do we deliver the performance required to hit those goals? I would say this is another topic we could talk about forever, but the systems that we have in place now, Google, Meta, all these other things, are driven by data volume. Condensing data into a campaign where you have a sufficient amount of reliable conversion behavior on a regular basis is what the system really craves to be able to leverage that signal and deliver you the results you’re asking for.

What we often run into is that, let’s say there’s a business that has 100-plus locations, a dental group, physical therapy, whatever it is, they have a lot of locations. When you’re distributed that widely, it’s often tempting to say, “Well, let’s give every location a certain amount of budget.” In a lot of cases, that budget and the conversions each campaign, if they’re individualized, is driving, is insufficient for the algorithm and the systems now we all use to really pick up that momentum and run with it. You’re spreading a limited amount of budget and data really thin across a bunch of different touch points.

One of the things that you may want to do to balance that ability to harness the system to drive performance with your capacity needs is make some smart decisions on how you can combine forces. We often say, again, taking the example of if you have 100 clinic locations and relatively low conversion volume in each campaign and low budgets, you can do some analyses about, hey, these campaigns have similar capacity needs, similar platform performance. Let’s combine them together in the system so that now collectively they have a higher budget and collectively they have higher conversion history. The algorithm loves that.

Now it’s got something to play with. You’re not really setting them up with dissimilar other clinics, which can cause problems where one clinic runs away with the budget or runs away with the performance. If you can group them together with similar themes and levels of need, you can best of both worlds. You’re hitting the capacity needs for that group, and you’re harnessing the collective performance to improve how the algorithm is outputting things.

Rich: Now with portfolio bidding and shared budgets, you don’t even have to consolidate all of your campaigns into a single campaign. You’ve got some fluidity inside of the platform to pull locations out if needed.

Evan: In fact, yes, that’s a great plug for shared budgets and portfolio bid strategy, because often you don’t want to or can’t. Some of these clinics, they have different geographies. You can’t merge them into one campaign. You need to keep them isolated, but these shared budgets and portfolio bid strategies make that so it’s not a factor.

Rich: Yes, love it. Brandon, we talked about location. What about service lines? How does different service line needs impact the capacity element of the investment strategy?

Brandon: I think with service lines, you have to treat them as a bit of a portfolio within the portfolio because each of them is going to have their own efficiencies in how difficult or easy it is to acquire, say, a new patient, for example. They’re also going to have different lifetime values in many cases. We have to think about that in the mix of how we allocate funds and efforts toward any of those service lines.

When thinking about capacity specifically, that’s a pretty important one. You may have a high-value service line that’s included in the mix, but at a certain point, it’s not going to make sense to invest further in that. Your next positive outcome is actually going to come from maybe a lower-value service line that’s at 60% capacity, for example. When we’re thinking about that, obviously, that value and the efficiency to acquire patients for different service lines is going to be a factor, but it’s not the only one. We have to be thinking about marrying those things together in a way that allows us to just tactfully move forward in a way that’s going to be beneficial for the entire business.

Rich: I think it’s also just important to understand that not all capacity is equal. To your point, high acuity versus low acuity, and then factoring in things like how much demand is there for each of these service lines, and what’s my incremental cost going to be at a certain level, or my marginal cost going to be at a certain level. It’s all going to vary, and it just makes the formula a little bit more complex.

Good segue into how we think about forecasting and marginal economics, which is a concept that we’ve really started to embrace, I’d say, over the last 18 months. Brandon, I’m going to throw it back to you. If someone’s not familiar with marginal economics, give us a brief overview of that concept and how it might plug into how we think about investment strategy.

Brandon: I think when thinking about marginal economics, it’s important to start with what that is versus, say, your blended CPA, for example. A blended CPA is going to look at your average cost to acquire a result or, say, a patient. Marginal economics moves to what is it going to cost for the next one. That’s really important when we think about overall investment strategies and how we proceed with those things. When you’re doing something that is putting more dollars into your total investment, if your cost per acquisition is going up slightly, it may actually be significantly more than it looks like. We have to be able to understand exactly how much that next result is going to cost.

Often, that happens by maybe starting with your baseline investment, determining what’s that next incremental investment going to be because you already have your baseline cost to acquire a patient. Then understanding how much that’s going up and only looking at that top end of the incremental investment and the results that you’re getting from that. When you’re looking at it that way, it really helps to see that, okay, maybe your cost to acquire the next patient is actually double what your average is, or more in some cases, just from a slight movement. It’s a pretty important thing to understand, rather than thinking that it’s a static thing or that it’s only going up a couple of dollars, for example.

