Business Review Healthcare · Telehealth Psychiatry OR / WA

MindRx Group
Business Review

A structurally advantaged W2 telehealth practice running a paid acquisition engine that is leaking 50% of its qualified demand at a single mechanical step. The patient is real, the providers are real, the demand is real — the constraint is the verification stage between form-fill and first appointment, and every other lever multiplies through it.

About the Business
MindRx Group is a psychiatric & behavioral health telehealth practice serving Oregon and Washington — 100% telehealth, insurance-billed, W2 clinician model. Founded July 2021, the practice now runs ~5,000 active patients across 13 PMHNP-BC providers (3 onboarding, 1 interviewing) with $10,500 patient LTV at $330 average insurance payout per 30-min visit. Current intake is ~100 new patients/month against a 300/month North Star — and the structural ceiling is supply, not demand.
90 days
Period Reviewed
5
Channels Audited
8
Competitors Mapped
4
White Space Bets
$21.8M
Annualized Gross Revenue
Section 1 · Executive Snapshot
Where we are. What's broken. What's the upside.
A 90-second read on the diagnostic: KPI dashboard, the four issues constraining performance today, and the four opportunities sized against measurable lift. The center of gravity is one stage of the funnel. Every numeric claim carries a confidence tag so the team can stay ahead of any KPI we're stating with thin evidence.
Confidence Levels Used Throughout
H Direct from primary data (BQ, kickoff hard facts)
M Derived/estimated from primary data
L Single-source claim or unvalidated estimate
⊕ Methodological Notes — How We Treat Uncertainty
A diagnosis is only as honest as the data behind it. Six rules govern how this Business Review handles the gaps:
1 · PMax economics treated as suspected, not confirmed. Stated CPA H shows 4.5× advantage; cost-per-PATIENT L is unknown and operator hypothesis is that PMax brings elevated spam. Reallocation is gated on patient-conversion signal flow.
2 · Effective patient CPA math is shown openly. $400 stated ÷ 50% verification = $800. The 50% multiplier is the weak link (single-source). Section 2A walks the math.
3 · Cost-per-patient by channel is shown alongside stated CPA with N/A for every channel that doesn't have stitched UTM-to-IntakeQ attribution. The visibility gap is part of the diagnosis (Section 2D).
4 · 12-month CPA timeline shows only what we have (90 days BQ) — earlier months are explicitly N/A and pending historical pull (Days 30-60).
5 · Previous-agency context is a known unknown. Logical Position kept budget in Search for 5 years; they likely had reasons we can't see in BQ alone (spam patterns, conversion-event definitions, account history).
6 · Confidence pills (H/M/L) appear inline next to every major numeric claim. If a tile or stat carries an L, treat it as a working assumption requiring validation, not a finding.
New Patients / mo H
~100
↓ 33% vs. 150–180 historical
Target: 300 / mo
Effective Patient CPA L
~$800
↑ Inflated derived: $400 ÷ 50%
Target: $500
Patient LTV H
$10,500
→ Healthy ~32 visits
LTV:CAC 13:1 effective
Verification Pass Rate L
50%
→ Static single-source · BAA gates SIG-02
Target: 75% by D90
Paid Dependency M
~95%
↑ Rising CPC +42% YoY H
Target: <75%
AEO / Organic Yield M
~0
→ 5 yrs flat (precise GSC pending)
Cat. shift: −58% CTR to AI H
⚠ Top 4 Issues — Constraining Performance Today
1
The funnel breaks at insurance verification — 50% of qualified form-fills are lost at a single mechanical step. Stated CPA $400 becomes effective patient CPA ~$800 because half the funded leads never reach a clinician. → ~25 patients / mo and ~$245K / mo gross revenue sit in this single stage
2
The Google Ads conversion signal is a form-fill, not a patient — making PMax look 4.5× cheaper on stated CPA H while cost-per-PATIENT remains unknown L. Operator hypothesis: PMax brings elevated spam, which collapses cost-per-patient parity vs. Search. The previous agency's budget concentration in Search for 5 years likely encoded this. → measurement gap, not a confirmed reallocation lever; Meta Pixel patient-form-fill event also unconfigured.
3
Bimodal review distribution — 80% 5★ on clinician care, 20% 1★ clustered on billing friction. The Oct 2025 admin-team meltdown surfaced as a 1★ keyword cluster ("cancellation fee", "predatory") that suppresses every paid impression and every brand search. → blocks the review-compounding loop
4
Zero AEO and zero formal PCP referral channel — no compounding moat as paid CPC inflates 42% YoY. Five years of SEO has produced zero organic patients. The category is shifting to AI-mediated discovery (−58% organic CTR) with no defensive content position. → structural fragility, not just inefficiency
↑ Top 4 Opportunities — Where the Upside Sits
1
Fix the verification stage — the highest-leverage single move. Mary Kay's billing-team rebuild + landing-page payer pre-screen + intake-form redesign moves pass rate 50% → 75%. → +25 patients/mo at constant spend · ↓ effective CPA $800 → $533 · ~$245K/mo gross
2
Pipe a true patient-conversion signal into Google Ads + Meta — then re-evaluate PMax. Step 1: redefine the Google Ads conversion event from form-fill to verified/booked-patient (offline upload from IntakeQ post-BAA). Step 2: ship Meta Pixel patient-form-fill event. Step 3: run a 30-day PMax cost-per-patient measurement. Reallocation upside is real M only if PMax cost-per-patient is also lower; if PMax brings elevated spam, the right move may be the opposite.
3
AEO greenfield + formal PCP referral network — build the compounding moat. 10 AEO articles in the open category lane (insurance + telehealth questions); structured outreach to 5–7 active PCP partnerships by D90 ($50–100 CPA vs. $800 on Google). → +15–25 patients/mo by D90, compounding through D365
4
Amplify the W2 + in-state + insurance-billed positioning. The DEA NPRM and the Done Global founder conviction (Nov 2025) are structural tailwinds. The category is consolidating away from the marketplace model — and MindRx is on the favored side, but the messaging doesn't say so yet. → permanent positioning moat as 1099 chains exit
Section 2 · Current State Diagnosis
Funnel · Channel Mix · Messaging · Data Visibility
Four audit lenses on the same engine. The funnel tells us where the business breaks; the channel mix tells us where structural risk is concentrated; the messaging section tells us why the category is consolidating in a direction the brand is structurally aligned with — but not yet talking about; the data-visibility lens tells us which of these we can manage today and which we're flying blind on. The visibility gap itself is part of the diagnosis.
2A

Funnel Performance & The Primary Growth Constraint

The funnel has one critical leak — and it's not where most of the budget assumes it is. Click → form-fill is healthy at the working CPA. The break sits one stage deeper, at Form Submit → Insurance Verified, where 50% of qualified, paid-for demand is lost on a single mechanical pass. Every downstream lever — show-up rate, retention, LTV — compounds against this stage.
