Compliance Was Just the Starting Line: How OrthoCarolina Cut Cost Per Lead by 80%

Most healthcare organizations treat compliance with privacy laws and marketing performance as a trade-off. Either protect patient privacy or drive performance, but not both. OrthoCarolina's Chief Growth Officer, Blair Primis, rejected that premise. Getting compliant wasn't the finish line. It was the starting point for learning where growth truly stalled.

The result: an 80% drop in cost per lead, ads safely optimized from appointment data in Epic, and eventually a fix to OrthoCarolina’s own booking process that added roughly 1,200 more appointments in a single week.

The Challenge: Protect Growth in a High-Visibility Market

Shortly after stepping in as Chief Growth Officer for OrthoCarolina, Blair Primis found a marketing engine that had already been shut down. Without a compliant tracking framework in place, the organization had pulled all of its advertising.

“We were dark for about three and a half months,” Blair says. “Literally turned off, shut down, did zero.”

With more than 35 locations competing for attention alongside two enterprise health systems, OrthoCarolina needed to rebuild its marketing engine, without taking on new regulatory risk.

The Solution: A Privacy-First Data Foundation

OrthoCarolina wasn’t just looking for a piece of software to deploy and walk away. Blair knew this was his chance to remake measurement with a privacy-first foundation, and he wanted a partner to help him on that journey. "We look for partners and not vendors," he says. "A vendor is somebody you do a bunch of RFPs for, get the lowest cost, deploy it. It's a set-it-and-forget-it mentality." 

What OrthoCarolina needed instead was a team that would advocate for the business proactively. One that would surface problems before anyone asked them to look.

In early 2025, OrthoCarolina implemented Freshpaint to:

• Ensure privacy-compliant tracking
• Restore data sharing integrations with Google, Meta, and other ad platforms
• Unify cross-channel performance data
• Enable optimization toward booked appointments

Within weeks, compliant tracking was restored. Ads were back online. Risk was mitigated.

And what started as a compliance safeguard quickly became infrastructure for growth. 

The Outcome: Privacy Fuels Performance

Freshpaint's privacy-first data foundation let OrthoCarolina unify performance data across Google, Meta, Bing, The Trade Desk, and call tracking, and optimize toward booked appointments instead of clicks. Within months, cost per lead (CPL) dropped 80%.

“We’ve been able to stitch together a partnership with Freshpaint and other technology platforms that will really allow us to drive our cost per lead down. I’m not kidding – 80% reduction in cost per lead.”

Lower CPL improved budget efficiency and showed executive leadership that compliant marketing could drive measurable ROI. But for Blair, the real surprise was what Freshpaint turned out to be: "It's really a performance marketing partner that just happens to have really cool compliance software."

Once the data started flowing, the results stacked up:

• A booking flow that finally worked. Marketing data exposed drop-off inside the scheduling flow. Cutting the online booking process from more than a dozen questions to four added roughly 1,200 appointments in a single week.
• Campaigns that pay for themselves. Top campaigns now acquire patients for single-digit dollars, with weekly return on ad spend estimated between 500% and 900%.
• Ad click to arrived appointment, in one view. Leadership can now see which campaigns produce patients who actually show up, not just leads, with the EHR compliantly integrated into OrthoCarolina’s marketing tech stack.
• Brand spend, backed by proof. With performance running efficiently, the team shifted toward a roughly 60/40 brand-to-performance split. "Really good brand is a turbocharger for performance marketing," Blair says.

The Takeaway: Compliance Was the Starting Line

OrthoCarolina started with a simple goal: get compliant and get ads back on. What it got was a clear view of what was actually limiting growth — a booking flow patients were abandoning, not weak demand — along with a significant improvement in ROAS and an entirely new set of insights to influence geographic expansion, operations, and brand.

“Freshpaint sits squarely at the center of our optimization plan,” Blair says. “Without Freshpaint, there are no other components.”

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