Outsource Marketing

The question often comes up, “Should we outsource our marketing?” There are numerous reasons for doing so: cost savings, expertise, training, and ease of management being the primary ones.

Let’s take a look at cost first. Marketing is not a single skill even though we often talk about it that way. It’s kind of like saying “lawyering” or teaching. While you start off with a law degree, family law vs corporate litigation vs immigration law are all incredibly different skill sets. One can get a degree in teaching, but that doesn’t mean a graduate is equally able to teach English Writing vs Chemistry vs Auto Mechanics.

In marketing, there are worlds of difference between a Graphic Designer, Copywriter, Campaign Data Analyst, and SEO Specialist. There is even a world of difference between a graphic designer for websites vs a graphic designer for standard fare like brochures or paid media images.

One of the biggest mistakes we see many healthcare providers make is that they hire a Marketing Director who they then expect to be able to do all these separate skills, which is simply not possible. To give an example, our Director of SEO has 10 years of experience just doing SEO. It’s all he’s done for those ten years, yet he’s still constantly learning. You wouldn’t hire a teacher to teach every single subject in your high school, so you shouldn’t be hiring just one individual to oversee all of your marketing.

Sometimes we have clients ask us to “just teach them the basics.” While we can give a 30,000-foot view so they understand some basic principles, there’s no way we can teach 10 years of knowledge in a couple hours or even a couple weeks. When we hire SEO specialists, we require several years experience and still put them through 80 hours of training before they’re allowed to start on a client account with us. Even though they’ve had several years of experience, they always come out of our training stating that they, “learned a ton.” 

All of this is to say, if you want to do effective marketing, you can’t hire an individual or even a couple individuals; you need an entire team, and that’s where the cost savings comes in. At the very least, a decent marketing strategy needs the following:

• Web Content Writer. This person can’t just be a good writer, but must understand SEO, different content needed for different stages of the patient journey, and a strong background in the particular field they’re writing for. Again, someone used to writing fiction or history papers is not going to be able to write for behavioral health without significant training.
• Paid Media Content Writer. Writing ads versus writing SEO-focused web copy are two completely different things requiring separate skills. We’ve tried many times to have the two different types of writers stand in for each other and the results are always mediocre unless we provide extensive training in the type of writing they’re unfamiliar with. An ad writer knows how to speak to an audience with emotional impact while also subtly encouraging them to take action. It sounds easy, but we have an entire 2-hour training on just how to write Headlines for ad copy and new writers still need significant practice before they become good at it.
• Copy Editor. Copy editing is again a completely different skill set from writing itself and needs to be a separate position if you want good copy. Writers cannot copy edit their own work. Copy editors are extremely detail-oriented and must enjoy looking at a piece of content word by word for spelling and grammar errors as well as being able to look at a piece holistically to provide structural and organizational recommendations. They need a thorough understanding of formal English grammar rules as well as various style guides (AP vs APA vs Chicago, etc.). Did you know that, contrary to the popular grammar myth, using “that” in place of “who” in adjectival relative clauses is perfectly okay? We’re willing to bet you don’t even know what a relative clause is nor do most writers. That’s why Copy Editors are essential.
• Content Lead or Manager to hire, train, and manage the team. This person rarely writes themself, but needs leadership and organizational skills to manage the team, keep projects moving, and make sure the team is on top of deadlines across projects.
• Paid Media Specialist. Different from ad copywriting, this person has an analytics background and understands data and strategy outside of simply an ability to write good copy. Good marketing requires a sophisticated understanding of all the technical aspects of the different marketing platforms, how to create and optimize funnels, and how to troubleshoot when there are problems.
• Technical SEO Specialist. This person knows things such as crawl time, link depth, code for mobile and speed optimizations, schema, title tags, meta descriptions, etc.
• On-page SEO Specialist. This person is up-to-date on the 100+ known signals Google uses in its ranking algorithm to ensure pages are not over or under optimized for each signal. They also understand SEO silos/clusters and interlinking to maximize rank potential across the entire site.
• Off-page SEO Specialist. This person is a backlinking expert. They have in-depth knowledge of citations, Web 2s, and backlink outreach strategies.
• SEO Lead or Manager to hire, train, and manage the team. This person usually has deep expertise in one of the areas of specialization in SEO and has working knowledge of the other two. They also have strong leadership and organizational skills.
• Graphic Designer (Web). This person not only has the technical skills to use Adobe Creative Suite, but the creative skills to translate visions into reality. On top of that, they need to understand basic elements of web design. It doesn’t matter if they can create the most beautiful design in the world if the coders can’t actually make it. Conversion optimization is also a very important element of web design and many graphic designers without a background in marketing make pretty designs that are functionally deficient when it comes to getting visitors to take action, so they need to have some solid marketing chops as well.
• Graphic Designer (Media). This person has the aforementioned technical and creative design skills, but also a background in paid media marketing. What good is a trifold brochure for doctor’s offices when they’re just going to throw it away? A good designer knows that doctors use things like desk calendars or one-page flyers to stick on cork boards. They know what elements of graphics make paid media more likely to convert (photos work better than illustrations and color is better than black and white in most cases, for example).
• Creative Director. This person has the standard leadership and organizational skills, but also has branding chops. They know how to align graphics and message connected to the strategic goals of the organization.
• Web Developer. This person can code. They know CSS, HTML, Javascript, and WordPress.
• Web Lead or Manager. This person needs both a design and a coding background. Clean code functions well, but the website also needs to work for users of the site. Many developers struggle with creating sites both functional and aesthetically pleasing as there is a strong tendency for people to be analytical or creative, not both, so the right Lead Developer is worth their weight in gold. Your average Web Developer is very analytical, so the Lead Developer is critical in making sure the site actually looks nice and optimizes the user experience.
• Data Analyst. This person handles all tracking and reporting across campaigns. They’re responsible for maintenance of real-time dashboards as well as report building related to campaign results.
• Marketing Strategist. This person is the person most often hired into a Marketing Director role at most companies. Rather than highly specialized expertise in one area, they tend to be a jack of all trades that knows a little bit of everything. They aren’t able to write great copy, code, or optimize for SEO themselves outside of the most basic, but they know enough to know when something looks good. This person also provides clear guidance and direction so that the entire strategy makes sense. They know where to allocate budget and energy for maximum effect. They also know how to ensure SEO, paid, creative, and web are all working together towards the same objective.
• Project Manager. As you can imagine, having all of the above people working on a project with many elements interdependent on each other requires some complex project management. The Project Manager organizes the project so that the various elements are done in an order that makes sense, the team has everything they need, and that the project stays on track to meet deadlines. 