L90D · DTC Patient Acquisition
BAA gating EHR data
Click / Session
~10,000 sessions 100%
↓ ~2.0% click-to-form · est. from $40K spend ÷ $400 stated CPA
Form Submit
~200 form-fills/mo paid + organic blend
↓ 50% verification pass rate · PRIMARY CONSTRAINT
Insurance Verified
~100 verified/mo 50%
↓ [DATA GAP] · BAA blocks IntakeQ/EHR linkage
Booked & Attended
~100 attended/mo est.
↓ [DATA GAP] · 1st→2nd visit retention unmeasured
Active Long-Term
~100 net new/mo ~$10,500 LTV
Form → Verified
50%
healthcare typical 70–90%
Stated CPA (Google)
$400
form-fill cost / verified rate
Effective Patient CPA
~$800
post-verification + show-up
LTV : CAC
13 : 1
healthy in absolute terms
⊕ Primary Growth Constraint
The funnel breaks at Form Submit → Insurance Verified.
~200 paid-for form-fills enter the funnel each month M. ~100 reach a verified-patient state H. Half of the qualified demand the business has already paid to acquire never reaches a clinician. The leak is not creative quality, not bidding strategy, not landing-page copy — it is one operational stage where commercial-payer eligibility, patient documentation, and admin handoff all collide. The result: stated Google CPA of $400 M becomes effective patient CPA of ~$800 L because every patient is paying for the one that didn't make it through verification.
Strategic implication: Solving verification is the highest-leverage single move in the engagement. Moving pass rate 50% → 75% creates +25 net patients/mo and ~$245K/mo gross revenue at constant media spend. Every other lever — including channel reallocation — multiplies through this stage. Fix this first, or fix everything else twice.
⊕ Effective Patient CPA · How We Get From $400 to $800
The doubling isn't a Google Ads number — it's the verification stage applied on top. Here's the math, with confidence on each input.
Stated Google CPA M
$400
Founder kickoff figure. Google Ads "conversion" event = form-fill, not patient. BQ 90-day blended is $197 (Search $246 / PMax $55) H — discrepancy may reflect time-window or how Anthony defined "stated."
÷
Verification Pass Rate L
50%
Single-source from founder. SIG-02 (verification rate signal) blocked on BAA execution — until that ships, we treat 50% as a working assumption, not a finding. True rate may be 30-70%.
=
Verified-Patient CPA L
~$800
What we don't know: the additional drop from verified → booked → attended → 1st-to-2nd visit. Each downstream stage that's <100% pushes effective active-patient CPA above $800.
What's anchored: $400 stated CPA (founder) and ~100 active patients/mo (clinical roster math). What's a working assumption: the 50% verification multiplier — single-source. Sensitivity: if true verification rate is 60%, effective CPA is $667; if it's 40%, effective CPA is $1,000. Resolution: SIG-02 (post-BAA) replaces the assumption with measured data; SIG-13 (retention cohort, post-BAA) adds the verified→active multiplier. Until then, every projection in this BR sized off "effective CPA" should be treated as directionally correct, magnitudinally uncertain.
2A·ii

Payer Mix · Where the Verification Drop Concentrates

Tier 1 · Fast Verifiers
Aetna · Cigna · UHC / Optum
Eligibility check turnaround~Same day
Estimated pass rate~70–80%
Verification frictionLow
ActionSteer paid intent here
Tier 2 · Moderate
Providence · BCBS
Eligibility check turnaround1–3 days
Estimated pass rate~50–60%
Verification frictionMedium
ActionPre-screen on LP
Tier 3 · Slow Payers
Moda
Credentialing lead time~4 months
Estimated pass rate~30–40%
Verification frictionHigh
ActionDe-prioritize until ops fix
◆
The 50% blended pass rate is a payer-weighted average. The drop concentrates in Tier 2 / Tier 3 payers where verification friction is structural, not operational. Steering paid intent toward Tier 1 payers (Aetna · Cigna · UHC) lifts the blended rate without touching the operational fix — a tactical lever inside the strategic one. Medicare · Medicaid · Apple Health remain excluded from the panel by policy.
2B

Channel Mix — Imbalance & Dependency Risk

⊕ Structural Imbalance + Dependency Risk
~95% of patient acquisition is paid-Google-dependent. The business is one CPC inflation cycle away from a margin event — and the category is already in one (mental-health CPC +42% YoY).
Over-Invested · Risk
Google Search
93% of Google budget · $246 stated CPA · single-channel concentration
Funding the entire business at a channel where mental-health CPC is rising 42% YoY. Vendor-managed (Logical Position) for 5 years; SEO content side has produced zero organic patients.
Misallocated · Broken
Meta Ads
$1K/mo spend · $0.38/click · 1.87% CTR · 0 measurable conversions
Pixel patient-form-fill event is not configured. Spend is live, click quality looks acceptable, but the entire acquisition signal is invisible. A single ops fix turns a leaky channel into a measurable one.
Investigate · Measurement Gap
Performance Max
7% of Google budget · $55 stated CPA H · cost-per-PATIENT unknown L
Stated CPA shows 4.5× advantage; cost-per-PATIENT is not yet measurable. Operator hypothesis: PMax produces cheap form-fills with elevated spam rate (the previous agency kept budget in Search for 5 yrs — likely had visibility we don't). Until patient-conversion signal flows through to Google Ads (Day-14 unblock), this is a signal to investigate, not a confirmed reallocation lever.
Acquisition Spend Mix · L90D H
$131K
Total Spend
Google Search 86%
Google Performance Max 6%
Meta Ads 2%
AEO / Organic ~0%
PCP / Patient Referrals ~0% formal
Stated CPA by Channel H
= Cost per Google Ads "conversion" event (form-fill)
$375 target
Google Search
$246
$246
Performance Max
$55
$55
Meta Ads
Pixel broken
N/A
PCP Referral
No tracking
N/A
AEO / Organic
No tracking
N/A
Cost Per PATIENT by Channel L
= Cost per actual new patient (verified + booked + attended)
Google Search
~$800 effective
~$800
Performance Max
N/A — operator hypothesis: spam-elevated
N/A
Meta Ads
N/A
N/A
PCP Referral
N/A · est. $50–100
N/A
AEO / Organic
N/A · est. compounding-zero
N/A
⚠
Why these two charts disagree. Stated CPA H is a Google Ads measurement of the form-fill conversion event. Cost-per-PATIENT L requires UTM persistence into IntakeQ + booked-appt conversion definition + 30-day baseline — all listed in Section 2D (Days 14–60). Until both charts can be drawn, treat the Stated CPA delta as a signal to investigate, not a budget-reallocation rationale. The previous agency kept budget concentrated in Search for 5 years; their account-level visibility likely included spam patterns and conversion-quality signals we don't yet have.
