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Is the marketing funnel dead?

That question started bouncing around among those at Jarrard Inc. who have backgrounds and specialize in healthcare marketing. It’s a provocative question, and provocative questions lead to sharp conversations that make for good podcasts. So, we asked two of those experienced healthcare marketers to have that conversation on the record.

Pattie Cuen served at UCLA for two decades. There, she established the medical center’s first internal communications team and orchestrated an award-winning branding campaign for the system. More recently, Cuen held a high-level position at Cedars-Sinai.

Abby McNeil is a vice president at the firm and deputy lead of our Regional Practice. McNeil has served in a number of prominent roles, including vice president of communications and public affairs for CHRISTUS Health, where she sat at the helm of all corporate communications and helped guide the organization through COVID.

Listen to the conversation or read the transcript below.

Key Insights

  • The marketing funnel isn’t dead. But it’s not really the most accurate model, either. It serves a useful, mostly two-dimensional purpose to get a snapshot of how consumers move from awareness to conversion. It’s also helpful as a relatively simple tool to present marketing concepts and different levels of messaging to people outside the field.
  • The funnel doesn’t take into account the time involved as people move from one stage to the next. That time could be five minutes for a digital engagement or weeks/months for an out-of-home campaign like a billboard.
  • Another way to think about the customer journey is as an elliptical. Once someone converts and makes a purchase – or, in healthcare, becomes a patient – the selling process starts all over, and the patient has to choose you all over again. And again. And again. It’s not one-and-done. Meanwhile, each person is sitting in the funnel – or spinning on the elliptical – of other providers, making it a multi-dimensional environment for conversion and retention.
  • Because of that elliptical process, the patient experience has to be dialed in right alongside the marketing messages and platforms. If someone buys but can’t schedule a followup appointment for weeks, they’ll go somewhere else regardless of how great your marketing campaigns are.

Read the Transcript

David Shifrin: Pattie, I’m going to give you the opening salvo here. The marketing funnel as a visual, as a graphic, and as a model for thinking about kind of the customer journey has been around for a minute.

What I want to know is, how has the marketing funnel evolved?

[00:01:53] Pattie Cuen: Yeah, no, you’re right. It’s been a traditional model that’s been used for quite some time. It’s evolved as – I feel like every time I look it up, there’s different words that are used from the originals, which I believe were going from awareness to consideration to preference to actual action or purchase and then loyalty.

But, as I look at models today, a lot of those words are changing to reflect better what the purchasing process is. I think some of the bigger changes are that it’s a reflection, that it’s not a linear process, and maybe some models have come out to try to reflect that a little bit better.

But, at its core, it still remains as an icon or an image that helps bring through that the basic fundamental in marketing – we are appealing to a much broader audience. And that gets narrowed down at some point to the point of those that actually purchase and those that stay with an organization or loyalty.

[00:02:58] Abby McNeil: We’ve also used the funnel for reporting. I used to use it for CRM reporting too. Where we had the broader awareness marketing channels with out-of-home or broadcast at the top, all the way down to those direct-to-consumer CRM or postcard outreaches, direct mail, right?

Where we think that they have a propensity to buy all the way down to paid search, where someone is actually actively searching for a service we want to sell. So, a lot of us think of the marketing funnel on the beginning and the end, right? They’re how we place those ads and how we sell, and then how we report how many people responded to what call to action.

I think though, they miss sometimes – to Pattie’s point – the cyclical nature of the buying process. Where especially with patients, they don’t just buy once. They have to keep choosing you and coming back. It’s true that it’s often cheaper and easier to cross-sell new services to existing patients.

But, if you make it hard for them to continue to choose you or they have a bad experience, they are more likely to not advocate for you and to defect from the elliptical model that some other people use to indicate that digital has changed the process, and we’re not moving through this step-by-step process anymore.

We are going to ask our friends. In some cases, we are choosing quickly and then we are buying, and then we have to continue that process over and over.

[00:04:35] DS: Yeah. I love the idea of the sales elliptical, Abby, especially because you’re one of the biggest advocates at the firm for the under-desk treadmill lifestyle.

[00:04:46] AM: The sales elliptical is a real thing. You get a great workout, and you get new patients. Can’t recommend it more.

I will say that’s the other thing I like about a more elliptical model versus a funnel – is that it does depict for us the things that the marketing budget or process can’t control in impacting. Consumer choice, right? So, it very clearly highlights that there’s this inner loyalty loop, and experience matters and access matters.

If you could get to us once, but then you can’t make another appointment for three weeks, or we advertise something that had a six-week waiting time to get an appointment, we are going to lose that patient. And so, I think the elliptical model does a good job of giving us a more holistic view of how people are choosing and what is impacting that choice.

