The Bottom Liine Ep. 1

How To Get More Leads For Your Healthcare Practice, with Alex Membrillo of Cardinal Digital Marketing

Alex Membrillo joins us for our inaugural podcast episode to share his expertise in patient acquisition strategies. Alex is the CEO of Cardinal Digital Marketing, an agency which specializes in working with healthcare practices.  Learn what marketing channels drive the most leads, where practices are wasting their time, and what you should be focused on at various stages of your marketing growth.



Ken:  All right. Today we’re asking the CEO of Cardinal Digital Marketing how health care practices can get more leads. This might be cheating. But let’s see what he says. 

All right. So in our last primer episode, we distilled all the ways practices can increase revenue into five general buckets. And today, we’re going to start with bucket number one, which is lead generation or getting more patient leads. So Alex is joining us today from Cardinal Digital Marketing. Why don’t you introduce yourself? 

Alex: Ken, you said I was the inaugural interviewee? Now I’m disappointed. It sounds like there was one before me.

Ken: There was a primer. There was a primer.

Charlie: I Primed you, Alex!

Alex: Sweet. I don’t know what that sound looks like. So. Hey, everybody. So this is fun to be on the other side of the Health Care Marketing podcast. I’m Alex. We’re really running very similar circles as Charlie. We are the agency side though, so we help multi-site PE-backed provider groups scale their patient acquisition through digital marketing and SEO paid search website analytics.

You think it, we can do it as long as it’s online and helping patients find the care they need. We do it in part through great technology partners like Liine. I was not paid to to say that, but and I hope you guys don’t ask me Liine specific stuff. I got people that work with your platform all the time but I can help with high level fluff that you can.

Ken: No fluff!

Alex Okay. No fluff. No fluff. Now that guys, listeners, it’s going to be great. We’re not going to screw around. I got to go. Don’t let me me intro myself again. Let’s keep going.

Ken: That was perfect. That was amazing. Yes, we aren’t here to talk about Liine, that’s for sure. No Liine. Let’s start with just in general discussion and then we can go into some questions if we need to. But I guess big question, as a fellow marketer myself, I have an opinion on this. I want to hear what you think, though.

Do you think it’s unfair to talk about marketing lead generation without marketing as a whole? Are we are we kind of cheating? Talk about lead generation in isolation without talking about branding….and 

Alex: These days, I would say these days I would say yes. I think the patient journey is more complex. You know, five years ago, I started the agency 14 years ago, simply threw up anything to make a landing page. You didn’t need call tracking or a call center. You just threw an ad on Google ads and sent them to any page on a website and they can work as the competitors were worse than that.

So you know, that was good. But over the last few years, the patient journey has become more complex. We see brand impressions on Facebook, instant tick tock, YouTube, display ads, wherever it may be or do our own research. How about I turn when I see all of your research? Hell, we had a lead from ChatGPT the other day, which was crazy.

So I think the patient journey is complex. I think it’s shortchanging it to just talk about lead gen. I think the whole thing is performance marketing brands are part of it. Brand and performance marketing go hand in hand to drive patient volume. So I see it as one or the other and then stop giving clients the option to opt out of brand or upper funnel campaigns in the say like this is what eventually drives your CPL down.

So you have to do it. Great tech partners will help you figure out what channels are successful and where you’re falling down operationally, but you got to do it all together. These days. And I’ve got a shirt that would make you think that I only cared about one channel.

Charlie: Run PPC! You gotta send me that, that’s cool.

Alex: They’re good to go on $25. Well, what else? Which what was your opinion, Ken?

Ken: I kind of agree that we’re we’re basically asking for the icing on the cake when there’s, like, the whole rest of the cake is kind of important, too. But we’re going to try and cheat a little bit anyway because we’re going to try to talk just lead gen exclusively,

But that’s where we’re at in the funnel. Okay? So let’s let’s just go and try to bite right into the meat. If you had to pick two or three marketing channels or activities for a health care practice and you don’t know anything about this practice, is there an answer like is are you going to tell them like, these are the main things at work?

Alex:  Yeah. Channel is hub and spoke website has got to be a great because there’s no point driving SEO or listings or reviews or PPC traffic from your spokes back to a shitty looking website that doesn’t conversions, got no online booking, etc. So the website matters a lot, the right content in the right places and that and the right creative to to convince people you’re there, provider group to go with.

But then SEO reviews and Google ads is really all I need at a basic level for smaller groups. And then you start scaling 10, 20, 50 locations. You got to start layering on all the upper funnel channels because you run out of demand at the bottom of the funnel. But bottom of the funnel stuff is good up to like 20 locations.

I mean, yeah, you’re using scale pretty well with that.

Ken: So you think 20 locations is a good kind of break point to the like an upper funnel?