⊕ 12-Month CPA Timeline · Google Ads Blended L
Only the most recent 90 days have validated BQ data. Earlier periods are pending historical pull (Days 30-60). The shape over time matters more than any single point estimate.
$300
$200
$100
$0
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
~$200 BQ
~$197 BQ
~$197 BQ
Jun '25JulAugSepOctNovDecJan '26FebMarAprMay
What this shows: 90-day BQ pull (Mar–May 2026) gives a stable ~$197 stated CPA. What it doesn't show: the 9 months prior — including any seasonal swings, the budget cut from $50K → $40K, the Oct 2025 admin meltdown, and any legacy CPA spike that motivated the recent budget reduction. What to do with it: request a 12-month historical BQ pull (Day 30-60 deliverable) before any conclusions about CPA trajectory or reallocation are finalized.
Channel Spend % Stated CPA Contribution Trend Verdict
Google Search 86% $246 ~50 patients/mo ↑ CPC +42% YoY (category) Over-Invested
Performance Max 6% $55 ~50 conversions/mo ↓ CPA stable Under-Invested
Meta Ads 2% N/A — Pixel broken 0 measurable $0.38 CPC, 1.87% CTR Misallocated
PCP Referral Network — $50–100 est. 2 informal partners Dormant 5 yrs Latent
AEO / Organic — $0 marginal ~0 patients Cat. shift: −58% CTR to AI Latent
2C

Messaging — Why Current Positioning Misses What's Winning

⊕ Category-Winning Messaging vs. Current Positioning
The category is consolidating around a positioning MindRx already structurally embodies — W2 clinicians, in-state licensing, insurance-billed continuity. The marketing doesn't say so yet, and the strongest proof points sit invisible on the website.
⬆ What's Winning Post-1099 Implosion
Hook
Trust signal first. "Your provider answers their messages." "On staff, not on contract." Lead with continuity-of-care anxiety, not the diagnosis. Done Global / Cerebral patients are the most valuable audience right now.
Format
Specific, named, longitudinal. Real clinician names, multi-year patient testimonials (the Healthgrades Salim / Cary Shore archive is gold). The category is exiting "stock-photo telehealth" — specificity is the format.
Source
Earned + structured first-party. 200+ Birdeye reviews, 70+ Healthgrades — already collected. Category leaders are converting longitudinal review streams into landing-page social proof and AEO citation depth.
Authority
Regulatory + clinical. "W2-employed. In-state licensed. Commercial insurance only." The DEA NPRM and the Done Global founder conviction (Nov 2025) are tailwinds — patients are searching for the model that didn't fail.
⬇ What MindRx Is Currently Doing
Hook
Generic mental-health framing. Service-list copy. Hooks lead with conditions, not with the trust crisis the category is now navigating. The differentiator is the model — but the model isn't the headline.
Format
Stale & generic. 6+ "Morgan" testimonials reference a clinician no longer on roster. Current 13-clinician roster is underused on the page. Specificity is owned in the data and missing from the surface.
Source
Earned but invisible. 200+ flagship Birdeye reviews exist; site-side surfacing is minimal. Winter Hawks community sponsorship ($2,845 → Sunshine Division season 1) is on the books and not on the homepage.
Authority
W2 / in-state model under-claimed. The strongest moat in the category — never paid-per-script, never multi-state marketplace, never DEA-vulnerable — is barely surfaced. The structural advantage is not the message.
The structural gap is between what MindRx is and what MindRx says it is. The model is structurally aligned with where the category is consolidating; the marketing is still talking about the previous era. The unlock is making the model the headline — and surfacing the proof points already sitting in the review stream.
Birdeye Aggregate
4.3★
200+ flagship reviews
Healthgrades 5★ Share
~80%
on clinician care
Healthgrades 1★ Share
~20%
on billing / admin
"Morgan" Testimonials
6+
stale, must purge
AEO Citations
0
target ≥3 by D90
Review Distribution · n ≈ 270 across Birdeye + Healthgrades
Star Rating Share
~80%
~3%
~2%
~3%
~12–20%
5 ★ 4 ★ 3 ★ 2 ★ 1 ★
5★ Cluster (~80%)
Concentrated on clinician quality and continuity. "She really takes the time." "Salim responds in less than 24 hours." This is the proof the category is now searching for — and it's underused on the website and absent from paid creative.
3–4★ (~5%)
Mixed feedback, mostly process-related. Wait times, clinician transitions, payer-specific friction. Not a structural pattern; expected variance for a 5K-patient panel.
1★ Cluster (~12–20%)
Bimodal break — billing/admin friction post-Oct 2025 admin meltdown. Keyword cluster: "cancellation fee," "predatory," "punishment is one sided." Operational source; Mary Kay's billing-team rebuild is the unblock for review-compounding.
2D

Data Visibility — What We Can't Yet Measure

⊕ The Visibility Gap Is Part of the Diagnosis
Seven operational metrics needed to manage the funnel are unmeasurable today. $40K/mo of media decisions are being made on stated CPA when effective CPA is ~2× higher — because the attribution doesn't yet connect funnel stages to channel sources. The Day-14 unblocks below define what changes.
Metric We Need Current State Unblock Owner Window
Booked Appt → New Patient rate (overall) Data Gap IntakeQ/EHR linkage blocked BAA execution + IntakeQ data flow into BQ Anthony + Mary Kay + legal D0–D30 · gating
Booked Appt → New Patient by channel Data Gap no UTM persistence UTM stitched into IntakeQ patient record at form-fill Eng + Senior Growth Marketer D14–D45
Cost of Booked Appt by channel Partial Stated CPA = form-fill, not booked appt (Search $246 · PMax $55) Redefine Google Ads + Meta conversion event from "form-fill" to "booked appt" (offline upload from IntakeQ post-BAA) Senior Growth Marketer D7–D21
Cost of New Patient by channel Data Gap blended only (~$800 effective) UTM persistence + redefined conversion + SIG-12 monthly P&L Jarred + Doug D30–D60
GA4 default-channel-group breakout Broken property G-TX7C26MFBE deprecated Audit existing GA4 or replace; configure form-fill + booked-appt events Josh Flores + Anthony D14 deliverable
SEO KPIs vs benchmark (avg position · CTR · impressions) Data Gap GSC access blocked on OAuth 2FA · 5-year baseline ≈ 0 organic patients Google OAuth 2FA confirm; SIG-07 weekly GSC delta signal live Anthony (2FA) + Senior Growth Marketer D1–D3
Sources by booking CVR (GA4) Data Gap sequenced behind GA4 + booking-event def GA4 fix → booking-event configured → 30-day baseline accumulates Senior Growth Marketer + Mary Kay D14–D60
The visibility gap is strategic, not operational. Until these signals exist, the team is making $40K/mo budget decisions on form-fill CPA when effective patient CPA is 2× higher, and choosing channel reallocation on stated metrics that may not match what's actually producing patients. Three unblocks (BAA · GA4 · OAuth 2FA) are the gates that turn the audit from estimate-driven to measurement-driven. Every signal we ship dual-writes to local + Supabase + Airtable so recommendations land in front of the team for approval, not in a slide deck.
