The American Marketing Association took promotion out of its definition of marketing in 2008. Inside most health systems, marketing still means advertising. Part of the reason is simple: impressions and clicks are easy to count, and the rest of the job is not.
That habit is about to cost patients. Adults covered through Medicaid expansion now have to document work, school or community service hours to keep their coverage, and prove eligibility twice a year instead of once. Most states start in January, and a few already have. The last time renewals piled up, during the unwinding after the pandemic, most people who lost Medicaid lost it to paperwork. The state had an old address. The notice was confusing. The deadline passed.
Those are communication failures. Health system marketing already owns the tools that address them: contact data, plain-language writing, patient messaging, the web path from a confusing letter to a person who can help and relationships with trusted voices in the community. None of it is promotion, and almost none of it shows up in a board report.
The natural partner sits down the hall. Every nonprofit health system has a team responsible for community benefit, and the IRS rules that team works under exclude activities done mainly for marketing purposes. That sets up the open question between Chris Boyer and Reed Smith. Should marketing power coverage outreach from behind the scenes and measure renewals instead of impressions? Or should the hospital’s name go on it, because patients open a message from their own doctor before one from the state?
Chris Bevolo takes the argument further. After 25 years in health system marketing, he launched ServingOverSelling, a call for health systems to move promotional spend into access, patient experience and community work. He is candid that cutting ads will not fix healthcare affordability, which he places mostly with insurers, PBMs and pharma. His case is stewardship. When patients cannot afford care, a dollar spent on self-promotion is hard to defend at any scale.
If a patient loses coverage in January over a letter they never understood, which department owned that letter?
MENTIONS FROM THE SHOW
- Healthcare’s Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com
- ServingOverSelling, Chris Bevolo’s movement asking health systems to reallocate promotional marketing spend toward serving patients and communities. The pledge, the serving and selling definitions and the private community signup are on the site: https://www.serveoversell.com
- Chris Bevolo, founder of Bearing 287, on LinkedIn: https://www.linkedin.com/in/chrisbevolo/
- ServingOverSelling launch announcement, September 27 2026: https://www.einpresswire.com/article/944590118/industry-veteran-launches-servingoverselling-movement-to-encourage-health-systems-to-curb-promotional-marketing
- The Reallocation, Chris Bevolo’s weekly LinkedIn newsletter. Find it from his LinkedIn profile. No direct link verified
- Joe Public Doesn’t Care About Your Hospital, Chris Bevolo’s book on transforming health system marketing. No link verified
- American Marketing Association definition of marketing, released January 2008. The 1985 definition it replaced named pricing, promotion and distribution. The current one covers creating, communicating, delivering and exchanging offerings that have value for customers, clients, partners and society at large
- One Big Beautiful Bill Act (Public Law 119-21), signed July 4 2025. KFF’s summary of the Medicaid work requirement provisions: https://www.kff.org/medicaid/a-closer-look-at-the-work-requirement-provisions-in-the-2025-federal-budget-reconciliation-law/
- KFF, “An Early Look at Policy Decisions as States Get Ready to Implement Work Requirements.” 43 states including DC must implement. Nebraska began enforcing May 1 2026, Montana July 1 and Iowa December 1. Arkansas began checking compliance July 1 without disenrolling anyone before January 2027. States showing a good-faith effort can get extensions no later than December 31 2028: https://www.kff.org/medicaid/an-early-look-at-policy-decisions-as-states-get-ready-to-implement-work-requirements/
- healthinsurance.org summary of the law’s coverage changes, including six-month eligibility checks for expansion adults starting in 2027: https://www.healthinsurance.org/blog/one-big-beautiful-bill-act-brings-sweeping-changes-to-health-coverage/
- KFF Medicaid Enrollment and Unwinding Tracker. As of September 2024, at least 25.2 million people disenrolled, 69% for procedural reasons and 31% found ineligible: https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/
- Congressional Budget Office estimate of the Medicaid provisions of Public Law 119-21, 7.5 million more uninsured in 2034 out of about 10 million for the law overall: https://www.cbo.gov/publication/61837
- IRS Instructions for Schedule H (Form 990), 2025. Defines community benefit reporting for nonprofit hospitals and excludes activities provided primarily for marketing purposes: https://www.irs.gov/instructions/i990sh
- Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
- Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
- Chris Boyer website: http://www.christopherboyer.com/
- Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
- Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social
From the cold open:
- “AI doom loop,” used in the cold open for the argument that AI tools monetize the work of human creatives while weakening the economics that pay for new human work, leaving future models less original material to learn from. The term circulates in commentary on AI and creative markets. No single originating source located, so no link
Recommendations from this episode:
- Chris: YouTube Kids, Google’s separate app for children, with parent-set profiles and age-filtered recommendations. Shows Chris mentions include Ms. Rachel and Sesame Street. Note that the free app does run limited paid ads, which Google requires to be family-friendly. YouTube Premium removes them: https://support.google.com/youtubekids/answer/6130541
- Reed: I Used To Work There, a storytelling podcast hosted by Kelly Kennedy where people tell real workplace stories, from disasters to the unexplained. Available on Apple Podcasts, Spotify and most podcast apps: https://podnews.net/podcast/i11bhg