Rich: I think the common thing that we see is paid search looks great from a blended CPA point of view, like, “Oh, let’s just throw another 10,000 in paid search. My CPA might go from 50,000 to 54,000. Paid social is 200,000. It makes more sense to just keep pushing in search.” To your point, the incremental or the marginal CPA might be $1,000, when you could have been getting five times that many leads on social or five times that many new patients on social. Really understanding where you are in the curve and how much diminishing returns there’s been on those channels is super important.

Brandon: Yes. I think that’s so often overlooked when assessing different channels like that, honestly. It’s so easy to assume that just because it’s double the cost of what you’re used to in search that you’re just not getting the same return. That additional layer of the marginal economics, I think, really helps to tell that story.

Evan: I would just add the advantage. We just talked about it, about the different service lines. That can come into play as well. Let’s say you’ve got four service lines and one is an obvious standout in terms of revenue generated. If that one is scraping the bottom of the barrel in terms of available demand, then its increase in CPA would offset its revenue priority. It may be smarter to say, “Well, I’ve got more headroom in this lower revenue-driving service line, but comparatively, that’s going to get me more net revenue than the other one because we’ve run out of room.”

Rich: Yes, because the front-end acquisition cost, the CAC, is so much lower.

Evan: That’s right.

Rich: All right, Kemp, how do you play a role here in terms of, obviously, the concepts of marginal economics, but also forecasting? How do you forecast outcomes before the dollars are actually spent? How do we ensure that these models are accurate? Crucially, for you guys to do your best work and really have a lot of confidence in any model that you put together for short-term forecasting, what inputs do we need from the client or from the media team in order to make those as accurate as possible?

Alex: The biggest thing is just going to be data, really, at the end of the day. We need historicals. How have you spent your budget in the past two years, if you have it, across channels? Then also, do you have access to revenue or actual new patients? A lot of times we run in situations where we want to get into forecasting, but the deepest thing we can forecast is maybe Salesforce leads or maybe even just platform conversions. While that is better than nothing, ideally, you want to be forecasting actual revenue or new patients.

Then from there, essentially, how it’s done. In addition to that, too, understanding more of the environmental factors that are going on. What’s happening outside of just your media mix and how you’re spending the budget? Are you running promotions? Are there economic factors going on in your specific industry that would be affecting demand? Lots of different things, price changes. That’s where you fill in the gaps of, here’s how I’ve spent my budget. Here’s what we’ve got from it. Again, important distinction there is we don’t need channel attribution for this. You’d be able to say, “Paid search drove 1,000 new patients.” We just need, how much did you spend on paid search? Then how many new patients did you get in total for your business?

Then from there, again, it’s just statistics and math to understand the relationship between as we spend more or less, how does that change our revenue or new patients? Then as we’re talking about incremental budget, where am I on that curve for a given channel? If I add $10,000 more daily or monthly, where am I on the curve again? Understanding that relationship and just knowing where you are on that curve.

Rich: When we say we need data, how much data are we talking about? 3 months of data, 12 months of data?

Alex: We’re talking about 2 years if we can get it. 22, 24 months. We can make it work within 12 months of data. It depends on what you’re trying to forecast, too. If you’re trying to forecast an entire year, then definitely we would like to have a full year’s worth of data. If we’re forecasting a quarter, we can make that work with what we have. Again, it just goes into the quality of your inputs and the quality of your outputs. You might have to just take it with a bit more of a grain of salt if you’re only using a quarter’s worth of data to forecast.

Rich: Presumably, if you’re up and down all over the place with different spend levels and everything in the business is changing and everything in the marketing function is changing, those kinds of clients, harder to forecast.

Alex: Yes, for sure. It’s much easier when everything’s established and baseline. Obviously, we live in a dynamic world. We have to be able to overwrite what the machine is telling us, and say, actually, you got a little wrong there.

Rich: How accurate are these forecasts? I know I’m asking you a tricky question. The answer is, it probably depends. If you had to give an average in terms of your typical margin of error, what are we aiming for with these forecasts?

Alex: Our aim is about 5% on either side, 5% to 10%. I think what we tend to see when we first start doing forecasts is more like 10% to 15% range, but the idea is that we are iterating and training and calibrating the model after each forecast that we do. We’re giving it the scorecard, so to speak, and say, “Here’s where you got it right, here’s where you got it wrong. Go figure out why.” Then over time, you get down to that 5% range. Again, like I said before, the more data you’re giving it, the more inputs. Usually, that’s going to be better outputs and more accurate forecasts.