◆
What we can answer today (provisionally). Google Ads "conversion" CPA: $246 Search · $55 PMax · $197 blended (BQ 90-day). Meta CPA: N/A — Pixel not configured. Effective patient CPA (after 50% verification drop): ~$800. Organic SEO baseline: ~0 patients in 5 years (precise GSC metrics pending). Everything else marked "Data Gap" above is what the next 14 days unblock.
Section 3 · Category Dynamics
How the telehealth psychiatry market actually behaves.
The category is in the middle of three structural shifts — a regulatory consolidation that favors the W2 / in-state / insurance-billed model, an AI-mediated discovery shift that destroys old SEO economics, and a buying-cycle pattern driven by insurance resets and clinical urgency. Diagnosing without the category is diagnosing half the engine.
⊕ Demand Cycle · 12-Month Patient-Acquisition Index
Insurance-billed mental-health acquisition has two peaks — Q1 deductible reset and a Q3 back-to-school / fall-anxiety surge. Summer is the trough. Q4 is dominated by year-end utilization, not new acquisition.
14%
12%
9%
8%
7%
5%
5%
8%
12%
10%
7%
3%
JanFebMarAprMayJun JulAugSepOctNovDec
Three things to know: (1) Q1 (Jan–Feb) is the deductible-reset peak — patients who delayed care now use new benefits. Highest paid efficiency window. (2) Late August → October is the second peak — back-to-school, fall anxiety, ADHD evaluations. (3) Q4 (Nov–Dec) is a deceptive trough — existing patient utilization spikes (use-it-or-lose-it deductibles) but new-patient intake softens. Paid spend should ramp into Q1, not out of it.
⬆ Sub-Segment · Faster Growth
PMHNP-Led Telehealth Psychiatry
+12–15% YoY · projected fastest-growing healthcare role through 2032 (HRSA)
MindRx plays here directly — 13 of 13 clinicians are PMHNP-BC. Talkiatry is MD-heavy; LifeStance is mixed. PMHNP supply expansion is the structural advantage on hiring as well as on positioning. The sub-segment lane is owned by training pipeline, not by capital.
→ Overall Category · Steady
OR + WA Commercial Telepsych
$1.2–1.32B TAM · $755M SAM · MindRx target SOM ~$39M (~5%)
9.6M adults × 23.4% AMI × ~50% commercial × 45% med-mgmt × 13 visits/yr × $330. The market is large enough that share capture is a credible 12–36 month story without out-competing scaled multi-state players head-to-head.
Shift 01
1099 Marketplace Model Imploding
Done Global founder convicted Nov 18, 2025 — first federal prosecution of a telehealth co. for illegal drug distribution. Cerebral $3.6M DOJ settlement (Nov 2024) + $7M FTC (Apr 2024). The category is consolidating away from the marketplace model. MindRx is on the favored side, but the messaging still doesn't claim it.
Shift 02
DEA NPRM Tailwind for W2 + In-State
Federal Register Jan 17, 2025 proposes a permanent telehealth controlled-substance framework that structurally rewards W2 + in-state-licensed + insurance-billed practices. DEA flexibility extension runs through Dec 31, 2026. Regulatory winds are MindRx-shaped.
Shift 03
AI-Mediated Discovery Disrupting Search
Organic CTR down 58–61% on AI-Overview queries (Seer Interactive, Sep 2025). Mental-health CPC up +42% YoY (LocaliQ). The classical SEO engine is collapsing inward; AEO content authority — citation in LLM answers — is the defensive asset, and currently ~0 brands in OR/WA telepsych own it.
⊕ Patient-Acquisition Triggers · The Annual Rhythm
Jan 1 → Feb 28
Deductible Reset Peak
Index 12–14. Highest paid efficiency window. Patients who delayed care use new-year benefits. Brand search + Google Search peak; landing-page payer pre-screen highest-leverage here.
Mar → Jun
Steady Build
Index 7–9. Demand normalizes; testing window for creative + landing-page experiments. Time to ship AEO content into rising AI-search citations.
Jul → Aug
Summer Trough
Index 5. Patients vacation; clinician burnout peaks. Lowest CPC efficiency; budget should taper. Paid breathing room for lifecycle and infrastructure work.
Late Aug → Oct
Fall Surge
Index 10–12. Back-to-school, fall anxiety, ADHD evaluations. Second-highest acquisition window. Search intent shifts toward "ADHD diagnosis OR/WA" and pediatric/young-adult psych.
Nov → Dec
Existing-Patient Utilization
Index 3–7. New-patient intake softens; existing patients use deductible-met benefits. Retention/visits-per-patient drives revenue, not new acquisition. Q4 is a retention quarter, not a paid quarter.
◆
Strategic implication. The category rewards three structural alignments MindRx already has: W2 + in-state + insurance-billed (regulatory tailwind), PMHNP-led specialty depth (workforce growth lane), and OR/WA geographic concentration (mass-marketplace players can't replicate state-level continuity). The execution gap — verification leak, channel concentration, zero AEO, no formal PCP referrals — is what's keeping the structural alignment from compounding into share.
Section 4 · Core Problems
Four problems. Ranked by impact.
Each problem is named, traced to its root cause, and quantified by 90-day impact. Sorted by severity — Problem 1 is the highest-leverage fix and the strategic floor under everything that follows.
Problem 01 · Critical
50% insurance-verification drop turns paid spend into half-economics
↑ Severity
Half of every paid form-fill never reaches a verified-patient state. The leak is operational — eligibility check turnaround, payer-specific friction, intake handoff — not creative or media. Stated CPA $400 becomes effective patient CPA ~$800 because every funded patient is paying for the one that didn't make it through. This is the strategic floor: every other lever multiplies through this stage.
Cause
Form does not pre-screen for payer panel; verification batched, not real-time; admin-side friction post-Oct 2025 reorganization. Tier 2/3 payers (Providence, BCBS, Moda) drag the blended rate. BAA execution is gating SIG-02 (verification drop-off signal) — Mary Kay's manual log is the pre-BAA proxy.
Impact (L90D)
~25 net patients/mo recoverable at constant spend if pass rate moves 50% → 75%. ~$245K/mo gross revenue sitting in this single stage. ~$735K over 90 days unrealized.