Alex: Yeah. Then you got to really start bringing that marketing director and get more sophisticated. You’re probably doing to know about every quarter you need like a new marketplace. You’re going to have brand awareness campaigns when you open. Yeah, it gets more complex, but you can get to 20 locations, sell out there, be firm without having done any of that complex, expensive stuff.

Ken: Hmm. Interesting. Are there any particular activities or channels you’re seeing overlooked, like any kind of hidden secrets?

Alex: Yeah. SEO. Yeah, maybe because we work with a lot of PE backed groups. I think the timelines are too short, that the patience is limited and but it’s a phenomenal channel if it’s looked at correct. It’s like a content thing to make your website render a good see as the person who’s looking at the UX of the website and helping get commercial rates up for traffic and organic.

They’re teaching you how to get patients into the door faster. So yeah, I think SEO’s like tried and true and it’s not going anywhere. And Google’s search volume hasn’t decreased at all. And so yeah, very much alive and well and underplayed, especially in our little niche.

Ken: And is that mostly local SEO or how does that kind of shake out.

Alex: Yeah. Just for the medical group. So I think that matters to be in maps, right. Got to be in maps, someone types “orthopedic surgeon near me”. That’s going to be a maps and reviews and all that stuff. But you can optimize those listings and then below it you have organic, which matters and for locations, providers and then all the educational content matters too.

But as he goes, phenomenal. And I would assure patients in the field that was great. So it’s all people ads, Facebook ads and you know, it’s not I don’t think that’s the right approach.

Charlie: Do you think they’re overlooked because most agencies suck at that, or why do practices not dive in.

Alex: Suck at explaining the value of and I do love this, I have to add, it’s a dynamic background for you guys.

Charlie: Oh, it’s great. Yeah.

Alex: Yeah, it’s good. And you can see, like I hand drew this in COVID – logo and stuff that I over paid someone to do this. No I’m kidding.

I think I think SEO is miscommunicated the value of it. I think when we’re initially bringing on the project, the PR firms like, well we need advertising. Okay, quick returns.

No it’s like a 1 to 2 play. Your play bring me in after your first run after funding year one, or year two. So we’ve got a three year ramp on it like don’t bring me in when you’re maximizing EBITDA to sell. But it’s a phenomenal channel. It’s still the best still drives the majority. 

Charlie: That is great.

Ken: I want to say I love the personality here.

Charlie: This is a straight what a bunch of rubbish. All right, let’s move on.

Ken: I was going to ask about the breakdown. So you said SEO is majority for a successful, successfully, I guess structured marketing.

Alex:  Yeah.

Ken: Okay.

Alex: Yeah, Yeah. And then they get bigger. Google ads takes over a huge scale as much as it does much faster. But up to 20 locations.

Ken: Awesome. Or how about let’s just keep rolling. So are there any particular places you see practices who just don’t quite know what they’re doing? Are they wasting time or money in certain places?

Alex: Yeah, So good question. You know, the ones where I think they’re wasting time is they’re scaling advertising before they set the proper technology foundations. They get really big because they’re good at advertising, but then realize they didn’t set up like a like a CRM, a call center. And I’m not saying that just because it’s like a state all the time.

Alex: It’s very hard to go back and implement call center or sorry, call tracking CRM marketing automation at 500 locations. It’s like dude just set this up at 20 locations. It seems like a big expense because they’re small, they will be a bigger distraction trying to move through instead of just trying to move your sailboat right now to do things correctly.

Also, getting the right technological foundation when you’re a smaller is cool, you’re going to learn faster and again, it’s an investment up front. But like if you’re not an idiot, the learning should be good enough to, like, usurp your competitors pretty quickly, even when you’re small. So, yes, I think technology needs to be set up for front, and I think marketing is going to change too.

Like after the recommendations I find myself making these days are like tech investments when people are getting go over like, Yeah.

Go get these things and we can help. And if you don’t have these things, we’re going to be flying blind. I kind of don’t want to mess with you.

Charlie: Yeah. So another way of saying or to play that back, there’s not necessarily a particular channel or activity that you see them wasting money on. It’s all of them. But because they don’t have good technology to know what’s working and then they’re also not optimizing what they’re doing with the leads, right? They’re just they’re not going to be able to optimize any channel that they’re messing with.

Alex: That’s right. Get that tracking. You’re never going to know, and Liine might say differently, but I don’t think you’re ever going to know like multi-channel attribution and you don’t need to like directional information. You need to know how the operations are taking falls and converting to CRM. So I understand that how to work your patients on an ongoing basis of that ongoing referrals and stuff like that.

So it’s not really the wrong advertising. It’s like the wrong structure or the wrong thought I had. Yeah, like too quickly. So yeah, I mean the advertising, I don’t see like huge issues there. It’s generally like they’re just not doing it and they don’t have the tech in place and they want to start running before that stuff. So yeah, different cases.