[00:05:41] PC: I think one thing to keep in mind is, in the traditional model, yes, it’s one step after the other, but there is no definition of the time that takes. So, especially in healthcare, people don’t seek out healthcare until they need healthcare. There is no indication on a traditional model of how long it would take someone to go through that process.

So, that is something that as a professional, you need to add that editorial and that information, as using the tool simply describes a process. Whether that process takes a day or five minutes as it might in digital, or it might take five years as it might in certain other types of promotion.

But that’s the part that’s not in the tool in it of itself, but that’s the role of the person using it to help educate and define what the purpose of it is.

[00:06:45] AM: I think that the other thing the funnel misses is the way that each piece is interconnected, so it’s not a clean line and that somebody sees our billboard, and then goes on our website, and then buys our thing.

It’s very rare that someone will drive past our billboard and then actually follow a call to action, right? So, it is good about showing us that we’re just building awareness and familiarity with our service, our brand, or whatever that is.

But there may be some people who see the TV commercial and then get the direct mail piece and are more likely to follow through with a call to action because they have some familiarity with this or understand the value proposition in a different way.

[00:07:31] DS: Yeah. So, I mean, Pattie, Abby’s talking here about external audiences, potential patients, and customers. What about how this applies to internal groups if you’re a chief marketing officer making decisions about your marketing approach?

[00:07:48] PC: For those who are in marketing, like a chief marketing officer that’s making decision-based budget decisions especially, or even staffing decisions, how are you staffing for the various levels? It’s informative and maybe directional, but it’s not the tool that’s going to provide all those answers. However, in conversations with peers who are not familiar with marketing or who need to understand maybe a little bit more because everybody has an opinion on marketing, but they may not be that familiar.

It’s a super useful tool to show there’s different levels of messaging, different levels of investment we need to be making. So, it’s a useful tool to educate peers, educate those who are maybe approving your budget, and others that it’s important for them to understand that investing all the money and awareness is then going to leave no money for all the other phases. And regardless of whatever tool you use, you need to invest in the non-awareness marketing because that’s where you’re converting patients.

[00:09:02] AM: Again, I think that marketing mix is so important. There was a time in my career when I probably over indexed the direct-to-consumer pieces and left the awareness pieces without enough love. And then when that happens, you start to get pushback from audiences who aren’t consumers but are still important around that awareness. So, physicians come to mind, right? And so, I think, again, you have to just balance your marketing mix with those awareness and direct-to-consumer pieces.

[00:09:33] PC: Yeah, I think that brings up one important thing is to take a step back from whatever tool, because that funnel – sure, awareness is at the top and it’s feeding, consideration and preference and ultimately buying, but it’s also feeding many other things. So, it’s not as though all the dollars spent on awareness, therefore, only should be measured for the ROI of patient conversion.

That awareness is feeding many things. As Abby just said, you’re standing in the community, your contribution to community… all those things are very important. Your relationship with legislators in the area, your relationship with other hospitals – Those are all things that are very important. That awareness is also feeding.

So, while this funnel might stand alone, it’s really a model that, I guess, if we had to depict, it would have these other little models to the side of it saying, “This is what it’s doing for community. This is what it’s doing for something else.” And also, you have all your competitors’ funnels at the same time, right?

So, a person is not only standing… Let’s say if you think of a person who we’re trying to target first with awareness and then bringing them through the funnel, that person is in other people’s awareness funnels as well. They’re not just standing alone in there. So, the tool is not useful in terms of – it’s lacking the depiction of that of what the context is. It’s very useful to show a very specific… either in budgeting or messaging or to educate around. There is a process here. It’s not completely, you just put an ad out and people come. So, it’s useful, but it doesn’t stand alone in and of itself.

[00:11:24] AM: So, the funnel is trash unless you’re trying to depict that there are a lot of people who see one thing and less people who see another – I think is what we’ve come to here.

[00:11:34] DS: Thinking about – we just talked about sort of filling the funnel, all the awareness. And then also, Abby, to your point earlier about on the elliptical where you have to keep reselling people… So much of that depends on the experience that people have when they purchase the first time, and then between the first and second and third and so on.

And then there’s also when we think about reputation. It’s the family and friends. It’s the word of mouth. It’s the organic, so talk a little bit about that relational aspect and how that completely unquantifiable metric fits into all of this.

[00:12:09] AM: Yes. I think it’s really critical to think about how the buy cycle has been disrupted, not just by digital tools, but by declining trust in institutions and physician referral, right? Like we have seen over the years… the tendency to use friends and family recommendations a lot more, and to trust that a lot more from a consumer perspective than a physician referral.