Rich: Evan, is forecasting something that every medical marketing team should be doing? Is there a certain amount of sophistication that is required? Where do you see a place for forecasting, and at what size and at what scale?

Evan: Good question. I would say it actually requires a lot less sophistication than you think. Alex just talked about some more advanced components and building models with a lot of detail. We’ve touched on this at the start of this conversation that organization of data is important, even from a base level. Can you, in your CRM, isolate performance from different channels, organic, direct, paid search, social? Even from that level, that organization can often be sufficient. Then from forecasting, of course, greater data and modeling is an added benefit.

We work with a lot of companies that aren’t able to or don’t have the data readily available to look at simple things, which I would say is, if you’re looking at what you need to deliver in November, you need a few ingredients, your goal, holistically. Then look at those channels, recent trends and against year-over-year data where you can, to say, “Well, organic, we’ve seen this trend lately, and we saw this behavior last November. The rough estimate is going to be this volume we’re going to expect.” You’re just divvying it up. “We’re going to expect roughly organic to deliver here, direct to deliver here, paid social to deliver here, and search is– this is what we would require from paid based on platform metrics.”

I think it can be a lot simpler to get more than you think out of it than it may originally feel. The modeling is fantastic and is another way to dial the knobs in for further sophistication, but from a base level, I would say being able to just, I’ve got my goal, I’ve got a smart estimate on what these channels have been and likely to deliver, and this is now where we should invest to hit or exceed our goal.

Rich: Yes. A Google Sheet, a marketer, some seasonality, and a bit of historical data, and you can put something together.

Evan: You can do a lot with that, surprisingly.

Rich: Yes. Okay. We’ve got our forecasts. We’ve figured out capacity as an element. We talked about just general measurement needs. Let’s talk a little bit about allocation frameworks and how those work in the real world. Evan, I’m going to come back to you. How do you work with clients to balance the investment between mature markets, core markets, when we deal with it a lot, especially multi-local clients, markets where they’ve been in a long time, they’ve got a lot of locations, they’ve got significant amount of brand awareness, so they’ve got a lot of tailwinds that are really aiding performance?

They might be very profitable, but they’re not trying to open locations there. They’re not necessarily trying to grow there. They may be already capturing the optimal level of demand there. How do you balance between those mature markets and then growth markets that they’re trying to break into where they are less known, there’s more risk? We probably can’t expect the same level of performance. How do you guide them? You don’t want to pull away from what’s working to fund what has much higher potential risk, much more speculative, but they do need to grow in those markets. How do you accomplish that for you?

Evan: Yes, it’s a good question. Again, it’s a handful of ingredients that you need to take into account. Obviously, if you’re looking at aggregate, we see this a lot with healthcare. We work with lots of businesses that expand into new markets and are launching new clinics, new locations, or even if they’re not location-based, they’re expanding to cover more areas. Your overall goal is going to be important. What do we as a business need to deliver in, again, saying Q4 or the month of November in terms of revenue? That can inform how much, can we get more efficient through paid media in the mature markets?

There’s often an ability to do so and carve that out. How close can we get or can we meet or generally exceed our total aggregate goal through our mature, reliable markets? Then determine how much risk you can accommodate with the new markets. There will be thresholds that you’ll want to invest in if, let’s say, you’re launching to cover a new state, you’re going to want to have a sufficient baseline level of budget that will allow you to get past the algorithm and start delivering results.

Otherwise, I think you’re juggling a few things. How much can we deliver here? What may we need in the new markets in terms of performance? How much risk can I afford? How much, to your point, can we pull budget from these other reliable markets and accommodate that risk to support new ones? Ideally, you’re doing this balancing act so that regardless of if the new markets– and we would expect that. New markets should not be expected to perform as well as existing established markets and established campaigns. If I pull that much, is my aggregate output going to drop in a negative way that we can’t afford, that can inform it?

The last thing I’ll say is that doing that balancing act can help you inform, especially if you’re working with your marketing team in advance, how aggressively should we jump into new markets? Should we just do this one trial location or market first rather than four because now we’re going to have to pull too much budget that would potentially be a problem for net output?

Rich: Yes, if you’re essentially borrowing budget from those core markets to fund the new markets.

Evan: If you’re doing many markets at once, you might be dropping your net output too low.

Rich: Agreed. On the same theme about weighing risks, Brandon, obviously, we believe in a test-and-learn approach at Cardinal. What percentage of total budget should be invested in testing new channels or running testing so that we can thrive insights and grow the program?

