Most Direct Care owners can tell you what they spent on marketing last month. Far fewer can tell you what it brought back.
That's not a knock on anyone. Your books show marketing as one expense line, and your membership platform shows members. Nobody hands you the report that connects the two. So the question "is this working?" gets answered by feel: the panel seems to be growing, the website looks better, a few people mentioned the Instagram post.
Feel is a fine place to start. It just doesn't tell you whether you can afford to do more of what's working, or what to stop doing.
In October I ran a workshop on exactly this with Stephani McGirr of Amplify DPC. Stephani brought the marketing side. I brought the numbers. Out of it came a one-page scorecard: eight numbers you can pull in about fifteen minutes, on the same day each month. This post walks through those eight, what each tells you, and how to put them together into one answer.
For every dollar you put into marketing, how many come back, and how fast?
That's it. Every number below either feeds that question or tells you where the answer is breaking down.
One ground rule before we start. There are no industry targets on this scorecard, and that's deliberate. A practice in a small town with a $75 membership and a practice in a metro with employer contracts aren't playing the same game. Your own trend, month over month, is the benchmark that matters.
1. New members this month, by source. Count everyone who joined and tally where each one first heard about you: referral, website or search, social, employer, events, other.
If you don't know where people are coming from, add two questions to your enrollment form: Where did you first hear about us? and What made you decide to join now? The first tells you what built awareness. The second tells you what closed the decision. You need both, because people rarely move in a straight line. They see a post, hear about you at church, get frustrated with their current doctor, and then search for you.
2. Lead-to-member conversion rate. New members divided by inquiries (or by meet-and-greets; pick one denominator and stick with it). Next to it, track the median number of days from first inquiry to enrollment. Use the median so one slow decider doesn't skew it.
If inquiries are up but conversion is flat, the problem usually isn't awareness. It's what happens after someone reaches out: how fast you reply, and whether every meet-and-greet ends with a clear next step.
3. Cost per new member. Total marketing spend divided by new members.
Count everything: ads, agency or freelancer fees, software, events, printed pieces. Include anything you paid on a personal card. This is the number most owners have never calculated, and it's the one the rest of the scorecard leans on.
4. Average price per membership. Monthly membership revenue divided by active members. This is not your sticker price. Family plans, discounts and employer rates all land in this number, and it's often lower than owners expect.
5. Member lifetime value. Average monthly price times the average number of months a member stays. No stay history yet? One divided by your monthly churn gives you a working estimate of months.
These two answer the question we started with.
6. Lifetime value to cost-per-member ratio. Lifetime value divided by cost per new member. It tells you how many dollars come back over a member's life for every dollar you spent to bring them in.
7. Payback months. Cost per new member divided by your monthly gross margin per member. Gross margin per member is the monthly price minus the direct cost of caring for that member: clinical staff time, supplies, labs you absorb.
Here's a worked example. This is an example practice with round numbers, not a client:
Payback is the number I care about most as the CPA in the room. The ratio tells you whether marketing pays eventually. Payback tells you how much growth your cash can carry. A practice can have a great ratio and still feel squeezed, because it's paying for this month's new members with money that won't come back for five months. When you know your payback, you can decide how fast to grow before you hire, or before you spend.
8. Churn and net growth. Split cancellations into two counts: members who left within their first 90 days, and members who left after 90 days. Then net growth: new members minus everyone who left.
That split matters more than the total. Members who leave inside 90 days usually point to onboarding: they joined and never quite got settled. Members who leave later point to retention. They're two different fixes, and a single churn number hides which one you need.
Total marketing spend divided by total revenue. Again, there's no "right" percentage here. Watch your own trend. If spend is climbing as a share of revenue while numbers 6 and 7 hold steady or improve, you're investing in growth that pays. If spend climbs and the scoreboard slips, you've found something to look at.
The point of tracking eight numbers isn't to grade yourself. It's to know where to put your next hour. Stephani's framework maps each number to a phase of the patient lifecycle, so when one slips, you know which phase to work on:
The Direct Care Marketing Scorecard has all eight numbers on one page, with room to write this month and last month side by side. It's free, with no form to fill out:
Download the Direct Care Marketing Scorecard (PDF)
Pick a day, say the fifth of each month, and fill it in from your membership platform and your books. After three months you'll have something more useful than any industry average: a trend line for your own practice.
Marketing numbers don't live on their own. Your payback months shape how much cash you need on hand, which shapes what you can pay yourself and when you can hire. That's where we come in.
Book a Free Tax Strategy Session and bring your filled-in scorecard. We'll walk through what your numbers mean for your cash flow, your pay and your taxes.