What was acceptable before should now be questioned

Marketing as a formal function in the hospital and health system space is still relatively young. The first hospital marketing departments didn’t really start appearing until around 40 years ago, in the 1980s, and the first SHSMD Annual Conference didn’t take place until 1996. A lot has changed since then, of course, with the marketing function in the health system space growing into a full-fledged industry and annual spending on health system marketing, branding and communications tagged at roughly $10 billion annually. Over the past 40 years, the marketing department has grown into a sophisticated function that employs millions in martech investments and often dozens of staff members, and spends billions across the industry on promotional marketing.

But over that time – and especially over the past 5-10 years – a lot has changed. Most critically, our healthcare system is facing a crisis. The U.S. ranks at or near the bottom of advanced countries in terms of healthcare outcomes. Yet our system is the most expensive in the world, for both the country and its citizens. The American healthcare system is the leading cause of personal bankruptcy in this country. Patients face medical debt that breaks families. Many watch their hospitals sue them for bills they could never afford to pay. People die because they cannot access or afford the care they need. Millions are facing the loss of government subsidized healthcare coverage thanks to the current administration, and millions more experience catastrophic healthcare expenses. The actual providers of care – nurses, techs, doctors, aides – all suffer from difficult work environments and deep levels of stress. We’re the richest country in the world, yet we’re the only first-world country without universal healthcare (of the 48 teams in the 2026 World Cup, the U.S. was the only one without universal healthcare). Our healthcare system is broken, and with millions facing financial distress from medical expenses, every dollar we spend counts – or should.

At the same time, many health systems have been facing significant financial struggles from a myriad of sources – the continued increase in healthcare costs (labor and supplies) from inflation and tariffs. Cuts to Medicare, Medicaid and NIH funding. Millions struggling to cover their healthcare costs due to the loss of coverage and poor economic conditions, leading to rising bad debt for systems. The economics likely won’t get any better anytime soon, with potentially more federal cuts on the horizon, threats to 340b funding and site-neutral payments, and continued economic hardship for many Americans. With revenue under pressure and costs rising, health systems need to do whatever they can to strip away what’s unnecessary to sustain the clinical care they deliver

Finally, and ironically given their financial struggles, health systems have been under intense scrutiny for rising costs in healthcare. Since before the Covid pandemic, I tracked what we called “The Value Attack,” which is the shift in the public, press and policy spaces to blaming hospitals and health systems for the growing cost of healthcare in this country. Systems deserve scrutiny just like the health insurance, pharma and med tech sectors do, and yes, this includes high-profile promotional marketing. That Super Bowl ad? Your new fancy logo signage? Your massive sports sponsorship? All of those are easy targets for those who want to blame health systems for rising costs.

For most of the time since the inception of the formal health system marketing space four decades ago, systems could spend more promoting themselves and no one outside the organization really cared (including often consumers – see below). Those days are gone. Combine that with crumbling healthcare system in the U.S. and the financial struggles of health systems themselves, and leaders should question whether spending so much on promotional marketing makes sense. 

There are far better ways to drive value for your organization than promotional marketing.

Before we outline why the vast majority of promotional marketing efforts are ineffective, here are three meaningful ways your organization will be better off reallocating that time, energy and spend to serving people rather than selling them:

1. As noted above, given the current healthcare crisis in this country and the financial struggles your organization likely faces, spending millions on Super Bowl ads, sports sponsorships or a large brand campaign can draw unwanted scrutiny to your health system and actually do more harm to your reputation than good. It’s increasingly harder for health systems to defend such high-profile expenditures when so many people in the communities we serve struggle to afford healthcare. Additionally, these expensive public efforts give more fuel to the fire for policy makers, politicians, influencers and the media call into question the non-profit status of health systems. Spending money on extravagant promotional campaigns is a great way to paint a target on your back – pulling back will help you defend your mission and value to the community when push comes to shove.

2. As we’ll outline below, much of what health systems spend on promotional marketing does little to actually benefit those organizations. That’s not casting judgement on the skill or expertise of marketers – that’s just the reality of this space. Consider the value of that spend were it be invested in ways that actually benefit those you serve, such as the patient experience, access, community health or health literacy. Which do you think has a more effective, longer-term impact on those in the community – a program to partner with community groups to improve diabetes, cancer or heart disease in your community, or a six-month campaign promoting how awesome your organization is? As we have said for years, health system brands are built not by what they say, but rather what they do.

3. Another critical aspect of the healthcare crisis in the U.S. is the state of the healthcare workforce. Your health system employees continue to struggle with difficult work environments, reduced resources and an increasingly older and more difficult patient population. Imagine spending half of what you spend on promotional marketing to better engage your employees. Sending a message that you really do put their interests first will do more for your actual brand experience, and therefore your brand reputation, than any advertising could hope to do.

Or course, if promotional marketing actually created value for health systems on a proven and continual basis, it might be harder to encourage cutting this budget and reallocating it in these ways. But here’s the hard truth: the vast majority of health system promotional marketing efforts do little to support the growth of their organizations. Brand campaigns, US News ranking expenditures, sports sponsorships, service-line promotion – all of these typically fail to lend in a material way to the strategic vision of your organization.