Each of the above roles will cost a company at least $50,000 a year plus benefits in most areas of the country. Leadership roles or individuals with 10 or more years of experience will start at at least $80,000.

Let’s say you want to do a simple SEO project and you’re on a budget, so you eschew a full team, just hiring a content writer and a jack of all trades SEO specialist, no specialized roles, no copy-editing, no Marketing Director to guide strategy, and you use stock photos, so no graphic design. Those two roles will cost $100,000 a year, or $8,333 a month, not counting benefits. Try to build a team of 4 or 5 and you’re already tripling that cost. 

A marketing agency like ours starts at $10,000 a month and our smallest projects have 8 different people working on them, all specialized in their area of expertise. So for $110,000 a year, a provider gets an entire team of trained experts producing high-quality, optimized campaigns. That’s the value of hiring a marketing agency. 

The other advantage related to staffing is that the allocation of labor capital is extremely efficient. What is a provider going to do with a full-time Graphic Designer? Maybe they need to create a couple blog images, some social posts, and a brochure a month. That’s about 20 hours of work. What are they going to do for the other 140 hours a month? Providers can try to hire contractors or freelancers, but these tend to not be reliable. If a provider doesn’t give them work every week, then they need to pick up other clients, so suddenly you find they aren’t available when you need them because their schedule is full with other work.

Sometimes we’ll see providers try to hire interns. This is a mess and it’s probably one of our biggest pet peeves. Interns are for work a provider doesn’t care about that much or that doesn’t require experience, expertise, or strong skills, like data entry or photocopying. Interns don’t know how to write for the space, they don’t know SEO, they don’t understand paid media. There is a world of difference between writing a college essay versus content that ranks on Google or converts in ads. There’s a world of difference between having a personal social media account and running a business account that requires results. Most of the time, when having to work with interns or the result of their work, we end up having to spend more time fixing it than if we’d done it all in the first place.