Problem 02 · High
Channel measurement gap — the conversion signal flowing into Google Ads is form-fill, not patient
High
Stated CPA shows Search $246 / PMax $55 — a 4.5× delta H. But "stated" measures form-fill cost, not patient cost. The previous agency kept budget concentrated in Search for 5 years — likely encoding spam-pattern visibility we don't have in BQ alone. Operator hypothesis: PMax brings cheap form-fills with elevated spam, which would collapse the CPA delta when measured against verified/booked patients. Meta compounds the problem — $1K/mo of spend with patient-form-fill Pixel unconfigured produces zero measurable conversions despite acceptable CTR (1.87%) and CPC ($0.38) H.
Cause
Two layered measurement failures. (1) Google Ads conversion event = form-fill (not booked or verified patient) — so all bid optimization, audience signals, and PMax algorithms are training on a noisy proxy. (2) Meta Pixel patient-form-fill event wiring incomplete — engineering ticket. The structural fix is to redefine "conversion" upstream of channel reallocation decisions.
Impact (L90D)
Reallocation upside is real M only if PMax cost-per-patient is also lower than Search's. If PMax brings elevated spam, the right move may be the opposite of what stated CPA suggests. Until patient-conversion signal flows into Google Ads + Meta, channel rebalancing is a working hypothesis, not a confirmed lever.
Problem 03 · High
Bimodal review distribution suppresses both paid efficiency and brand search
High
~80% of reviews are 5★ on clinician care; ~20% are 1★ clustered on billing friction post-Oct 2025 admin meltdown ("$480 cancellation fee," "predatory," "punishment is one sided"). The 1★ keyword cluster is what every prospective patient sees on brand search — suppressing CTR on $40K/mo of paid Google and undermining the entire trust positioning the category now rewards.
Cause
Operational, not marketing. October 2025 admin-team exit + Advanced MD platform migration created billing-friction surface area. New billing team in-flight (Mary Kay's track). Loop 4 (review compounding) is deferred until the operational fix lands — prompting more reviews on a broken process amplifies the problem.
Impact (L90D)
5–10 patients/mo recoverable from CTR lift on paid Google + brand search once 1★ share drops below 10%. Compounds: review velocity 2× baseline once Loop 4 activates. Clinician-care signal becomes the headline, not the billing complaints.
Problem 04 · Medium
Zero AEO + zero formal PCP referral = no compounding moat against +42% YoY CPC inflation
Medium
5 years of SEO vendor effort has produced zero organic patients. PCP referral relationships are 2 informal contacts (Bridgeport, Embark) — no structured outreach, no CME/case-presentation cadence. The category is shifting to AI-mediated discovery (−58% organic CTR) at the same time mental-health CPC inflates 42% YoY. The paid engine is becoming structurally more expensive while no compounding asset is being built to offset it.
Cause
SEO scope inside a paid-Google vendor relationship — content built for keyword targets that don't index in AI summaries. PCP outreach treated as relationship-management overhead, not a structured channel with measurable CPA. AEO is greenfield — Anthony hadn't heard the term at the prospect call.
Impact (L90D)
15–25 patients/mo by D90 from 10 AEO articles + 5–7 active PCP partnerships at $50–100 CPA vs. $800 effective on Google. Compounding through D365 — content authority + relationship equity are durable assets, not paid impressions.
Section 5 · Competitive Landscape
Where competitors sit. How they win. Where the white space is.
Eight competitors mapped across two axes (model + geographic concentration), creative/messaging patterns, and acquisition strategy. The narrative is consistent across every dimension: the category is consolidating in MindRx's structural direction — and the execution gap is the only thing keeping that consolidation from compounding into share.
5A Positioning Landscape
Two structural dimensions define telepsych today: model (Marketplace / 1099 ↔ W2 / Specialty) and geographic concentration (Multi-State Sprawl ↔ In-State Continuity). MindRx sits in the W2 + In-State quadrant — and no scaled competitor occupies the same coordinates in OR/WA.
⬆ W2 / Specialty Practice
Marketplace / 1099 ⬇
Multi-State Sprawl →
In-State Continuity →
Multi-State · W2 / Specialty
In-State · W2 / Specialty
Multi-State · Marketplace
In-State · Marketplace
LifeStance
Talkiatry
Two Chairs
Cerebral
Done Global
Brightside
Headway
Mindful Therapy Grp
MindRx Group
MindRx occupies a uniquely defensible coordinate — W2 specialty practice with deep in-state OR/WA concentration. LifeStance and Talkiatry are W2 but multi-state; the marketplace cluster (Cerebral, Done, Headway, Brightside) is fighting a regulatory headwind that strengthens MindRx's lane every quarter. Mindful Therapy is in-state but mostly therapy + 1099 — not a structural replicator. The position is owned. The execution gap is what keeps it from compounding into category authority.
5B Creative & Messaging Patterns
How each competitor talks to the same OR/WA patient. Two patterns dominate the post-1099 era: trust-signal-first messaging and longitudinal clinician proof. The marketplace cohort is still running pre-2024 generic-mental-health framing — that gap is the messaging white space.
Brand Positioning Creative / Messaging Channel Strength Where they win Where we win
MindRx Group
In-State · W2 · OR/WA · PMHNP-Led
 W2 telepsych specialty practice; insurance-billed; OR/WA only Generic mental-health framing. W2 / in-state moat under-claimed; stale "Morgan" testimonials; Winter Hawks invisible Google Search (concentrated) — —
LifeStance Health
Multi-State · W2 · NASDAQ:LFST
 "Outcomes-focused practice management" — 8K clinicians, FY25 profitable ($1.42B rev, $146M cash flow) Outcomes-led; payer-network breadth as headline; aspirational clinician imagery Paid Search · SEO · Brand Scale, payer breadth, M&A capacity (PNW consolidation risk for clinician labor) In-state continuity; PMHNP specialization; founder-led culture
Talkiatry
Multi-State · W2 · MD-heavy
 "Value-based behavioral health" + AI scribe; 800+ psychiatrists, 60+ payers, 45 states MD-credentialed authority lead; AI scribe as differentiator; tech-forward UX Paid Social · Brand · SEO Series D Feb 2026 ($210M); MD-heavy roster appeals to acuity-conscious patients PMHNP workforce-growth lane; in-state regulatory simplicity; insurance-billed continuity
Cerebral
Multi-State · 1099 Marketplace
 Subscription telehealth; controlled-substance prescribing footprint shrinking post-DOJ/FTC settlements Discount/access-led; brand recovery-mode after $3.6M DOJ + $7M FTC settlements Paid Social · Brand recovery Brand recall (negative-leaning); price accessibility Trust position (W2, never DEA-vulnerable); insurance-billed continuity; OR/WA depth
Done Global
Multi-State · 1099 · ADHD-Focused
 ADHD-focused 1099 telemedicine — founder convicted Nov 18, 2025 (federal drug distribution) Effectively dormant for new-patient acquisition post-conviction — Pre-2025: ADHD search-term dominance, now collapsing Direct beneficiary of patient migration away from convicted operator
Headway
Multi-State · Marketplace · Therapy-Forward
 Insurance-first marketplace for therapists/coaches; Series D Jul 2024 at $2.3B valuation Marketplace-discovery framing; "find a therapist" hook; payer-acceptance breadth SEO · Paid Search · Brand SEO scale on therapist-search terms; payer-network breadth Psychiatric medication management (not therapy-only); W2 continuity vs. marketplace churn
Brightside
Multi-State · Subscription
 Subscription-priced med + therapy; Series C-II Jul 2025 (back-to-back C rounds) Subscription-pricing transparency hook; member-care framing Paid Social · Brand Subscription pricing simplicity for the cash-pay segment Insurance-billed (no surprise fees); W2 clinician continuity
Two Chairs Psychiatry
Multi-State · W2 · Hybrid
 "In-home + telehealth psychiatric care" — W2, insurance-billed; not in OR/WA per current footprint Hybrid in-home + telehealth as differentiator; clinician-quality narrative Brand · Paid Search Hybrid in-home model where deployed OR/WA market presence and payer-panel depth
Mindful Therapy Group
In-State · 1099-Heavy · Therapy + Med
 Portland-local; therapy-leaning; mixed model (1099 weighted) Local-clinician network framing; therapist-led acquisition Local SEO · Brand Local SEO on Portland-specific terms; therapist density W2 retention model; insurance-billed continuity; PMHNP medication-management depth
5C Acquisition Strategy
How each competitor actually acquires patients. Three patterns dominate the W2 cohort — payer-network breadth as the SEO lever, brand-search compounding through clinician profiles, and PCP referral structuring. None of them are out-spending MindRx — they're out-systemizing.