In many cases, physician referral is still really high, but we’ve seen it fall off a little bit and that word of mouth or friends and family recommendation increase in importance in influencing consumer choice.

I was a great example of this. I have a lot of experience in healthcare and choosing physicians, but our twins were born early and one of them got out of the hospital a lot sooner than the other one.

We needed a pediatrician because they won’t let you break those kids out of the NICU till you can prove that you’ve got a pediatrician. So, I just went on the Moms of Multiples Facebook group and was like, “who’s a pediatrician that’s great with twins?” and got a couple recommendations.

I chose one who happens to have twins herself and made an appointment right there, right? There was nothing linear or funnel-like about that experience. It also was a – it’s an important decision to me as a parent, but as an exhausted parent who needed a quick answer. I get that’s not always the case. If I’m shopping for a cardiologist, I probably am going to do a little more research that may be more funnel-like.

So, I think there may also be a difference in choice related to service lines or kinds of service. I wonder if that’s also why, like for oncology, we tend to see a lot of drop off between diagnosis to first appointment. Usually, we think that relates a lot to time, right? If there’s a long time, I’m gonna just go find somebody who can see me sooner, and that’s reasonable.

But I also wonder if I don’t just have time to do research after the shock has worn off a little bit more, and I may change my choice. Or who I want to follow that journey with me in that.

[00:14:15] PC: Yeah, I agree. And also, awareness is also – yes, we can measure it at times in our community, but I don’t know that the measurements are always truly reflective of what maybe a strong brand precedes that awareness as well. It’s hard to attribute just a hospital that’s been in a community for a very long time and has a good brand ahead of it.

How much of awareness is attributed to that versus other things that are more measurable? It’s hard to say. So, that kind of layer is that… That’s why it’s the largest, right? Because everything is funneled into there.

[00:14:56] AM: Next week, we’ll be doing a podcast on the difficulties of marketing ROI and why it’s so difficult to measure. I think Pattie just hit on one of those examples because those pieces are interconnected, but there’s still a lot of great ways to measure.

[00:15:11] PC: Right.

[00:15:15] DS: So, what is our advice with all of this? We’ve reframed our thinking. We’ve built the marketing elliptical; we’ve killed the marketing funnel.

[00:15:23] PC: But have we killed the marketing funnel?

[00:15:25] DS: We have not killed it.

I was supposed to open this by asking, “is the marketing funnel dead?” as the whole point of this podcast, and I missed the opportunity and now I’m trying to backtrack it.

[00:15:39] AM: You’re fired.

[00:15:42] DS: So, what do we say? What’s our advice?

[00:15:44] PC: I think, for me, the emphasis standing in the shoes of a chief marketing officer – you have the responsibility to educate people around you on marketing. How does it work? It’s really hard. I have found in my experience, it’s a little bit harder than if you’re the chief fill-in-the-blank officer where your discipline is really well defined.

Marketing… everybody’s a consumer, so everybody has an opinion on it, right? And they’re entitled to that opinion, but it shouldn’t influence business decisions. So, to me, you have that responsibility to educate the people that are important to the success of marketing for the organization.

So, using a tool. I’m not going to advocate only using a marketing funnel. I found it to be a useful, easy tool. I’m sure there’s other useful, easy tools, but there has to be a tool that at least provides that visual and that simplicity for a hugely complicated discipline, right? Marketing is very complicated.

We touched on digital. We touched on even out of home and other awareness. There’s so many avenues in terms of marketing investment that, as a leader, you need to package that somehow for your peers. You need to come to the table prepared to explain at some level how these all work together.

That’s your responsibility as a leader. So, using a tool that helps put them all in perspective without implying that it’s that simple, yet the depiction of it can be simplified.

[00:17:35] AM: I agree. I know I’ve talked a lot of trash about the marketing funnel, and I will continue to do that, but I don’t really care what tool someone uses to visualize their results or their investments or something like that. To Pattie’s point, they just need a way to do it – a way that’s simple enough to be understood by people who aren’t in the weeds about your click to call metrics or whatever who don’t understand how your paid search works, right?

Like, it needs to be at a high enough level to influence trust, basically, in the marketing leader. And it needs to be simple enough to understand that it’s useful, but let’s not oversimplify what we’re dealing with here. There are a lot of factors that influence patient volume, consumer choice, those sorts of things, and we need to continue to be in conversation about those regardless of what picture we put up in our slide deck.

That’s an ongoing conversation. It’s built on top of a relationship that you have with your C-Suite, with your other leaders, with your local marketing teams – whatever that looks like. And I’m just as interested in those conversations and relationships as whatever picture you use to depict your day-to-day work.

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