The Hidden Cost of Last-Click Thinking with Blair Primis and Brian Gould

Most healthcare marketers think their job ends when they drive traffic. Generate demand, hand it off to operations, hope the experience converts. If conversion rates are low, that's someone else's problem.

This mindset is why healthcare marketing struggles to prove ROI. And it's why organizations waste millions driving demand they can't capture.

Blair Primis (Chief Marketing and Experience Officer at OrthoCarolina) and Brian Gould (VP of Marketing Experience at vybe urgent care) have built their entire strategies around a different principle: marketing isn't a lead generation function—it's a growth engine that owns both demand creation and the operational capacity to convert that demand into revenue.

Both hold dual mandates: marketing and experience. That's not an org chart quirk. It's recognition that in healthcare, your product is the experience—and marketing that product requires controlling both ends of the funnel.

Their conversation with Freshpaint CMO and “Marketing Rounds” host Ray Mina reveals what changes when marketing takes ownership of the full patient journey. Brian literally turns off ad spend at locations that can't convert. Blair moves providers between buildings to balance supply and demand. Both track campaigns to arrived appointments, not just website clicks.

This is what growth engine thinking looks like—and why it requires fundamentally different infrastructure, metrics, and cross-functional relationships than traditional healthcare marketing.

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1. Stop Letting Physicians Save Your Bad Experience

Healthcare has relied on a dangerous crutch for decades: let the physician save the bad experience.

Parking is a nightmare. Check-in takes 20 minutes. You fill out the same forms you filled out last visit. Wait time is 45 minutes past your scheduled appointment. But then the doctor walks in—competent, caring, excellent—and somehow that's supposed to make it all okay.

"We have for decades relied on the physician to save the crappy experience," Blair said. "Everything about it was so bad. And then when you finally get in the room, it's the doctor that romances and delivers. We got away with that for decades. We have to get away from that."

This isn't just about being consumer-friendly. When you rely on physicians to overcome operational friction, you're capping your growth at their individual capacity. No matter how good the doctor is, if the experience to reach them is terrible, you're losing patients before they ever arrive.

Blair and Brian have both reframed experience as the core product—not as operations' responsibility, but as marketing's responsibility to deliver on the brand promise.

• Brian built his entire patient journey around one word: "easy." Easy to visit. Easy to trust. Easy to return. "We have five steps and we've laddered every sub-part of the patient journey into five key areas where if we don't make it easy, there are other options out there," he explained.
• Blair uses different language but means the same thing: "Our brand is relevant for them. It isn't just about brand awareness or recall. It is about are we relevant?" Relevance means you've earned the right to be considered—not through advertising, but through actually solving problems in ways that matter to patients.

When experience is someone else's problem, marketing optimizes for clicks and hopes for conversion. When experience is marketing's problem, you optimize for the complete outcome—awareness through retention.

What this means for you:

Audit whether your marketing team has actual influence over patient experience. Not "we collaborate with ops"but genuine authority to change processes, reallocate resources, and make decisions about access and capacity. If you're driving demand but can't control whether that demand converts into positive experiences, you're not a growth engine. You're a lead generation vendor hoping operations can close the deal.

In an ideal world, marketing and experience should report to the same leader, with shared metrics that span the full journey. Because, if marketing is measured on leads and experience is measured on satisfaction scores, you've built structural misalignment into your growth strategy.

2. When Your Campaigns Work Too Well, Turn Them Off

What happens when your campaigns work too well? You drive a surge of appointment requests. Wait times spike to 30 days. Phone hold times double. New patients get frustrated and go elsewhere. You spent money to create demand you couldn't capture—and possibly damaged your brand in the process.

Most organizations treat this as an unavoidable trade-off and do nothing. But Brian believes it’s worth shutting down marketing over. "I've actually turned one center completely off." When a location consistently failed to convert online traffic into completed visits, he stopped spending there entirely. Not because the location was bad—because the system wasn't working, and continuing to drive traffic would waste money and frustrate patients.

Blair takes a different but equally bold approach. When providers hit 10+ day wait times, his team shifts patients to different locations or moves providers to where demand is highest. "We're not gonna turn off the spend for that location, we're just gonna physically move the patient to a new spot."

Both strategies require something most healthcare marketing organizations lack: cross-functional authority to manage the supply side of the equation.

• Brian's approach isn't punishment—it's resource allocation based on conversion efficiency. "You want the marketing dollar to be spent efficiently and you also wanna work with that center manager to say, we can pinpoint a couple of things here. How do we get better?"
• Blair's provider movement strategy requires tight coordination with operations. "We will begin to shift them around. So one location has long waits, we're gonna bring a provider from a short wait and move 'em to the building that has a longer one."

Neither option is something marketing can do alone. But it's something marketing must drive if growth is the goal. The insight both have internalized: Marketing spend without operational readiness is delayed revenue capture at best, wasted budget at worst.

What this means for you:

Stop accepting "we can't control operations" as an answer. If you're accountable for growth, you need visibility into and influence over the operational constraints that limit conversion.

Build reporting that shows:

• Campaign performance by location: cost per lead, volume generated
• Conversion performance by location: appointment booking rate, arrival rate
• Operational performance by location: wait times, capacity utilization, phone answer rates

When a location consistently underperforms on conversion, you have three options:

1. Fix the operational constraint (add capacity, improve processes)
2. Redirect marketing to higher-converting locations
3. Turn off marketing spend until constraints are resolved

What you can't do is keep spending money driving demand to places that can't convert it—and then blame operations when ROI looks bad.