Brandon: I think the first part to address with that is that you have to be testing unless you are in the situation where you’ve just found this opportunity and you’re scaling and there’s no change to your acquisition costs. You’re just doubling, tripling down on that effort. There’s still testing that’s going to go on even in that effort. As far as actually reserving budget, I think that’s the only excuse to not be reserving a portion. Typically, we’d be pointing to maintaining a 5% to 15% range to allocate toward testing really at all times, ideally on the upper end of that, so that we’re really driving enough data and results to determine where we go next from those tests.

I think that’s pretty important. You have to look at that allocation of that budget a little bit differently than the rest. I think regular mistake I see in that is treating it as, well, it’s just a new channel. We’re just expecting the same results. Or, it’s a new effort. We just want it to repeat the same results. Part of the point of testing is to– it should fail in some cases to learn from that. There has to be that control and that winner. If we’re not doing those things, we’re not giving it a real opportunity. It’s not a true test. I think we truly have to dedicate a percentage of that budget toward that effort knowing that that’s the goal.

Rich: Plenty of things to consider here in terms of how we’re divvying up the budget. We’ve got growth markets, we’ve got testing channels, elements of the investment strategy that could be less efficient, but it’s still crucial in order to drive overall growth for the client.

Brandon, I’m going to stick with you. How often are we reassessing the investment strategy? It sounds like probably we’re forecasting every month, but are we doing our investment strategy monthly, quarterly, daily? How frequently are we actually doing the forecast or the investment strategy, and then how frequently are we coming back and reassessing it?

Brandon: I think obviously there’s going to be some variability there, of course. It has to be based partially on how that fits the business, of course. There’s a good, I think, range of what we’d be looking to do here. We’re not looking to reallocate on a daily basis based on these things. We have to have the right amount of data, the right amount of time to determine outcomes from testing from these investments, for example. In that case, we’re often looking more in a quarterly type of a cadence where we’re really creating that space.

That doesn’t mean that you’re not doing it more frequently. Obviously, there’s going to be things that happen, especially on that monthly cycle that you want to really stay within to make the adjustments throughout. You can’t do that to the point where you’re not creating stability and enough data to tell you what the next steps should be. I think that’s one of the mistakes that happens is either going way too fast and expecting to take those steps in days or a week or two, for example. That’s not going to happen, typically. Or, making it far too long and then not being able to keep the pace of that iterative cycle.

Rich: It’s going to depend on scale, but typically, it’s somewhere in that monthly or quarterly range, depending on the client and how things shift.

Brandon: Yes, I think so. I think that quarterly reservation for that cycle is an important one. Then obviously, you want to be able to adjust in that monthly rhythm so that you’re getting the right outcomes.

Evan: Yes. I definitely add here that like all parties involved, it behooves everybody to really lock in those expectations of needs, what’s coming down the pipe. Are you launching new clinics? Because if you lay this out so everyone can plan in advance, it’s a much better system than if you start having to make quick turns, that is going to be detrimental to performance every time, basically. The further out you can plan, like we said, quarterly, adjust monthly, keep an eye on it weekly or more. If you set those goals in advance and what to expect in advance, you won’t be in the position to have to be adjusting aggressively, frequently, all the time, which can really diminish performance.

Rich: Yes, totally agree. Kemp, if someone’s watching this session and maybe they have a flat marketing budget or they have a marketing budget that just doesn’t have a ton of rigor around it and a ton of investment strategy around it, how do they get started? What’s the first step that they should take in terms of putting more of a strategic lens behind how much they invest, where they invest, and the tools that they use to make that determination?

Alex: I think the first step is really just taking stock, and how am I currently allocating my budget? What’s my strategy? What am I trying to achieve with it? I think sometimes we’re just haphazardly putting budget here and there just because that’s what it feels right, but really writing it down and saying, “Okay, here’s how I’m currently allocating budget, and here’s how I’m trying to achieve with that.”

Then the other piece I think, too, is getting your hands on the right data. I think a lot of times when we have these data silos or you’re working with very limited data, that’s where your allocations can really go run amock, so to speak. I think getting your hands on the right data points, marrying those data points, taking stock in what you’re currently doing, and then saying, “Okay, with this new level of clarity that I have with this data being married together, where am I missing the mark and where do I need to rethink about how I’m doing my allocation?”

Rich: Getting the data, understanding the needs of the organization, understanding maybe service line-level needs versus location-level needs. Really a lot of taking stock to begin with before you dive in and start doing forecasting and actually building out different budgets.

Alex: Yes.

Rich: All right. A couple of questions for everybody. I know we are running up close on time. We’ve got about six minutes left, so maybe not all of you have to answer these, but we can get a couple of questions. Anybody who wants to jump in. What is the biggest mistake that you tend to see marketers make when they are planning their investment strategies, when they’re doing budget planning? What is the number one got you that you often see?

