Revving the Virtual Care Growth Engine: 10 Rules for Getting DTC Right with Growth Vanguard

For years the smart money in virtual care was B2B. Sell to employers, ride PEPM, and let enrollment do the growing. The momentum has flipped, as our CEO, Keaton Bedell, clearly documented in an earlier post outlining the death of PEPM. The DTC model gives a company something its B2B counterpart never did: a controllable acquisition engine via a direct path to the end-user.

While DTC does provide such an engine, virtual care companies need to use the right fuel and set the right course for this engine to drive sustainable volume and economical acquisition. Many founders and growth teams find themselves stalling instead of speeding.

We wanted to go deeper on this topic, so we asked one of the best growth marketers we know to help us share some DTC best practices.

Tim Ming is the founder of Growth Vanguard, a leading DTC growth marketing agency specializing in patient acquisition for digital health companies. We worked with Tim to develop the 10 rules below. Whether you're in the formative days of building your marketing efforts, or find yourself stuck in the marketing mud, these rules are for you.

Rule 1: Make sure you have a compliant measurement infrastructure

The tools used in traditional consumer marketing, such as standard tracking pixels and cookies, can create serious privacy and compliance issues if they transmit protected health information or other sensitive data to third parties. See recent settlements against healthcare providers who used pixels.

Companies such as Ours Privacy and Freshpaint have built the healthcare-specific analytics infrastructure intended to allow organizations to measure marketing and patient journeys while maintaining HIPAA compliance. This is foundational for a fully functional patient acquisition motion. It's surprising how many virtual care companies have skipped this foundational step — without it, you aren't able to run above board campaigns at all.

Rule 2: Understand, and plan for, the full growth marketing stack

In addition to a compliant analytics infrastructure, the full growth marketing stack includes an analytics team that can support comprehensive tracking and attribution for web, mobile and calls (for many companies, this is an external partner), ad budget for campaigns, and a partner to support creative and administer your ad spend. Sounds like a lot, but if you get the full stack in place, you are set for scale. It's important to plan for the full investment of growth marketing early on, while achieving buy-in from leadership and the board. Set reasonable expectations for what is needed for a sustained and successful marketing effort from the start.

Rule 3: Optimize SEM first, before exploring other channels

The majority of organizations believe in the power of search, but they get restless with it too quickly. Just when their SEM efforts start showing signs of life, they rush to launch a new channel, splitting time and budget before it is fully optimized. When SEM starts working for you, the priority is to fully optimize that channel before you expand into other channels.

A few best practices to help you optimize:

• Structure the account by intent, separating brand, non-brand, and competitor traffic, and give each theme its own budget instead of pooling everything and letting the cheapest clicks eat the money.
• Hold the line on match types and negative keywords so spend flows to the highest-intent queries rather than leaking into less relevant, low-value searches.

Another misstep we see frequently with paid search is companies moving too cautiously in their initial spend. If you under invest at the outset, you won't learn fast enough. This can lead to writing off search prematurely. As a rule of thumb, a minimum budget of $5k per month is recommended for initial testing. The budget should increase to at least $10k per month once quality leads have been acquired and attributed.

Rule 4: Consider paid social as a fast follow

Paid social is rising in relevance. Once you've optimized your SEM spend, it's next up as a channel. Historically, for digital health companies, CAC for paid social was simply too high. In most cases, it ran at least 50% higher than SEM. That's now changed, and, in some cases, paid social is on par with SEM.

It's important to understand that paid social is a different level of intent than search and a different acquisition pathway, and your conversion funnel should reflect that. For instance, leads from paid social aren't filling out forms, they are making calls. It's a different funnel, so make sure you are effectively tracking, analyzing and attributing these leads.

Volume is your biggest lever. Programs that ship 10 to 15 creatives a week consistently outrun the ones shipping a handful, because the platforms and algorithms reward fresh signals. A good rhythm is to keep the winning creative hook or price cue constant and rotate the story around it, then promote winners into new directions rather than micro-tweaking losers.

For companies testing the effectiveness of paid social, a good starting point is allocating between 10-20% of budget to this channel. If your CAC is close to par with SEM, then it's game on. If CAC is still trending too high for paid social, you should transition that budget right back over to search.

Rule 5: Commit to rigorous testing and accountability

There is no substitute for continuous learning, but it's one of the hardest things to maintain in growth marketing. It's easy to get distracted or become complacent. The world is moving faster than ever, and consumer behavior is far from static. For every channel, every campaign, every touchpoint, you need to be testing, learning and refining.