The Cost of Tools

We spend over $10,000 a month on software and tools to improve SEO, paid media, content creation, and graphic design. We have premium web design software, Adobe Creative Suite subscriptions, SEO and paid media tools up the wazoo, etc.. These all cost money, but enable the team to do 3 times the work than if they were trying to do it all manually.

A provider either needs to pay for those tools or they need to pay 3x the labor since it’s going to take the team 3 times as long to do the work without the tools. For example, in a typical ad campaign, we’ll launch between 50 and 150 ads in a wide array of split tests to determine best performing audiences, images, headlines, body copy, and CTAs. Can you imagine an ad writer manually writing 150 different ads for a single launch? It’d take a week just to launch a single campaign when we need to launch up to 5 campaigns per client per week.

Recruitment, Training, and Management

What skills are required for a good Technical SEO Specialist? How do they differ from an On-page or Off-page SEO Specialist? What questions should you ask in an interview to determine if they actually know their stuff? How do you evaluate the quality of their responses? What KPIs should you be tracking, what are reasonable timelines, and what are reasonable benchmarks? What kind of ongoing training should such a specialist have?

These are questions the vast majority of executives can’t answer and ones that most Marketing Directors don’t know either. That’s why an SEO team needs to be hired, trained, and managed by an SEO Manager. The same goes for paid media, graphic design, and web development. A jack-of-all-trades Marketing Director with their typical university degree and a background in branding and strategy doesn’t know how to hire, train, or manage these roles. 

This is one of the other main advantages of hiring an agency. A healthcare provider simply does not have the external expertise to appropriately hire, train, and manage the different departments needed to execute strong multi-channel campaigns. When we are hired to take over from internal teams, it’s almost always the case that tons of just basic mistakes are being made everywhere. It’s not that the Marketing Director or Executive Team wasn’t doing their jobs by holding these teams accountable, they simply don’t know how to evaluate the quality of the work in the first place. What’s the team doing right? What are they doing wrong? Do they even have the knowledge and skills necessary to do the job right? After all, there is no university that teaches digital marketing or SEO. Universities focus on big picture branding and strategy because they say, “the marketing world changes so rapidly, if we taught specifics, it’d be out-of-date by the time our students graduated.” So they don’t bother. This creates an enormous challenge for healthcare providers since they can’t rely on a university degree to train marketing staff.

This is also why, here at Circle Social, we have 80 hours of training unique to each department as well as ongoing weekly trainings. While we can often find potential job applicants with basic backgrounds in the skills we need, they almost always need extensive internal training before being ready to work on client accounts. 

By outsourcing to an agency, not only are providers saving significant money on labor, software, and tools, they also save on hiring, recruitment, and training costs. The internal training we have at Circle Social cost us over $100,000 to build. It costs us at least $3,000 to recruit, hire, and train new staff before they even start on campaign work. Most healthcare providers are not willing to invest that kind of cash to build out department specific trainings even if they had the internal expertise to be able to do so.

Expertise

Finally, it comes down to expertise. As we’ve already discussed, marketing requires industry expertise just like being a teacher, lawyer, or CEO. You wouldn’t hire the CEO of McDonald’s to run a hospital system. Hiring marketers with experience in ecomm or Disney Parks isn’t going to help in behavioral health. 

How does HIPAA work? What’s Legitscript? What’s an appropriate cost per inquiry on Google Ads versus SEO in behavioral health? What content is needed in the heroin silo? Why doesn’t overly positive imagery work in addiction treatment or behavioral health ad campaigns? 

When we’ve gone into providers and seen patient acquisition costs of $12,000 or more, the staff had no idea that that was too high. Since it’s what they’d always gotten, they simply assumed it was normal. 

Hiring an agency is not just about finding one with marketing expertise, it’s about finding one with expertise in your field. Healthcare expertise is a must and then expertise in your particular service line(s) is even more valuable.

We also have the added benefit of being able to see the entire space. Providers are only able to access their own data whereas we know what works across the country and over $350 million in ad spend.