Brand Primary Acquisition Lever Content / mo PCP Referral Structure Webinar / CME AEO / SEO Authority Outbound
MindRx Group
 Google Search (concentrated) ~0 2 informal None ~0 organic patients · 5 yrs None
LifeStance
 SEO + Paid Search + Brand 12+ Structured PCP outreach in major metros Quarterly clinical-content webinars Top-3 on "find a psychiatrist [city]" Payer-side relationships
Talkiatry
 Paid Search + AEO + Brand 10+ Tech-stack referral integrations (Epic) CME credits for PCPs AI-Overview cited on insurance Qs Employer-side B2B2C
Headway
 SEO marketplace 20+ (therapist profiles) Marketplace discovery (no formal PCP) None Dominant on "therapist [insurance]" Therapist-side recruiting
Two Chairs
 Brand + Paid Search ~6 Hybrid PCP + in-home referral Targeted clinician CME Mid-tier on category Qs Healthcare-system partnerships
Brightside
 Paid Social + Brand ~4 None formal None Mid-tier on "depression treatment" None
Cerebral
 Paid Social (recovery-mode) ~3 None None Brand-recovery focused None
Mindful Therapy Group
 Local SEO + Brand ~2 Local-PCP informal None Local Portland authority None
5D Where MindRx Sits in the Landscape
◆
MindRx has structural advantages no scaled competitor can replicate in OR/WA. W2 + in-state + insurance-billed is the regulatory-favored model in a category that just convicted a 1099 founder and is awaiting a permanent DEA framework. PMHNP-led specialty depth aligns with the fastest-growing healthcare workforce category through 2032. 13 active providers across the OR/WA panel of 6 commercial payers. ~5,000 active patients, $10,500 LTV, 4.3★ aggregate. The position is unambiguous.

The execution gap is what's keeping the position from compounding into category authority. ~0 content/mo vs. LifeStance / Talkiatry at 10–12+. 2 informal PCP partnerships vs. structured competitor outreach. 0 AEO citations vs. Talkiatry-cited AI Overviews. The competitive read is unambiguous: out-system, don't out-spend.
5E White Space — Where No Competitor Is Playing in OR/WA
Four lanes are uncontested or under-occupied in OR/WA telepsych. Each maps to a structural advantage MindRx already has. None require winning a head-to-head fight against scaled multi-state players.
⊕ White Space 01
PMHNP-Led Specialty Authority Content
10–15 high-intent insurance + telehealth questions ("Does Aetna cover telehealth psychiatry in Oregon?", "Is BCBS Washington telepsych in-network?") sit uncontested in AI summaries across OR/WA. Talkiatry owns the multi-state version; MindRx can own the state-specific lane authentically — 13 PMHNP providers, 6 payers, 5 years of OR/WA-only practice.
Defensibility: High · 12–18 month moat once cited · compounding asset
⊕ White Space 02
PCP Referral Structure (5–7 Active Partnerships)
Bridgeport Family Medicine + Embark are informal today. The structured outreach lane is empty in Portland metro — Mindful Therapy is therapist-led, multi-state players are too big to do clinician-to-clinician at the local level. CPA $50–100 vs. $800 effective on Google. Compounds through relationship equity.
Defensibility: Very High · relationship-based · permanent moat once built
⊕ White Space 03
Post-1099 Trust Migration Positioning
Done Global founder convicted Nov 2025. Cerebral $3.6M DOJ settlement Nov 2024. The patients leaving these platforms are actively searching for the model that didn't fail — W2, in-state, insurance-billed. MindRx is structurally that model and isn't yet saying so. Hook + landing-page positioning shift, not a new channel.
Defensibility: Medium-High · timing-bound · 12–24 mo migration window
⊕ White Space 04
Longitudinal Clinician-Continuity Storytelling
200+ Birdeye reviews + 70+ Healthgrades, including multi-year longitudinal patient testimonials (Cary Shore archive 2019–2024). The proof is already collected — it's just not on the website, not in paid creative, not in AEO content. Marketplace competitors structurally can't produce this; W2 multi-state players don't have the same in-state density.
Defensibility: Very High · earned over years · structurally unique
Section 6 · Growth Opportunities
Four strategic directions. Each tied to a measurable lift.
These are the strategic bets, not the tactical plan — the 30-60-90 will translate them into execution. What follows is the point of view: where the leverage sits, the expected impact range, and why this is the right move now.
Opportunity 01 · Highest Leverage
Fix the verification stage — the strategic floor under everything else
Quick
The 50% verification drop is the single highest-leverage point in the entire system. The lever is mechanical, not creative — landing-page payer pre-screen, real-time eligibility check, intake-form redesign for Tier 2/3 payers, and Mary Kay's billing-team rebuild closing the operational loop. Pass rate moves 50% → 75% and every other lever in the engagement multiplies through this stage at 1.5× the leverage they had before.
Strategic Direction
Reframe the form-fill → first-appointment journey as a single conversion surface, not three handoffs. Add a payer pre-screen before the form so Tier 3 patients self-route. Surface real-time eligibility status to the patient. Eliminate the batch-verification queue. The patient should know within 30 minutes whether they're verified — or be redirected before the form-fill.
