Turn Marketing From Line-Item to Growth Engine
Executive Brief (90 Seconds)
The insight: Marketing isn’t a discretionary line item — it’s the growth system that protects margin.
The signals that matter:
One in five patients switched providers last year, mostly because access was too hard.
Three-quarters of consumers check reviews first — and trust them.
Demand for 24/7 self-scheduling far outpaces what most health systems deliver.
The ROI outcome: Executives who govern marketing with CPA, payback, and contribution can show the board a margin-protecting ROI plan in 90 days.
Why This Matters Now
Healthcare leaders are operating in a margin crisis. The cost of capital is high, labor shortages persist, and competition is intensifying. In this environment, marketing is often the first line item flagged for cuts.
Yet consumer behavior tells a different story: one in five patients has switched providers in the past year, primarily because access was difficult. Reviews shape first impressions for three-quarters of consumers, and most trust what they read. Self-scheduling remains low despite overwhelming patient demand for 24/7 booking.
These signals point to one conclusion: marketing cannot remain a discretionary expense or a siloed department. It must become the operating system for growth. Executives who make this pivot see marketing not as spend, but as a lever to protect and expand margin.
The CEO Thesis: Marketing Is an Operating System
The decisive factor is not the CMO’s playbook but the CEO’s posture. When growth is framed around unit economics—cost per acquisition, payback periods, contribution to margin—marketing stops being subjective and starts being accountable.
Three truths define this shift:
Ease of access is key. Patients defect when scheduling, routing, or responsiveness is clunky. Fixing access is cheaper and more effective than buying more ads.
Trust is earned in public. Reputation velocity—the volume and recency of reviews—sets conversion rates. Reviews are no longer PR; they are infrastructure.
Scrutiny is permanent. Budgets will always be under pressure. The only way to defend spend is to tie it to metrics Finance already respects.
Executive Takeaway: If ease, trust, and unit economics aren’t on your dashboard, you’re flying blind into the next board meeting.
What Only the CEO Can Own
Delegating all of marketing to the CMO misses the point. The CEO must:
Own the economic model. Publish a single scoreboard that tracks CPA, payback, and contribution at the service line or segment level. These aren’t marketing metrics; they are enterprise metrics.
Insist on access before advertising. Driving demand into bottlenecks wastes dollars. Self-scheduling share and time-to-appointment should be nonnegotiable targets.
Tie brand to performance. Messaging must reduce cost per acquisition and shorten time to schedule. If it doesn’t move the economics, it’s decoration.
Why the Numbers Matter
Every inefficiency compounds. Each extra click or day between intent and appointment inflates acquisition costs. Each uncollected review is a missed opportunity to influence conversion. Each gap between patient demand for 24/7 booking and actual self-scheduling is preventable leakage.
Boards are not swayed by anecdotes. They want proof. Marketing must be treated like a capital portfolio—funding what clears the hurdle, stopping what doesn’t. Until leaders can present payback math on one page, scrutiny will continue.
Three Strategic Shifts
From Spend → Portfolio
Scattershot campaigns dilute impact. Instead, CEOs should back a small portfolio of big bets tied to enterprise priorities—say, cardiac access readiness or Medicare Advantage retention in high-risk ZIPs. Each bet must have finance gates: scale if CPA and payback beat thresholds; stop if not. And each must be paired with operational fixes—referral capture, call-center SLAs, scheduling improvements—so dollars buy outcomes, not just clicks.
From Campaigns → Operating System
Campaigns are episodic; engines are continuous. The operating system links narrative, demand capture, access, and attribution into a closed loop. Governance is weekly, not quarterly: a 30-minute executive review with CEO, CFO, COO, CMO, and access leaders. One scoreboard, decisive reallocations, blockers cleared in real time. The result: compounding gains as dollars shift toward winners every cycle.
From Modern Stack → Utilized Stack
Health systems often use only a fraction of their martech stack, fueling the “cost center” narrative. CEOs must demand a slim, high-utilization core:
Attribution and analytics at CFO-grade quality.
Listings and reviews that track reputation velocity.
CRM and nurture flows to reduce leakage.
Scheduling systems that convert demand into revenue.The insight: Marketing isn’t a discretionary line item — it’s the growth system that protects margin.
Executive Takeaway: Fewer bets, tighter loops, smaller stack.
That’s how you protect margin without cutting muscle.
The Governance Difference
Governance is where CEOs have the most leverage. A single scoreboard reviewed weekly by the top team changes the conversation. Marketing becomes a system priority, not a silo. Problems are escalated and solved quickly—whether it’s call-center responsiveness or scheduling constraints.
Finance sees that spend is being redeployed to proven motions. The board sees ROI tied to unit economics. Marketing stops being an easy cut and becomes a margin protector.
Reframing the Board Narrative
Boards don’t need to hear that campaigns ran. They need to see that economics improved. The narrative must be:
Customer retention improved because access was easier.
Conversion improved because review velocity accelerated.
Spend was redeployed—15–20% shifted into higher-yield channels.
A 90-day ROI plan was delivered with CFO-ready metrics.
Executive Takeaway: Boards don’t cut engines. They cut expenses.
The CEO’s 90-Day Playbook
The opportunity window is 90 days. In that time, CEOs can deliver proof the board can see:
Publish the economic model and the scoreboard.
Launch weekly 30-minute executive reviews.
Fund two or three strategic theses with finance gates.
Fix access bottlenecks before spending on advertising.
Cut martech bloat and enforce high utilization of core systems.
By day 90, marketing’s role in protecting margin will be undeniable.
A Private Signals Session
SPIRTO offers a 60-minute, closed-door CEO briefing designed to accelerate this growth shift: the SPIRTO Signal Session.
Within 72 hours of scheduling, leaders receive a Margin Protection Scoreboard, a one-page executive dashboard that reframes marketing as a margin driver instead of a cost center.
Why CEOs take this meeting: it reframes the discussion. Instead of debating cuts, the board sees a growth cycle at work—one engineered to protect margin.
Schedule a Private SPIRTO Signal Session, here.
About Paula Serios & SPIRTO
Paula Serios, Founder + CEO of SPIRTO, is a 35+ year healthcare operator who has led marketing for $175M–$30B organizations and partnered with more than 100 healthcare brands to drive up to 3× revenue lifts through M&A, value-based care, and digital transformation.
At SPIRTO, she leads fractional CMO/CGO teams and the AI-enabled Growth Lab, an executive-led system that connects brand, demand, and access into one accountable growth engine—delivering board-ready ROI plans in 90 days for mid-market health systems and plans.