1.  Our mission is to connect patients to quality care just like our clients'. Everything we do is about adding value to patients and communities. Through marketing and communications, we're not promoting just addiction treatment because people need treatment, just like we wouldn't promote hamburgers just because people are hungry. We work to add value to people's lives, to educate, to inspire, to provide hope and information. Marketing is so much more than connecting patients to care. Of course we do that, but we work to help everyone that sees our campaigns, which also makes sure they stick in people's memories and drives long-term results as well.
2. We have more data than any other provider in the country with over $2 billion in operating data and $350 million of data specific to marketing behavioral health and addiction treatment. That comes from all levels of care across the country, traditional rehab, MAT, psych hospitals, outpatient providers, and purely online providers. When large private equity firms like KKR need data and consulting in this space, they don't call McKinsey or Bane and Co., they call us.
   
   Our largest client does over $1 billion a year in revenue. The smallest we take on our start-ups or smaller providers expecting to do at least $5 million in revenue per year.
3. Behavioral health is our speciality. We're not just a vendor, we're a strategic partner. We know the business backwards and forwards. Because of our consulting work in addition to the normal agency work, we understand operations, call centers, business development, clinical programming, and the day to day that drives profit and loss for a provider. When census is down, we don't just tell you to spend more money on marketing, we help you trouble shoot the entire admissions and patient retention process to determine where efforts need to be applied in order to achieve the desired result. If your admissions (call) team is underperforming, more marketing dollars isn't going to help. We are strategic partners that help you grow your organization across the board.

It depends on many factors. Google Ads can start delivering results in as little as 30 days, but they’re expensive. SEO takes up to a year for a brand new site, but delivers the lowest cost per admission out of all digital channels once it starts working. Most other platforms take somewhere from 3-6 months.

Marketing can only drive awareness and inquiries, it can’t drive admissions (a common misconception many providers make). Admissions depend on:

• Your reputation both in the community and online. A bad or even just a humdrum reputation in either place drives up inquiry costs and decreases conversion rates.
• The ability of your admissions (call) team to convert. We can get the prospective patient or family to call. It’s your team’s job to help them finalize the decision.

This is a common question. We work with many of the largest programs in the country and over 100 facilities, so it’s highly likely we work with someone in your addressable market. The answer to this question is simple: if you’re not with us, then you’re against us. Even if we have a client across the street from you, you’re going to be going head to head with us anyway by working with another agency. Would you rather have us bringing our expertise to bear to help you compete or would you prefer to hire some random local agency that has no idea about behavioral health and you have to burn through tens of thousands of dollars as they make mistakes and try to learn the vertical? 

Our goal is to connect patients to quality care and that’s what we’re going to do. We do the best for every provider and the fact that we have massive amounts of data, experience, and expertise specific to behavioral health and, potentially, your addressable market, is the entire point of hiring us. Providers hire us because we know what we’re doing and get results, something an agency with no experience in the field is unable to do.

Additionally, we often give the examples of Elvis Presley and Starbucks. If we ran marketing for Elvis Presley and someone random musician came up to us and said, “Make me famous like you did Elvis,” we can’t use the same marketing because that person isn’t Elvis. Marketing is not about promoting widgets. We can’t say, “do you like good music, take a listen” and have that someone magically work for every musician. It’s the same reason Joe’s Corner Coffee Shop can’t simply copy Starbucks’ ads and become a global brand (after all, they’re easy to find and copy.). Successful providers have unique differentiators. Every marketing campaign and strategy must be tailored to that provider. Even if two providers are across the street from each other, the same campaigns, tactics, and messaging aren’t going to work.

This is related to the question about working with other providers, this idea that there is some kind of magical secret sauce that you don’t want other competitors to have access to through us.

1. From a marketing perspective, we are the secret sauce. Nobody markets behavioral health better than we do. We can 100% guarantee you’re not doing anything special we didn’t either invent or haven’t seen before. After all, why are you exploring outsourcing your marketing if you had some magic formula leading to breakaway success already?

2. Whatever does make you different or unique, we’re going to shout it from the rooftops for the world to hear. If you had some secret clinical approach that got better results than everybody else, keeping that a secret wouldn’t attract any patients. So, of course, anything unique about your organization is going to and needs to become public knowledge, whether we’re the ones doing the marketing or someone else is.

3. Success is about execution. The worst thing we can do to a provider is promote something that isn’t accurate. Starbucks isn’t successful because they have great marketing, they’re successful because they deliver a consistent, quality experience and product day in and day out across the country. Elvis wasn’t successful because of marketing, he was successful because of the music he made and his stage presence. Our marketing expertise is not the cornerstone of your success, only you can create a successful program. But we can absolutely amplify your strengths and differentiators so that more and more of the right people find your program.

