The Margin Mirage
APRIL 2026
The Margin Mirage
The Signal
Growth is up. Margin is down.
We’re hearing this more and more in conversations with leadership teams.
Volumes are coming back.
Campaigns look good.
Demand is there.
And yet…financial performance isn’t following the same trajectory.
Not dramatically worse. Just…not improving the way it should.
That’s usually the moment when the room gets quiet—because no one quite connects the two.
The Shift
From “Are we growing?” to “Is this growth actually worth it?”
For a long time, growth has been defined in ways that made sense:
More patients
More visits
Stronger engagement
But those measures don’t tell you whether the business is actually getting stronger.
What I’m seeing instead is this:
Strong demand flowing into lower-value services
Schedules filling, but not efficiently
Access points working hard, but not necessarily working smart
So yes, growth is happening.
But not all growth carries the same weight.
The Move
Start filtering growth through economic value—not just activity.
A few changes make a real difference here:
Be more selective about the demand you push: Not everything needs to be maximized. Some things need to be prioritized.
Look at access differently: If the right patients can’t get in—or don’t convert—you’re losing value before care even begins.
Connect the dots across teams: Marketing, access, operations…they’re still often running alongside each other instead of together. That’s where a lot of value gets lost.
This isn’t about doing more.
It’s about being more intentional with what you’re already doing.
SPIRTO Insight: The disconnect is pretty straightforward when you step back:
Marketing is measured on activity.
The business is measured in economics.
Those two don’t naturally align unless you force them to.
And when they don’t, performance looks better than it actually is.
That’s what I think of as the margin mirage.
Closing Thought
If growth is up but margin isn’t, I wouldn’t start by asking:
“How do we generate more demand?”
We’d start here:
“What kind of growth are we actually creating—and is it the kind we want more of?”
By Paula Serios
Chief Executive Officer, SPIRTO Healthcare Growth Consultancy
If this is something you’re seeing, you’re not alone.
We’ve been helping teams step back and quickly spot where growth and value are out of sync—and what to do about it.
Happy to compare notes in a quick 15-minute SPIRTO Introductory Session.