Expected Impact
↑ Verification 50% → 75%
+25 patients/mo at constant spend
↓ Effective CPA $800 → $533
~$245K/mo gross revenue
Why This Is Leverage
This is the upstream constraint. PMax reallocation, AEO content, PCP referrals, retention work — all sit downstream of verification. Solving here is the strategic floor that every other lever compounds against. Skipping this lever and shipping the others is paying for the leak twice.
Opportunity 02 · Sequenced
Pipe a patient-conversion signal into Google Ads + Meta — then re-evaluate channel mix
Sequenced
The current channel debate (Search vs. PMax) is being held on the wrong KPI. Stated CPA H = form-fill cost; cost-per-PATIENT L is unknown. Until the conversion signal flowing into Google Ads = a verified/booked patient, every reallocation decision risks optimizing toward cheap spam. The opportunity is sequenced: fix the signal first, then re-run the comparison, then decide.
Strategic Direction
Step 1 (Days 0-21): Redefine Google Ads conversion event from form-fill to booked-or-verified patient via offline conversion upload from IntakeQ (post-BAA). Ship Meta Pixel patient-form-fill event Day 7. Step 2 (Days 21-60): Run 30-day cost-per-PATIENT measurement on existing Search vs. PMax allocation. Step 3 (Days 60-90): Reallocate based on cost-per-patient, not stated CPA. The previous agency's 93%-Search concentration is a working signal — we don't override it without measurement.
Expected Impact
↑ Decision quality on $40K/mo
→ Channel reallocation becomes measurement-driven
+10–15 patients/mo from Meta (if Pixel fix surfaces an underutilized channel) M
PMax reallocation upside: conditional on Step 2 result L
Why This Is Leverage
Cheap to ship; high decision-quality return. The team stops debating channels on a noisy KPI and starts optimizing them on the right one. If Step 2 confirms PMax cost-per-patient is also lower, reallocation lands with conviction. If it shows the opposite, the team avoids a costly mistake. Either outcome is a win.
Opportunity 03 · Compounding
AEO greenfield + formal PCP referral network — build the moat against CPC inflation
Mid
Mental-health CPC is rising 42% YoY. AI-Overview is eating 58% of organic CTR. Paid-Google is becoming structurally more expensive, and there's no compounding asset to offset it. The fix is two parallel builds: 10 AEO articles in the open OR/WA insurance + telehealth lane, and structured PCP outreach to convert 2 informal partners into 5–7 active referral relationships by Day 90.
Strategic Direction
AEO becomes a first-class channel — content built for citation in AI summaries, not for keyword density. PCP referral becomes a structured channel — clinician-to-clinician outreach with named contacts, case-presentation cadence, and CPA tracked monthly. Both compound: content cited by AI keeps citing; PCP relationships keep referring.
Expected Impact
+15–25 patients/mo by D90
≥3 AEO citations on target queries
5–7 active PCP partnerships
↓ Paid dependency 95% → 75%
Why This Is Leverage
The compounding lane. AEO content + relationship equity get cheaper-and-better as they age. Paid Google gets more expensive every quarter. The mix shift bends unit economics in MindRx's favor every quarter forward — and immunizes the business against the next CPC inflation cycle.
Opportunity 04 · Positioning
Amplify the W2 + in-state + insurance-billed positioning — the regulatory tailwind is structural
Long
Done Global founder convicted Nov 2025. Cerebral and Brightside in capital-recovery mode. DEA NPRM proposes a permanent framework that rewards W2 + in-state + insurance-billed. The category is consolidating in MindRx's structural direction — but the marketing is still talking about generic mental health. Reframe the homepage, paid creative, and AEO content around the model itself; surface the clinician roster, the Healthgrades archive, and the 200+ Birdeye reviews as the proof.
Strategic Direction
Make the model the headline. "Real psychiatry. On Zoom. By W2 clinicians who answer their messages." Purge stale "Morgan" testimonials, surface the Winter Hawks community partnership, replace stock-photo telehealth visuals with clinician-named, longitudinal patient-quoted social proof. Everything earned over 5 years becomes the headline acquisition asset for the next 3.
Expected Impact
↑ Trust signal across all channels
↑ Brand-search CTR 15–25%
↑ Patient-migration capture
Permanent positioning moat
Why This Is Leverage
Permanent moat. Heritage + regulatory positioning don't decay; they appreciate as the category continues to consolidate. The work done here doesn't reset — it stacks. And the migration window (12–24 months as 1099 chains exit) is now.
Section 7 · Growth System (MH-1 Differentiator)
The differentiator isn't more reporting — it's a system that converts inputs into compounding patient acquisition.
Most growth engagements operate as three disconnected functions: paid media, content, and operations. The MH-1 system connects them through a structured loop where every output feeds back into the next input — performance compounds week-over-week instead of resetting at the start of every campaign.
Inputs
BQ baselines + Google Ads / Meta data
Verification + intake operational signals
Birdeye + Healthgrades review stream
Clinician roster + payer-panel data
Category + competitor scan (weekly)
PCP partner relationship signals
→
System
Daily SIG-01/02/03 signal triggers
Weekly review velocity + CTR loop
AEO content → AI-citation feedback
Channel-mix auto-rebalancing
Verification-rate guardrails + alerts
Monthly P&L + retention cohort review
→
Outputs
↓ Effective patient CPA, compounding
↑ Verification pass rate (D90 target 75%)
↑ AEO citations on target queries
↑ Active PCP partnerships
↑ LTV via retention cohort signal
↑ Net-new patients/mo toward 300 target
◆
For MindRx: the system unlock is closing the verification-rate → CPA → media-allocation feedback loop, while AEO and PCP relationships build the compounding moat in parallel. Daily signals (Tier 1) catch operational drift; weekly signals (Tier 2) catch creative + organic drift; monthly signals (Tier 3) catch retention + capacity drift. The system surfaces decisions; the human approves them. 15 signals across 3 tiers, dual-written to local + Supabase + Airtable.
Section 8 · Strategic Arc
Stabilize · Scale · Compound
The strategic sequencing — not the tactical plan. Each phase produces the conditions the next phase needs. Day-90 milestone: 100 → ~162 net-new patients/mo at $500 effective CPA. Day-365 destination: 300 patients/mo at sustainable economics. The 30-60-90 execution detail is the next deliverable.
Phase 1 · Stabilize · Days 0–30
Fix the floor before scaling the engine
Three structural fixes have to land first because every other lever compounds against them. Without these, gains downstream are wasted. BAA execution, GA4 functional state, and verification-stage redesign are non-negotiable Phase 1 outputs.
Priority · Verification rate moves 50% → 60%
Landing-page payer pre-screen + intake-form redesign + Mary Kay's billing-team rebuild. SIG-02 daily signal live (post-BAA).