But when you get a group small, you can do the right things. When you get a big have you, it’s just takes forever and I don’t have the patience for that. But yeah start small with the right tech.

Ken: So I’m sure a lot of practices are curious how much they should invest in marketing. Is there a kind of a hard and fast rule like percentage of revenue or growth trajectory they should look at? Or how do they….

Alex: 30% of every dollar that comes in should go to your digital advertising? I don’t know for medical groups. I know for agencies like high growth agencies like us will spend 15 to 20% every month on on marketing sales. And that’s what we do because we’re a high growth agency for medical groups, I don’t know, 5 to 10%, I would think fairly high.

But the higher growth groups like that spend a lot on advertising, do really well if they understand what the advertising is driving and then they just pour more fuel on the fire, those are groups that kill it. They put the right systems in place to know what that next dollar would do. And then they say we go spend ten or next dollars.

And then the opposite problem comes into play where we don’t have enough clinicians mid levels, whatever to support, and then they’ve got to solve that problem.

Charlie: Somebody just asked me this Ken. I can’t remember it was some P group and they brought on a new marketing person who doesn’t have a lot of health care experience. And so she asked me that. So I asked like five or six of our customers and 5 to 7% of revenues. What I heard in general on average. And then the high growth to Alex’s point, probably the highest I heard was 15.

But then people that were more aggressive that I would consider really legit were more like ten. And I think I think probably there’s plenty of practices that are five or a little bit below and it’s just is probably not enough.

Alex: It’s called a lifestyle business. That’s what it is. Yeah, it’s going to grow 10% a year and you’re going to give great care to your patients. And it’s the lifestyle is it’s not what I want and probably not what makes for the best clients. But it’s also okay.

Ken: Cool I let’s let’s kind of consider different stages companies and practices might be in so if they’re just getting started like, they, they really have no idea what they’re doing with marketing is there day one what they should be searching or jumping into? Should they start with the SEO, start with Google? Like should they ask questions before they even do that?

Ken: How would you kind of direct someone like that?

Alex: Yeah, website SEO. I want to make sure that you’re ranking or at least set out to rank for the most important keywords, like orthopedic surgeon near me, dentist near me, all that stuff. So you’re location pages is where I start. Make sure they’re awesome. They can hurt a patient. I’m going to make sure you have online scheduling that you have calls CTAs that you have an email form, and then I’m going to say, okay, all that’s in place start generating reviews.

Use our Birdseye radar array blah blah blah, and then we’re going to start advertising website and got it listing reviews.

Charlie: You you mentioned online booking a few times. Is that just like if you’re not doing online booking like you’re an idiot. Is that how you feel?

Alex: I guess I think so. But like there’s a lot of groups that aren’t. Yeah. So like you’re an idiot in a host of other like a gaggle of other idiots are right there with you. But like, I read so many stats that like our generation and younger all want to book…we don’t want to ****ing call.

What are we going to do, sit through 18 voice prompts? Okay, email form is going to take me three weeks? I call I sent an email to for email form to I don’t know, I guess because I got this weird shit on my eyes and it’s been two weeks and nobody’s calling me back. So like, I’d rather book the thing online and you can do that any time of night and stuff like that.

There’s not a lot of good online booking systems that let you see marketing all the way through. The next helper is pretty good for dental, but in the general medical space, like what do they say? A lot of blue ocean or whatever stupid buzzword is like someone go and invent that **** and make it easy to use for medical groups and marketing companies as well.

Charlie: Agree. And even if you don’t believe that you’re that most people are going to do it or they’re still like, who cares? Give give patients another way to schedule with you. Like, why wouldn’t you offer it.

Alex: As not internet? Why? Because the providers are picky on when they want to take. That’s true controls. It’s always that. It’s not that they don’t. Yeah nobody will come is that the providers are a pain in the ***. They own the provider group and they don’t want to step on their toes and tell them because it’ll ruffle feathers. I’m going to say like, All right, well, that’s fine. Don’t don’t ask me why the advertising is not working. What the ****? Your competitor does online booking so very simple.

Ken: Awesome. Well, let’s skip ahead to another practice. And this. This time they’ve been doing some SEO. They’ve been running ads. You’re just not sure where to go from there. You’ve kind of hinted at this already, your thoughts, but let’s just kind of pretend we haven’t talked about this. What would you kind of say someone should do to kind of go beyond SEO ads or should they just not?

Or how do they optimize?

Alex: Well, they should. They should. There’s only so much demand at the bottom of the funnel, aren’t you like how many people are searching for orthopedic surgeon here like I’ve done so you still have to like there’s a lot of we mostly work in the low acuity space where the health care decision is made in a day, but in my opinion, it’s influence over months.