We won’t use this space to make the comprehensive case for why so many health system promotional efforts are ineffective – either you will buy the argument or you won’t. And again, that’s not casting judgement on the skill or expertise of marketers – that’s just the reality of this space. Ask yourself: systems pour billions collectively into promotional marketing, and what does it really gain them? How does your promotional marketing actually drive material revenue or margins to your organization? Here are some classic promotional marketing efforts and the truth about their typical impact:

• Take for example market share, a common metric used in many other industries like retail or consumer packaged goods to track effective marketing. It’s a known truth in the health system space that market share barely moves among health systems year over year, unless there is some dramatic change in the make-up of a market, typically coming from mergers or acquisitions. For example, in the competitive Twin Cities market, the inpatient market leader in 2005 was Allina Health at 30%. And who was the leader in 2024? Allina, with a 31% share. That’s 20 years, with virtually no change in market share (data shows their share never varied from between 30-32% that entire time). In fact the only notable changes in market share among the major systems came when Fairview Health System acquired HealthEast in 2017, or when Fairview lost share in St. Paul thanks to the closing of a major hospital there, St. Joseph.

• How about all those branding campaigns? For years we’ve said “health system brands are built by what you do, not what you say,” yet systems spend hundreds of millions on advertising campaigns promoting how awesome they are. Many will show lifts in brand awareness, perception and mindshare, though where those are actually tracked properly, they are transitory (stats go up when the ads run, then back down when they’re done). But all that money spent, and the top drivers of patient choice are still what system they already use, then proximity, then insurance, then physician referrals. Advertising is so far down the list as to be negligible.

• Then there’s the new marketing darling, performance marketing, which theoretically uses segmentation to hyper-target and track new patients for specific service line offering, which should lead to demonstrable marketing ROI. For starters, how many systems, still to this day, can actually do this at a systemic level, or our actually measuring ROI in the right way? Even in the few cases where this is pursued in the right way, campaigns are run for years to track true contribution margin, the results are met with a yawn from the C-suite. What’s an additional $250,000 in contribution margin worth to a $5 billion entity? Real growth, material growth, the kind that CEOs, CFOs and board actually care about, comes from M&A, geographic or service line growth, and payor contracts, none of which involve promotional marketing.

• Or how about US News and World Report rankings? A number of years ago, my agency pursued work with a health system that was looking to spend $3 million dollars annually to influence physician votes for US News rankings. Was the goal to increase national referrals or physician recruitment? No said the CMO, organizational leaders just felt their rankings were too low and wanted them higher. After all the evidence over the years that consumers barely notice these rankings, and when they do, give them little value, health systems still pay millions collectively to US News to license the badges, tens of millions to try and influence physicians to vote for their institutions, and hundreds of millions to promote the rankings.

• ·Your multi-million dollar sports sponsorship? It is typically impossible to prove the actual impact of sports sponsorships.

Undoubtedly, some will push back against the claim that many promotional marketing efforts are ineffective and a waste of money. But most marketers we know realize what they’re doing has no material effect, they just don’t have a choice (see “What stands in our way?”) Based on the evidence and the decades of our experience in the health system marketing space, and likely, your own experience, it’s hard to deny there are far more valuable ways to invest marketing spend on serving your audiences rather than selling to them.

Helping to improve healthcare for all in our own way

My wife is a trauma therapist, and throughout my career, when I would introduce us at a party or social gathering, I made the joke “she puts into the healthcare system, and I take out.” Ha ha.

For more than 25 years, I built a successful career marketing hospitals and health systems. During most of that time, I convinced myself that what I was doing was necessary, normal and ethical. I told myself that like it or not, the U.S. has a market-driven healthcare system, and for organizations to succeed, they needed to grow, attract more patients, build brands – they needed marketing. Over time, I became a leading expert in the field, writing books, delivering keynote presentations at conferences, hosting my own retreats, and leading countless provider organizations in marketing, branding and promotional efforts. This was the system we had in the U.S., and I built a successful career within that system.

I feel far different today, and my growing disillusionment with my situation led to me walk away from that career in late 2025. From where I sat, I could no longer rationalize supporting so much money going to promotional marketing efforts that so often failed to deliver any meaningful impact when I was seeing the growing dumpster fire that is healthcare in the U.S. I was done taking from the healthcare system.

Given the awful state of healthcare in this country, and the growing financial strain health systems face, can we in good conscience continue to spend so much money and energy on promotional marketing efforts that deliver such low value? How is spending millions to sell consumers on your healthcare services true to your organization’s mission? Wasteful promotional marketing efforts divert money from those activities that would actually serve audiences and support the mission of non-profit organizations. (And no, spending money to advertise your services “to help patients find the care they need” doesn’t count, not with the internet, search, websites and AI to help patients.) When I started in this field in 2000, hospital marketing supported a cottage industry of agencies and consultants. Two decades later, the two biggest agencies in the space were private-equity backed, with a third private-equity backed group joining the fray last year. There are many arguments that private equity does great harm to American society as a whole, but there is no argument that when private equity enters a space, their one and only goal is to make money. A lot of it. Yet those profits could do so much good if reallocated.

Those of us on the provider-side of healthcare often call out our peers on the payor-side, and they do deserve all the criticism they receive. How can they sleep at night, we ask, when they actively prevent care as part of their business model, and use strong-arm tactics to negotiate lower reimbursement rates for providers? Completely fair.

Now it’s time we look in the mirror. Can we sleep at night knowing we’re spending billions as an industry on self-promotion instead of putting that money and energy into helping people, especially given the affordability crisis we face in healthcare?

I’m done taking from the healthcare system in this country and will be working to make it better for everyone by pushing for serving over selling.

I hope you will join me however you can.