Ad Agency FAQs

Both, and the entry point is different for each. For portfolio companies, we work alongside the CMO to build measurement infrastructure and run location-level campaigns. For PE firms evaluating a target acquisition, we provide Marketing Due Diligence – an independent pre-close assessment covering CAC benchmarks, attribution maturity, media waste, and local digital equity. The two engagements are distinct. Many of our portco relationships begin before or shortly after close, sometimes introduced by the sponsor.

There’s no hard minimum. The more relevant threshold is whether marketing is being held to a financial standard at your organization. If your operating partners are asking about CAC, EBITDA contribution, or ramp velocity – or if you’re expected to justify marketing spend in board language – you’re the right fit regardless of location count. That said, most of our ongoing platform engagements are with organizations running 30 or more locations.

Yes. The financial discipline we bring – attribution to revenue, CAC by location, share of wallet per patient – applies to any multi-site healthcare operator that needs marketing to function like a business unit. Sponsor pressure accelerates the conversation, but it doesn’t create the need.

Most of our clients do. We typically operate as an extension of the internal function – building the measurement infrastructure the team doesn’t have capacity to build, running location-level campaign execution, creative strategy, promotions and producing the financial reporting that connects marketing to the board conversation. The CMO and internal team handle brand, corporate communications, and strategy. We handle the infrastructure and the location-level work that scales.

We report on the metrics that show up in your operating results: cost per acquired patient by location, same-site EBITDA contribution, De Novo ramp performance against thesis, share of wallet per patient, and media waste as a dollar figure. The goal is a board-ready marketing report — one your operating partners can read without translation. If your current agency’s reporting requires you to translate it before taking it into a board meeting, that’s the gap we close.

Cost per lead counts inquiries. Cost per profitable patient counts revenue. The difference is what happens between the lead and the margin – conversion rate, service mix, case value, and whether the patient accepts a high-margin care plan or a routine visit. If your media budget is being optimized toward cost per lead, you’re likely generating volume at the expense of margin. The shift to cost-per-contribution-margin is the single change that most dramatically reframes the marketing conversation with your operating partners.

Share of wallet per patient is the revenue captured from a patient relationship relative to what that relationship could produce given your service mix. Most platforms have significant uncaptured share – patients who visit for one service and never return for adjacent ones. Marketing’s job is to shift demand toward higher-margin treatments and care plans, increasing revenue per relationship without requiring new patient acquisition. It’s same-site EBITDA growth without proportional media spend increases.

It means we cross-reference provider scheduling availability before increasing acquisition pressure at a location. If a location’s schedule is full, driving more leads there doesn’t improve CAC – it generates leads that don’t convert and makes your acquisition cost look worse, not better. We integrate capacity signals into our budget allocation model through RADAR so marketing spend is concentrated on locations where demand generation will actually produce revenue.

A 30-minute working session focused on your current launch infrastructure – not a sales call. We benchmark your approach against ramp performance norms across comparable platforms, identify the specific gaps creating drag on IRR, and give you a clear picture of where the underperformance is coming from. You leave with specific findings. No pitch, no proposal unless you ask for one.

The Portfolio Diagnosis maps revenue density gaps, reactivation opportunity, and share of wallet per patient across your existing location footprint. We analyze location-level data to identify where same-site revenue is being left behind and quantify what recovering it would mean in EBITDA terms. It’s designed to show you where the highest-return same-site growth is sitting before you decide whether to pursue it.

We analyze your current media mix, attribution model, and location-level spend allocation to identify where budget is generating volume without producing value – and put a dollar figure on it. Most platforms at 100-plus locations are running 30 to 40 percent more media waste than they realize. The audit makes that specific, not estimated.

Marketing Due Diligence is an independent assessment of a target acquisition’s marketing infrastructure, delivered before close. It covers CAC benchmarks against platform norms, attribution maturity scoring, media waste analysis, and local digital equity assessment — the variables that most directly affect post-close organic growth performance and that almost never appear in the CIM (Confidential Information Memorandum). We typically engage four to six weeks before expected close.

For platforms executing tuck-in acquisitions, the Acquisition Integration Assessment reviews your current integration process against our 90-day framework and identifies where patient and digital equity is most at risk in your next deal. We give you a concrete sequencing plan: what to lock down before day one, how to execute the brand migration without destroying local search equity, and how to retain the acquired patient base through the transition.

The Exit-Readiness Assessment evaluates your marketing infrastructure against the standard a sophisticated buyer or recapitalization process will apply: attribution integrity, organic growth consistency, CAC trajectory, and the provability of EBITDA contribution. You leave with a clear picture of where your marketing story is strong, where it has gaps, and what it would take to close them before the next milestone. Most useful 12 to 24 months before a planned transaction.

The dashboard framing is accurate for brand and campaign clients. For PE-backed multi-site healthcare platforms, RADAR functions as an investment intelligence tool – the answer to the question your operating partners ask in every review: where should the next marketing dollar go? It shows, location by location, which sites are generating returns on marketing capital and which are absorbing spend without producing it. Budget reallocation recommendations come out of RADAR, not just reporting summaries. It’s a management tool as much as a marketing tool.

Because the data shows that’s the lead time required to build sufficient local awareness and generate a meaningful demand pipeline before the location opens. A launch that starts at or after opening day is catching up, not building. Every month below ramp target is a direct drag on portfolio IRR – and for platforms opening 10 to 20 locations a year, the compounding effect is material. We start 90 days out because that’s when the difference between a 12-month ramp and an 18-month ramp gets made.

Three things, almost every time. First, local search rankings built over years collapse because the Google Business Profile migration is handled incorrectly or too slowly – a recovery that can take six to twelve months. Second, the acquired patient base receives no communication during the brand transition and quietly shops for a new provider. Third, nobody established a pre-integration baseline, so there’s no way to know what was lost or measure what needs to be recovered. The 90-day window after close is when all three problems either get prevented or become expensive.

Yes, and that’s where the framework creates the most value. For platforms executing multiple acquisitions per year, we build the process once and run it repeatedly – same sequencing, same baselines, same reporting structure – so integration quality doesn’t degrade as deal volume increases. Each clean integration accelerates return on acquisition capital. Each poor one creates EBITDA drag that didn’t show up in the deal model.

For a 161-location DSO, we rebuilt attribution from the ground up and reduced cost per acquired patient from $519 to $96, while growing monthly booked appointments from 1,099 to 2,842. For a vision platform, a 500-plus location eye care platform, we drove a 147% multi-channel conversion lift and a blended CPA of $63.24 while expanding same-site EBITDA contribution across the portfolio. Both clients are publicly referenceable by name.

Yes. For qualified prospects in the evaluation stage, we can arrange direct conversations with client contacts. Case studies with full financial detail are available under NDA for deal-stage conversations.

Most engagements begin with one of our assessments — the Portfolio Diagnosis, the De Novo Ramp Diagnostic, or the Media Waste Audit, depending on where the most acute problem is. These are structured to deliver specific findings on their own. If the findings point to a broader engagement, we scope that based on what we learned. For PE firms evaluating a target, engagement begins with Marketing Due Diligence, often introduced through the sponsor relationship before the portco CMO is even in place.