Priority · Channel measurement unblocked
Meta Pixel patient-form-fill event ships Day 7. GA4 audit complete Day 14. SIG-01/03/07 (Google + GSC) live.
Priority · Stale-asset purge + brand audit
"Morgan" testimonials removed; Winter Hawks partnership surfaced; clinician roster updated to current 13 + 3 onboarding.
Phase 2 · Scale · Days 30–60
Reallocate to the channels that work; build the channels that compound
Once the floor is stable, leverage shifts to amplification — PMax pilot scales, AEO content begins shipping, PCP outreach moves from informal to structured. The mix begins shifting from concentrated-paid to diversified-compounding.
Priority · PMax reallocation pilot live
20% Search → PMax 60-day pilot. Daily CPA monitoring. Vendor decision (Logical Position) finalized. Stated CPA target: ≤$200 blended.
Priority · 5 AEO articles shipped
Insurance + telehealth + OR/WA-specific queries. SIG-08 weekly citation audit running. Target: ≥1 AI-Overview citation by Day 60.
Priority · 3–4 active PCP partnerships
Bridgeport + Embark formalized; 2 new clinician-to-clinician relationships built. Monthly case-presentation cadence designed.
Phase 3 · Compound · Days 60–90
Occupy the white space; compound what's been built
With the engine stable and the new channels active, the final phase moves to compounding — verification at 75%, AEO citations rising, PCP network at 5–7 active, and the W2-positioning moat surfaced across every customer-facing surface.
Priority · Verification at 75%, effective CPA at $500
Tier 1 payer-steering live. Real-time eligibility surfaced. SIG-02 trending healthy. The strategic floor is rebuilt.
Priority · 10 AEO articles + 5–7 PCP partners
Compounding moat live. 15–25 patients/mo from non-paid channels. Paid dependency drops below 80%.
Priority · Provider hiring pipeline scoped
Cary's LinkedIn-thesis recruiting moat live for D90+. Credentialing pipeline started for 4-month payer lead times. Capacity scoping for 200+ patients/mo trajectory.
◆
The 100 → 300 path is two arcs. Days 0–90: 100 → ~162 patients/mo (marketing levers + operational fixes). Days 90–180: 162 → 220–250 (AEO + PCP compounding; review rating drift). Days 180–365: 220–250 → 280–320 (provider headcount expansion comes online; full system compounding). The 90-day milestone is the inflection point — the marketing levers stop pulling and the compounding assets take over.
Section 9 · KPI Guardrails
When we act. Not just what we see.
A reporting system tells you what happened. A guardrail system tells you what to do about it. Each metric below has a healthy threshold, a trigger threshold, a defined action, and an owner — so the team isn't waiting for the next monthly review to react.
Metric Healthy Trigger Action Owner
Verification Pass Rate > 65% (D60), 75% (D90) < 55% / 7 days Mary Kay billing audit; landing-page payer pre-screen check; reroute Tier 3 traffic to manual queue within 48 hrs Mary Kay
Effective Patient CPA < $600 > $750 / 14 days Pause bottom-quartile keywords; reallocate 10% Search → PMax; verify SIG-02 not regressing Jarred (MH-1 GM)
1★ Trailing-90d Share < 10% > 15% / 30 days SIG-11 keyword-mining surfaces topic; escalate to billing/admin track; pause Loop 4 prompting until clean Mary Kay + Jarred
Form-Fill Rate ≥ 200 / mo (paid + organic) < 150 / mo / 14 days Audit GA4 + Meta tracking; check landing-page conversion math; ship A/B test on hero asset within 72 hrs Senior Growth Marketer
AEO Citations on Target Queries ≥ 3 cited (D90) 0 cited / 60 days SIG-08 weekly audit reviewed; content-format adjustment (FAQ schema, payer-specific Q&A); ship 1 article/wk Senior Growth Marketer
Active PCP Partnerships ≥ 5 active (D90) < 3 active / 60 days Outreach cadence audit; case-presentation calendar reset; clinician-to-clinician CME proposals shipped within 2 weeks Jarred + Cary
◆
How guardrails operate. Thresholds are reviewed weekly and adjust to the prior 4-week trailing average — guardrails compound, not pause, the system. Tier 1 daily signals (SIG-01/02/03/04/05) trigger same-day actions; Tier 2 weekly signals (SIG-06/07/08/11) trigger weekly cadence reviews. Actions execute automatically; the meeting is to debate exceptions, not read the report.
Section 10 · What Happens Next
From this diagnosis → the 30-60-90 Plan → the path forward
This is the diagnosis. The next meeting translates it into a tactical plan with channel-by-channel detail, named owners, and the operating cadence. Between now and then, here's what's already in motion and how we'll align on the engagement path forward.
This Week · Data Visibility Unblocks
What ships before the next meeting
Seven workstreams already in motion — most are designed to close the visibility gap so Day-14 decisions are measurement-driven, not estimate-driven.
  • BAA execution aligned with MindRx legal + Mary Kay (gates IntakeQ/EHR linkage)
  • Google OAuth 2FA confirmed → SIG-01/03/07 daily Google + GSC signals live (unlocks SEO KPIs vs. benchmark)
  • GA4 audit on existing property G-TX7C26MFBE; replace if broken — Day 14 deliverable (unlocks default-channel-group breakout + sources-by-CVR)
  • Conversion event redefinition in Google Ads + Meta from form-fill to booked appointment (offline upload pipeline scoped post-BAA)
  • UTM persistence into IntakeQ patient record scoped (unlocks per-channel CPA and Book→New Patient by channel)
  • Meta Pixel patient-form-fill event ships Day 7 — turns invisible $1K/mo spend measurable
  • Stale-asset purge ("Morgan" testimonials) + Winter Hawks block drafted; Logical Position vendor-scope conversation prepped for Day 14
Next Meeting
30 · 60 · 90 Day Plan Presentation
A channel-by-channel build of the next 90 days. Specific tactics, named owners, named metrics, and the operating cadence the team will see week-to-week.
  • Channel-by-channel quarterly plan (Verification · Paid · AEO · PCP · Brand)
  • 15-signal cadence map (Tier 1 / 2 / 3) + Airtable recommendations workflow
  • Expected-impact targets by phase + KPI guardrail thresholds
  • Resource & team mapping (MH-1 + MindRx ops + LP vendor decision)
Beyond Trial · Path Forward
We'll align on the path forward together
Two engagement paths are typical at the end of trial — a continued focused engagement, or an expanded scope as outcomes compound. The next meeting is where we agree on which.
  • Continue — current scope with verification-fix engine and AEO/PCP build running
  • Expand the Team — add co-pilot specialists as outcomes compound (AEO content, PCP/CME, lifecycle)
  • Operating cadence transitions from weekly trial reviews to a monthly performance dashboard rhythm
100% refund if we don't continue after the trial.