Are you finding more efficient pockets, new keywords, new hypotheses? Are you constantly iterating and improving your ads and your website? Are you examining how you're engaging top of funnel versus deeper into the funnel? How are your results impacted by payer relationships, geographies or other nuances?

If "always be closing" is the sales mantra, "always be learning" should be your growth marketing motto.

Rule 6: Resist FOMO with AI

Many people feel like they are falling behind as AI continues to disrupt the marketing landscape. With paid search specifically, you might be worried that you're already behind the times when it comes to running AI ads vs SEM. In actuality, you're right where you need to be.

With Google, you have to demonstrate that you're ready for the next level of innovation by your media volume and velocity. In the meantime, make sure you're fully leveraging SEM and other channels, such as paid social, instead of burning energy worrying about missing the AI boat.

The same goes for campaign building and execution. AI is largely marketed to us as "magic." And while it can absolutely support massive efficiencies, you can't simply ask Claude for an SEM audit and get the results you need. On the campaign side, there are so many components that go into proper execution. It's fine to look at each piece and determine where you can augment with AI, but don't expect the technology to fully execute on your behalf. At least not yet.

Rule 7: Diversify your motions by going in-network with health plans

Being in-network with health plans quietly improves CAC, because a share of the traffic you pay for turns out to be covered, which lifts conversion and lifetime value on the same spend. It opens the largest pool of patients at the lowest incremental cost. Layering on additional motions, such as partner referrals and employer relationships will also help. But in-network is the best medicine if you're facing a cash-pay plateau or want to supercharge patient acquisition. DTC paid for by insurance is already real, not hypothetical. It is also a largely untapped opportunity. Based on a Bridge analysis of 2,752 DTC companies in virtual care, only 355 (12.9%) explicitly describe operating an insurance-based model.

Rule 8: Apply eligibility-aware messaging

Once you have diversified your motions, the advantage you have over a cold consumer brand is that you often know, from the data, who is likely to need the service. Use it. Message to the need rather than to the category, and put an eligibility or health check directly in the flow so individuals can self-qualify in a few clicks instead of wondering whether the benefit applies to them. That single step, an embedded "Do I qualify" checker, removes the most common reason eligible members stall.

Not all eligibility checks are created equal. There's a basic way of accomplishing this by simply checking whether a patient has an active policy or not, but doing this well is actually quite complex. Best practice calls for also determining whether the patient's benefit covers the specific service being provided and accurately estimating out-of-pocket costs the patient will incur. To help our partners accomplish this specific task, Bridge has built a custom eligibility check and out-of-pocket estimator that virtual care providers can easily drop into their sign-up flow.

Rule 9: Focus on lifecycle, CRM, and re-engagement

Activation is never a single email. It's a cadence that changes as the individual moves through the funnel: acquisition messaging in the first few months to introduce the program, then a shift toward education and adherence once someone is active. Consumers who do not act on the first pass get folded into a lighter quarterly re-engagement track rather than dropped. All of this runs on a CRM (HubSpot is a good home for it) that tracks each member's state and fires the right message at the right moment. The CRM is also what closes the loop, so you can see which touches actually produced activations and spend the next dollar accordingly.

Rule 10: Benchmark your performance

It's helpful to know how you're performing compared to industry benchmarks. Here are a few basic DTC benchmarks to get you started.

• Customer acquisition cost: Blended paid-search acquisition cost is typically in the low-to-mid hundreds, with branded terms only requiring a fraction of the budget needed for non-branded parameters.
• First-step funnel leakage: The first-step funnel drop-off is usually significant. Plan for 30-40% until you set your own benchmark.
• Conversion rates: Conversion rates can swing anywhere from the mid-teens to the mid-50s across campaigns, which is exactly why measuring attended visits matters.
• Measurement and optimization: Structural and measurement fixes on an existing account can move CAC by 20% on the modest end and considerably more when the starting point is messy.

Ready, set, go

Sustainable patient acquisition involves much more than buying ads. It requires the infrastructure to measure demand, discipline to optimize it, systems to convert and re-engage it, and reimbursement strategies that improve its economics. DTC gives virtual care companies control of the growth engine. Following these rules helps ensure you're off to the races.

For more growth marketing insights, feel free to visit the Growth Vanguard team here.

To learn more about how you can get in-network with health plans at scale, contact the Bridge team.