Evan: I can start. Look, there’s several big mistakes. I don’t know that there’s exactly one, but the trick that often happens is that while the aspirations can be grand for what you’d like to support, whether it’s a ton of different locations and a bunch of different service lines, the realities of how these systems operate, again, using Google as an example, Meta, LinkedIn, more and more we’re heading in an algorithm and AI machine learning world with everything we do. It’s the right inputs to these channels, the right amount of data is what allows them to work for you.

I think one of those mistakes is hoping that you can adequately cover all of this wishlist you have of every location gets an even budget and every service line related to each clinic or location gets a certain budget. Unfortunately, what we run into is the system, it’s not going to operate for you. It’s a reality check moment, which is you may have a directive or you may feel that you need to cover all these things. Some hard decisions often have to be made.

To deliver the right performance, you might have to sacrifice the level of investment you were hoping for across all these areas to get the system up and running, at which point, you can often– if performance is delivered effectively, it’s often a good reason to gather more budget to better fund these other locations.

Rich: I know we’ve covered off on quite a few mistakes in the course of these answers. I think the other one that I’ll just add that I see is people having a budget without necessarily having a goal. I think you’ve got to start with a goal. Specifically, not just a goal, but a digital goal, and ideally, one that is measurable. That, I see is a big challenge for some of these organizations that are spending, but they don’t know what they’re spending to try and deliver against.

All right, last question. Evan, you’re now banned from answering. Sorry. One piece of advice, you guys, for marketers planning their 2026 budgets right now. This is budget season, so what advice would you give them if you could just give them one piece of advice?

Brandon: I think what I would say is, don’t just treat everything the same from a budgeting perspective. What I mean by that is you may have a percentage increase goal that you’re really working toward next year, or hopefully, you do. We’re not just already setting the budget. If you have that goal, we have to understand the contribution from all of the channels that you’re going to be investing into. If it’s a 10% increase, that doesn’t mean a flat 10% increase to all channels. We have to understand that some are going to remain flat, maybe even decline, and others are going to have to contribute at a higher level to that overall goal.

I think that’s really important to think about, not just from a media perspective, but also from your total marketing mix, and then what part each plays in that. I would just give the advice of really making sure that you look at those groups individually for the value that they provide.

Rich: Any other advice from the data side of the house?

Alex: I was going to say, if you don’t have a goal, if you weren’t given a goal, I think you should still be setting goals for yourself, no matter what. That was the biggest mistake I was going to mention before is not having a goal as you’re planning your marketing investment. Even if you weren’t given a tangible goal, I think develop your– what was last year’s numbers look like? Could we just do a 5% increase on that, or whatever it is? Having some tangible something to chase towards from a new patient perspective.

Rich: Got you. Yes, I completely agree. Using benchmarks, coming up with something to target. All right, guys. We don’t really have a ton of time left for questions. We have a couple minutes. I’m not sure if we have any questions here, but I’ll take a look. Oh, we do. We have quite a lot of questions.

We’re going to tackle just one of these, I’m afraid, because we only have one minute left. Let’s start with the first one that came in. We’ve got a question here. What’s the difference between looking at blended metrics versus marginal ROI? Why does that even matter for how I allocate budget? We’ve talked about blended metrics versus marginal ROI. Let’s just talk about that second one really quickly. Why does it matter for how you allocate the budget? Who wants to take that one?

Brandon: I think it’s adding to what we’ve talked about earlier. Honestly, it matters because it should be determining where you allocate that budget. As we said before, marginal is where that next result is going to come from in the most cost-efficient manner. I think that is the thing that should be determining your allocation across your channel mix that you’re looking at next. That’s incredibly important. We think it looks great to look at that average number. It seems so straightforward to look at it that way. I think it’s often a mistake to just settle on that number. Going that extra step, looking at that increased cost that you’re going to run into, I think is pretty huge, actually.

Rich: I think wherever you can, even potentially, listing the marginal CPA on the forecast so that everybody is aware of what that next dollar is going to drive. It helps to ground some of the assumptions and the distribution that you’ve made with the budget.

All right. Well, great discussion, everybody. Thanks so much for everybody on the panel for joining me today to talk through investment strategy and all the hard work and [unintelligible] and everything else that goes behind it to get to that right approach for budgeting. I hope you guys have enjoyed this session of Scaling Up. We look forward to seeing you again in some of our future sessions. With that, I think we’re about done here. Thank you very much, everyone.

Evan: Thanks, everyone.