Right? So if you saw that veterinary hospital ads or Billboard TV, digital radio or display on YouTube over six months from when you moved into town, like when you finally got a search this time a vet clinic near me and you’ve got city that pulled out, they’re like, I’m going to go with the one that I celebrate impressions of over the last six months.

So yeah, running really smart brand advertising campaigns is very good. Facebook Insights still thinks best about YouTube also very good. And then Google has display ****. So that’s all very good. And if you live in Montana, you can’t do Tik tok. But no, I definitely think everybody should could go into the upper funnel channels once they’ve like built the right technology and marketing foundation for the website.

Very important like and I don’t want to see any billboards running if you can’t even run YouTube yet. So the best practices have a lot of creative in-house capabilities, not big teams, but modern, creative in-house abilities. They have a young marketer that knows the new channels and can speak to the patients that are also, you know, trying to utilize online technology and stuff like that.

So even the older populations like Senior Care, you’d be surprised they know how to use a phone and **** like really well, they know, they know how to use technology. You’ll see them pull up their all their all of their medical records and they know how to book online. Like it’s not an excuse to say, my demographics are older.

We don’t need that. They don’t want to call in either. Nobody wants to call it. No one wants to do it anymore. So the older young, regardless of what your patient demographic is, everybody wants the same thing, which is patient access made easy.

Charlie: I’m addicted to Instagram, so I’ve stayed off to TikTok. Should I, should I not download TikTok or what do you think.

Alex: I should do? My wife is on the TikTok all the time. I don’t know, man. I don’t want them.

Charlie: I’m not I’m not even going to I’m just going to keep it away from myself.

Alex: It’s the same shit. I don’t know.

Charlie: I know.

Alex: Yeah, same thing.

Ken: Awesome. We’re about to probably have to wrap, but I want to ask one more question because I think it’s important I hear this question.

Alex: Ken’s like, this is the worst podcast.

Ken: But no, this is the best actually. I’m actually super pumped about how this is going.

Alex: They’re all downhill from here.

Ken: Yeah, so I’ve heard this quite a bit. Practices or any business really. They’re working with an agency or they have some kind of marketing person. They don’t really know how to compare or it’s this working. Should I be shopping for a different agency? Like they don’t really know what they’re doing? Is there a certain data that they should be asking for, or how can they really know their agency is doing the right stuff, performing, I guess. How would you speak to that?

Alex: Yeah, What’s the goal? Filling capacity. Your capacity is not filled. Like what? Where is the problem? Back from there. Is it like patient is too high a corporate lead or you don’t know? Like, if you don’t know, then you may have the right technology partners like the best thing to do is go find an agency that has worked in your specialty.

If you’re a vet clinic, go find an agency that’s work with several vets and they get them on the phone. They’re not going to give you benchmarks in their case studies. I wouldn’t either. But they may tell you without naming clients, I could expect to see people around here expecting Casper booked. Client not patient. That space to be around here.

You should be ranking here. Go get opinions, and then it’s a gut reaction. But at the end of the day, you should know some of these jobs that are further down other than like ethics and impression and regs, like how many leads, how many patients are they sending traffic based on capacity or are they just spreading advertising evenly everywhere?

Are they talking about wider issues like tracking all the way through? Do they help you in a good call center, tracking practices and CRM? Are they talking technology or are they unsophisticated? The right agency can be the right fit when they’re smaller and unsophisticated. That’s probably the right solution is you don’t need crazy agency capabilities and as you grow need to get more sophisticated, it’s okay to break up and move on.

But go getting a second opinion from someone else in the space. I can go from there. Also, if you’re a VP of marketing at a vet clinic, just go to the link dead and go hit up other visa marketing that are not competitive channels. Ask them online. Pick on what your CBL. What is your agency doing? What technology is using?

Just go to LinkedIn to find someone that you could trust. You don’t even have to ask an agency.

Ken: I love that. That’s a good idea. I think it’s it’s been it’s been awesome. I love this. Alex, I want to give you a second. Tell people where they can find you in case they’re interested. Did you freeze? Oh, well, I can tell you where to find Alex if we have to. Their website is and hopefully he’ll jump back on, but definitely check them out if he if he doesn’t unfreeze because they are they’re awesome but there is Alex back.

Alex: Sorry.Ken you got me? I got you. We got what you need.

Ken: We got what you need.  I promoted your website. Anything else you want to say about yourself before we depart?

Alex: Yeah. No. Find us on LinkedIn. If you have any questions, hit up Charlie first, and then if he can’t answer. Yeah.

Charlie: I’ll give you his cell phone.  

Alex: Give them this weak *** Apple tracking stats here haha.

Ken: Thank you.

Alex: Thanks, brother.