Obviously, we also work with a high degree of confidentiality. If we didn’t, we wouldn’t be trusted partners of many of the largest providers in the country. While we’re going to share with the world what makes you uniquely you, we take the confidentiality of your data and other proprietary information very seriously.

No, we cannot. There is no way to target holders of specific policies with the exception of an ability to target employees are very large corporations. If you know Google has policies that work well for your program, then we are able to target that. 

The vast majority of colors are Medicaid, Medicare, or no resource because individuals in these socioeconomic groups struggle with addiction at rates 5-6 times higher than those with commercial insurance. Additionally, because they pay nothing out of pocket, they call anyone and everyone. The commercially insured are much more discerning and often spend a lot of time researching before making a decision to call. 

About 90% of Google Ads calls are Medicaid/Medicare/No resource. Because they have nothing to lose, they are more likely to click on ads whereas the commercially insured are more likely to skip over them. For organic search results, 75% of calls are generally Medicaid/Medicare/No Resource. 

It is possible to specify in ads or pages “No Medicaid” or “Private Insurance Only,” but we have tried that quite extensively and found it turns away as many commercially insured as it does those on Medicaid, so is not an attractive option.

I can’t see any calls from Facebook/TV/Radio/Billboards/Direct Mail, etc. Why aren’t these working?

This is one of the worst mistakes many providers make. Because they can’t see a click > call > admission like they can with a Google Ad or SEO, they assume that these channels aren’t working. They’re dead wrong. We can tell you that, with our $350 million in just behavioral health marketing data, the providers that have a multichannel marketing strategy in place are always the ones that have the highest census.

Nobody sees an ad for a bottle of tide on TV and a car ad on Facebook, drops what they’re doing ,and goes out to buy some Tide or a brand new car. That’s simply not how marketing works. Except for Google Ads and SEO, where people are already at the end of their decision-making process and often in crisis mode, most advertising channels require 7-12 touches before a person is ready to take action.

And there is a limited pool of action takers on any given day or at any given time. How many commercially insured individuals enter addiction treatment on any given month in Indianapolis, for example? The answer is less than 200 or 6 per day. No matter what you do, how many BD reps you have, how much you spend on marketing, you’ll never see more than an average of 6 people a day enter treatment in Indianapolis. And only 20% of patients come from Google, the other 80% come from other channels. 

Unlike Google, people do not call off of other channels for the most part. You can put a tracking number on a billboard, in a radio ad, on a Facebook campaign. But what you’ll find is that people simply remember the name, Google it, and call from there. If you’re only looking at calls or trying to connect every admission to the last channel someone called from, you’re misunderstanding attribution and marketing. Marketing is not linear math, it’s a complex interplay of many factors, of which granular tracking is mostly a pipe dream. Instead, one has to look at overall growth in traffic, inquiries, and admissions. There will always be noise and uncertainty in the data, but good marketing will always work in the aggregate as long as providers deliver on the promises made in the marketing messaging.

That’s exactly right. What you’ll find is that, if you actually listen to calls, even if the person called off a Google Ad or a Google search, they may have already known of you from elsewhere. But the fact is that they were usually not Googling your facility when they called. As we can see in the tracking data, they were looking for “drug rehab near me” or “good addiction treatment in CITY.” When they saw you pop up in results, that either jogged their memory or reinforced the fact that your facility is an option. Had you not shown up in results, they would have ended up calling somewhere else.

This is how most marketing works. There is an interplay across multiple channels and touchpoints that work to build trust and drive action. Channels rarely work in isolation, which is why a multichannel strategy is so effective.

We provide a very specialized and high level of expertise. Our services will not be the cheapest, but you'll find that we pay for ourselves several times over in terms of results as well as internal staffing cost savings from not having to build and manage your own team.

Our smallest contract starts at $5,000 per month or less than the cost of a single FTE. You'll get a minimum of a team of 8 assigned to your account.

From there, we have contracts that go up to $100,000 per month and everything in between. Cost is determined by the number of admissions you're trying to generate across how ever many facilities. 

Just paid media is 15% of ad spend for all spend over $20,000 per month. Otherwise, our minimum fee of $2,500 applies.

Websites start at $15,000 and go up from there depending on size, complexity, and need.

Contracts are the standard 12 months with 30-day notice to cancel.