3. Brand Is Your Turbocharger for Lower CAC

Tell me if you’ve heard this one before: CMO wants to invest in brand, CFO wants to see immediate ROAS, CEO wants both. 

While it may seem these three demands are at odds with one another, they’re not. And the sooner healthcare marketers understand it’s not brand versus performance, the better. Because brand is actually the force multiplier that makes performance more efficient.

But don’t take my word for it. "The brand is a turbocharger for your performance marketing," Blair said. "We had 15 segment targets that had loosely a million population in our community. Are we getting close to being relevant to that million people in those segments? That's how we can measure it."

Brian sees it the same way: "One of the ways that brand makes sense is because it lowers the overall blended cost of acquisition. We run a brand campaign because of how it offsets a lot of the other expenses that we have on the traditional SEM."

But here's what makes their approach different from typical brand marketing: they're building relevance, not just awareness. 

• Blair sponsors local softball teams, funds community running tracks, creates scholarships. Not just because OrthoCarolina is altruistic (though they are), but because when someone eventually needs orthopedic care, they want to be the obvious choice. "We need to be a member integrated into our community. Our brand is relevant for them even when they do not need our services."
• Brian focuses on showing up where underserved populations are: "Sometimes it's just showing up. Whether that's a community event in one of our neighborhoods, a Rocktoberfest, or an LGBT-Q event that says, hey, there's nobody else here except this healthcare organization."

That’s the difference between awareness and relevance. Awareness means they've heard of you. Relevance means they see you as part of their world, solving problems that matter to them, showing up in moments that aren't transactional.

What this means for you:

Stop defending brand investment with fuzzy metrics about reach and impressions. Start positioning it as CAC optimization infrastructure.

The strategic narrative to leadership:

1. Performance marketing cost is rising (prove this with your channel data)
2. Brand investment lowers blended CAC by creating preference before intent (show comparative acquisition costs for branded vs. non-branded traffic)
3. We're not choosing between brand and performance—we're using brand to make performance more efficient

Then measure what matters. Are you building relevance in specific population segments? Can you show that branded search or direct traffic converts at lower CAC than cold paid traffic?

4. Track to Arrived Appointments, Not Form Fills

Most healthcare marketing organizations can tell you cost per click. Many can tell you cost per form fill. Some can tell you cost per booked appointment. 

But almost none can tell you cost per arrived appointment—which is the only metric that actually indicates patient acquisition. Blair and Brian can and it's changing everything.

"Hands down, the best thing we have going for now a couple years is the ability to say, here's how much money we spent last quarter, here's exactly the return on investment we got, and here's precisely how we can dial this up and dial this down to scale," Blair explained.

Brian's doing something similar: "I am combining the data from two systems, our EMR and our scheduling system. Using Freshpaint and Google click IDs, I can get to a lot of exact paid conversions. We layer into it statuses like no-shows or cancellations."

This visibility fundamentally changes optimization strategy. You stop optimizing for volume and start optimizing for quality—campaigns that drive patients who actually show up, service lines that drive return visits, channels that deliver patients with higher lifetime value.

Blair described the mindset shift perfectly when talking about contact center calls: "This wasn't a patient on the phone. This is a lead. We paid money to make the phone ring. So if we don't book them, we have lost the moment." That reframing—from patient to lead—connects marketing investment directly to conversion outcomes. When you can see the cost to generate that phone call and whether it converted to an attended appointment, you can calculate real ROI.

Without that visibility, you're guessing.

What this means for you:

The infrastructure to track arrived appointments doesn't happen overnight. But you can start building toward it now.

Minimum viable version:

1. Connect digital analytics to scheduling system (track booked appointments, not just form fills)
2. Layer in no-show and cancellation data (understand which traffic sources drive committed patients)
3. Build toward EMR integration (confirm appointments actually happened)

Each layer unlocks new optimization opportunities. With booked appointments, you can optimize for conversion rate. With cancellation data, you can optimize for patient intent quality. With EMR confirmation, you can optimize for actual revenue generation.

Then comes the reporting shift. Stop reporting marketing performance in isolation (impressions, clicks, CPL). Start reporting it in the context of the complete funnel (campaign spend → leads generated → appointments booked → appointments arrived → patient revenue). When leadership sees the full picture—including where conversion breaks down—they can make informed decisions about where to invest.

What Growth Engine Marketing Actually Looks Like

Multi-location healthcare marketing has always been complex. But most organizations have treated that complexity as a reason to limit marketing's scope—drive awareness, generate leads, hope operations can convert them.

Blair and Brian have built something fundamentally different.

Not better marketing tactics. Not even better measurement. A different operating model where marketing owns the full growth equation: demand creation and operational capacity to capture that demand.

This requires infrastructure most organizations don't have:

• Visibility from campaign to arrived appointment
• Authority to influence operational decisions
• Shared accountability with operations for conversion outcomes
• Brand strategies focused on relevance, not just awareness

But most importantly, it requires shifting from "marketing as lead generation function" to "marketing as growth engine"—responsible not just for creating demand, but for ensuring the organization can convert that demand into revenue.

The organizations that make this shift won't just have better ROAS. They'll have a genuine competitive advantage in an increasingly crowded market where consumer expectations keep rising and operational constraints keep tightening.

Experience the full conversation where Blair and Brian discuss hiring for the AI era, why pickleball is orthopedic marketing gold, Brian's direct mail breakthrough with an elderly patient, and Blair's "we don't wish you any harm, but please get injured" philosophy.