How to Grow Multi-Location Care on a Flat Budget with Allison Horn

Most healthcare marketers have built their entire strategy around Google Ads. It's measurable, it's trackable, and when someone searches "dentist near me," you can show up and capture that intent.

But here's the problem: Google Ads doesn't create demand. It captures existing demand.

And when 85-90% of your budget goes to intent capture, you're competing in the same shrinking pool of high-intent searches as everyone else—paying premium prices for clicks while missing the opportunity to actually generate demand with targeted customers in your market.

Allison Horn has spent 19 years in healthcare marketing, with the last five building marketing infrastructure from scratch for Imagen Dental Partners—a multi-location dental group with nearly 120 practices. Each practice has its own brand, its own website, its own market dynamics.

What makes her approach different isn't sophisticated ad tech or massive budgets. It's that she's figured out how to pair accurate outcome data (booked appointments, show rates, case acceptance, production) with true demand creation strategies that meet consumers before they're actively searching.

Her conversation with Freshpaint CMO and Marketing Rounds host Ray Mina reveals what happens when you stop treating Google as your demand engine and start building an actual growth strategy—one that creates preference before the moment of need.

1. If All You Feed Google Is Last-Click Signals, You're Only Fighting for Scraps

Here's what most healthcare marketers don't realize: when you optimize Google campaigns based only on bottom-of-funnel conversions, you're training the algorithm to find people who are already searching for what you offer.

You're not creating new demand. You're competing with every other practice for the same pool of people who already know they need a dentist.

And that pool is getting more expensive and more crowded every quarter.

"If all you do is feed Google last click signals, you're only competing in the same shrinking pool of high intent searches and paying a premium for them," Allison said. "Pairing accurate outcome data like booked appointments, completed treatment, membership with top of funnel demand creation is where the real efficiency shows up."

This isn't anti-Google. Google works. It's effective for capturing intent when someone is actively searching.

But intent capture without demand generation means you're always reacting, never leading. You're waiting for consumers to decide they need you, then fighting to be the practice they choose.

The alternative is generating demand before that search moment. Building awareness and preference in your market so that when someone eventually needs dental care, your practice is the obvious choice—not just another option in the search results.

What this means for you

Audit your current budget allocation. If 85%+ is going to Google Ads and other intent-capture channels (paid search, LSA), you're over-indexed on competing for existing demand.

And if that’s the case, reserve budget for true demand creation tactics that reach people before they're actively searching:

• Community engagement: Local sponsorships, events, grassroots presence
• Direct mail: Targeted geographic campaigns (yes, it still works—more on this below)
• Strategic partnerships: Visibility in places your target patients already are
• Content and education: Building authority before the moment of need

How much budget to invest? Start with whatever you can realistically afford. Measure not just immediate conversions but long-term brand lift, share of local market, and whether your branded search volume increases over time.

2. Form Fills Don't Matter—Show Rates, Case Acceptance, and Production Do

Most healthcare marketers celebrate the wrong metrics.

They get excited about cost per click, click-through rates, form fills. They report these numbers to leadership as proof marketing is working.

But none of those metrics tell them whether they're actually growing the business.

Allison spent her first year at Imagen Dental manually listening to phone calls and dispositioning leads to understand what actually happened after someone engaged with a campaign. It was painful. But it revealed the massive gap between digital engagement and real business outcomes.

"Five years ago, I was listening to phone calls and leads and dispositioning them. If I never had to listen to another phone call just to see what happened, it would've been too soon," she said. "Now we have technology that does AI listening to our phone calls and tells us whether that patient was a new patient, an existing patient, did they book, did they not book."

But even booked appointments aren't the end goal.

Allison's team tracks the full funnel:

• Show rate: Did the patient actually arrive for the appointment?
• Case acceptance: When diagnosed with needed treatment, did they accept it?
• Production value: What revenue did this patient generate?
• Frequency: How many times did they return in the first 12 months?

One practice increased show rates from 51% to over 80% in one year—a 30% improvement—by focusing on post-booking communication and engagement.

Another practice saw average patient value from Google campaigns $400 higher than referred patients, with 1.5x more visits in the first year.

Those metrics matter. Form fills don't.

What this means for you

Stop optimizing for proxy metrics that don't indicate business growth. Map your current tracking capabilities:

• Level 1 (Basic): Can you track from campaign to booked appointment?
• Level 2 (Intermediate): Can you see show rates and cancellation rates by traffic source?
• Level 3 (Advanced): Can you connect to production data—actual revenue generated by patients from each channel?
• Level 4 (Sophisticated): Can you calculate patient lifetime value by acquisition channel over 12+ months?

Most organizations are stuck at Level 1. Getting to Level 3 requires integrating your digital analytics with your practice management system—which means partnering with IT and operations.

If you’re looking for a place to begin, start with show rate tracking. If you're spending $50,000/month on Google but have a 50% no-show rate, you're wasting $25,000. Fix the show rate problem before spending more on acquisition.

3. Strategic Targeting Beats Spray and Pray Every Time

When you're managing marketing for 120 individual practices across different markets, you learn fast that one-size-fits-all doesn't work. Rural Minnesota requires different tactics than urban San Diego. A market with a high Medicaid population behaves differently than affluent suburbs.

Allison's team uses data to make informed decisions about where to invest—not just throw campaigns at the wall and hope something sticks.

"We look at residents that live in the area and be very targeted. What's the likelihood that this community is gonna go to a dentist in the next 12 months and what their index score is," she explained. "If it's lower than 100, chances are we're probably gonna really struggle. But if the index is 120, that means 20% of residents are more likely to visit a dentist in the next 12 months."

This level of targeting informs every decision:

• Which practices get acquisition campaigns vs. retention-focused strategies
• Whether to invest in direct mail, digital, or community events
• How to allocate limited budget across markets with different propensities

One of her favorite examples was a rural Minnesota practice where she deployed direct mail—disruptive marketing that targeted towns three over where residents had limited dental access.

The result? 38% year-over-year production growth and 106% new patient growth. In one year.

The campaign worked so well they had to pause it—not because it stopped working, but because the practice was booked out 3-4 months and couldn't handle more demand.

What this means for you

Stop assuming all markets and all patients are created equal. Build a targeting framework based on:

Geographic propensity

• What's the propensity score for dental visits in this zip code?
• Are there underserved areas where competitors have limited presence?
• Should you focus on retention vs. acquisition based on market saturation?

Patient value analysis

• What's the average lifetime value of patients from different zip codes?
• Which demographics have higher case acceptance rates?
• Are certain services more prevalent in specific geographic areas?

Channel-market fit

• Rural markets may respond better to direct mail and community presence
• Urban markets may be more digitally native
• Affluent areas may be more receptive to cosmetic and elective services

Pro tip: Don't launch the same campaign everywhere. Use your existing patient data to identify patterns, then build market-specific strategies based on what's actually working in similar contexts.

4. Multi-Location Requires Local Trust, Not Just National Campaigns

Here's what doesn't work in multi-location healthcare: Pushing national campaigns from headquarters and expecting local markets to convert.

That’s because people don't choose a dentist because of your sophisticated marketing automation. They choose based on trust, convenience, and community reputation.

Allison's team provides infrastructure—campaign frameworks, graphics, tracking, strategic guidance. But execution happens at the practice level, driven by team members who live in that community.

"They don't wanna hear from Allison in Scottsdale. They wanna hear from the team members who live in Greenwood, who go to church with them, who play on the kid sport team," she said.

When a practice in South Carolina runs quarterly events—smile consults, clear aligner days, even Botox events—Allison's team supports their team with better tools, graphics, and tracking. But the practice owns the execution.

Those events drive significant revenue in a few hours that would normally take days to generate. And when something works, Allison documents it, creates training modules, and replicates it across other markets.

But replication doesn't mean copy-paste. It means adapting the framework to local context.

The Ohio practice that sponsors local high school basketball for $150? That's not a corporate brand play. That's hyperlocal community integration that builds trust one relationship at a time.

What this means for you

If you're managing multiple locations, stop thinking about national campaigns. Start thinking about:

Scalable frameworks with local execution

• Provide campaign templates, tracking infrastructure, and strategic guidance
• Let local teams adapt messaging and execution to their market
• Document what works and create playbooks for replication

Community integration over advertising

• Local sponsorships (school teams, community events, nonprofit partnerships)
• Practice-level social media showing real team members and real patients
• Grassroots presence at farmers markets, festivals, local gatherings

Boots-on-ground tactics that build trust

• Direct mail campaigns targeting underserved areas (yes, it still works)
• Community events run by the practice (consults, education, promotions)
• Partnerships with local businesses and organizations

The strategic principle at play here is straightforward. National campaigns create awareness. Local presence creates trust. And in healthcare, trust converts better than awareness.

In short, build infrastructure that empowers local teams to be visible and relevant in their communities—not just another healthcare brand running ads.

The Shift Healthcare Marketing Must Make Today

Google Ads will always have a place in healthcare marketing. Intent capture matters. When someone searches for a dentist, you need to show up.

But if that's your entire strategy, you're fighting for scraps in an increasingly expensive, increasingly competitive market.

The organizations that win won't just capture intent better. They'll create demand before the search moment. They'll track outcomes that actually indicate business growth. They'll use data to target strategically rather than spray and pray. And they'll build local trust through community integration, not just national ad campaigns.

That's the transformation Allison Horn described. And it's what separates healthcare marketers who justify their budgets from those who prove they're growth engines.

Most healthcare marketing organizations aren't there yet. They're still optimizing for clicks and celebrating form fills. They're still putting 80% of their paid media budget into Google and hoping it scales.

The ones that make this shift—that build true demand creation infrastructure alongside intent capture—will have an enormous advantage in markets where consumers have more choice than ever and competition keeps intensifying.

Experience the full conversation where Allison discusses the importance of relationships and trust in getting buy-in, why she manually listened to thousands of phone calls in year one, how direct mail drove 106% patient growth in rural Minnesota, and what marketing will look like when AI eliminates most phone calls entirely.