Growth in telehealth is deceptively easy to misread.
Dashboards light up. Paid campaigns report strong ROAS. Retargeting looks like a hero. Branded search climbs. The team feels momentum.
And yet margins feel tighter. Scaling feels riskier. Operational strain creeps in quietly.
That’s not a marketing issue.
That’s a measurement issue.
The marketing efficiency ratio exists for exactly this moment when channel metrics feel impressive, but leadership still needs to know:
Is the business actually scaling efficiently?
MER is not a campaign metric. It’s a business truth test.
What Is the Marketing Efficiency Ratio in Marketing?
The marketing efficiency ratio (MER) is straightforward:
MER = Total Revenue ÷ Total Marketing Spend
If a telehealth brand spends $250,000 across paid media, content, creative production, agencies, and affiliate commissions and produces $750,000 in total revenue, its MER is 3.0.
When someone asks, "What is MER in marketing?" The operator's answer is this:
It’s the blended measure of how much revenue the entire business generates for every marketing dollar invested.
Unlike channel-level reporting, MER marketing thinking considers the entire system. It doesn’t ask which ad platform deserves the credit. It asks whether all marketing activity combined produces scalable output.
That difference is critical in healthcare.
Why MER Exists in Modern Growth Models
Traditional performance marketing was built around clean conversion paths. Click, purchase, done.
Telehealth does not work like that.
A typical patient journey may include:
- multiple research sessions
- comparison against competitors
- delayed sign-up
- clinical intake and review
- insurance or prescription workflows
- fulfillment logistics
- refill decisions weeks later
Attribution models struggle in that environment. They overcredit the last touchpoint, often retargeting or branded search, while undervaluing the upstream demand generation that created the conversion opportunity in the first place.
MER exists because leaders cannot run regulated healthcare businesses on distorted attribution alone.
When you measure total revenue against total marketing spend, you remove the incentive to fight over which channel “won.” Instead, you force the conversation toward system efficiency:
Is marketing investment increasing business output proportionally, or are we buying increasingly expensive revenue?
What MER Measures (Revenue vs Efficiency)
MER measures efficiency at the business level. It is not a profit metric. It is not a margin metric. It is not a channel diagnostic.
It answers one question:
For every dollar we invest in marketing, how much revenue is the business generating?
That allows leadership to track trend lines:
- Is MER stable as we scale?
- Does it improve with creative optimization and funnel refinement?
- Does it deteriorate when we increase spending too aggressively?
In telehealth, this blended efficiency view matters because growth is influenced not just by advertising, but by:
- onboarding friction
- clinician capacity
- shipping timelines
- support response time
- refill adherence
MER captures whether the entire growth engine marketing plus infrastructure is functioning cohesively.
Why Subscription Healthcare Depends on MER
Subscription healthcare is a delayed-value environment.
The first transaction rarely represents the true value of a patient relationship. Revenue continues through renewals, refills, and adherence-driven care cycles. But those revenue streams depend heavily on operational execution.
Here’s the structural reality:
If marketing performs well but intake flow creates drop-offs, MER declines.
If marketing scales but fulfillment introduces delays, refund rates may rise, compressing revenue and weakening MER.
If marketing acquires low-quality traffic that churns after one cycle, revenue fails to compound, and MER will eventually reflect that decline.
MER becomes a proxy for system alignment.
In subscription telehealth, profitable scaling requires coordination between:
Campaign metrics assume marketing controls growth.
MER reveals whether the infrastructure supports it.
For a platform like Bask Health, where care delivery, compliance, and digital operations intersect, this distinction is not theoretical. It’s foundational.
When MER Fails as a Standalone Metric
MER is powerful. It is also incomplete.
Because MER focuses on revenue relative to spend, it can mask profitability issues if not paired with margin awareness.
For example:
A rising MER paired with a shrinking contribution margin can indicate that operational costs are increasing faster than revenue. In telehealth, this might stem from pharmacy costs, logistics inflation, payment processing risk, or increased support demands.
Similarly, aggressive discounting can temporarily inflate revenue and stabilize MER while weakening long-term retention behavior.
There’s also the retention illusion. A company can maintain MER by continually acquiring new patients to replace churn. In the short term, MER appears healthy. Over time, acquisition dependence increases risk and volatility.
That’s why MER should be viewed as the efficiency layer within a broader framework alongside lifetime value, contribution margin, and payback sensitivity.
Efficiency without profitability is fragile.
Efficiency without retention is temporary.
Strategic Implications for Leadership Teams
For executive teams in telehealth, MER becomes a scaling gate.
When marketing spend increases, one of three things will happen:
- Revenue scales proportionally, and MER holds steady.
- Revenue scales faster than spending, and MER improves.
- Revenue lags spend, and MER declines.
The third scenario is the most instructive.
A declining MER during budget expansion rarely means “ads stopped working.” It usually indicates one of three structural issues:
- Traffic quality is deteriorating
- Funnel conversion is under strain
- Operational capacity is limiting revenue realization
This is where platform-level thinking matters.
If your intake systems, workflow management, or revenue tracking architecture are inconsistent, MER becomes noisy. Reliable decision-making requires clean revenue measurement and disciplined categorization of marketing costs.
That infrastructure layer is often overlooked in growth conversations, yet it determines whether MER reflects reality or misleads leadership.
Healthy telehealth scaling occurs when:
- Marketing investment grows
- Operational systems keep pace
- Retention remains stable
- MER trends flat or upward
That is defensible growth.
Actionable Takeaway: Run a MER Integrity Check
Instead of calculating MER once and celebrating the number, stress-test it.
Pull the last six months of:
Calculate monthly MER and observe the trend, not the snapshot.
Now ask:
- Did MER decline during periods of aggressive scaling?
- Did revenue realization lag behind acquisition volume?
- Did operational changes coincide with MER volatility?
If the answer is yes, your issue is unlikely to be confined to advertising performance.
MER is most valuable when it triggers investigation, not celebration.
In telehealth, sustainable growth is not achieved by squeezing more from campaigns. It is achieved by aligning marketing with infrastructure, retention, and margin discipline.
The marketing efficiency ratio doesn’t promise clarity.
But when interpreted correctly, it tells you whether your growth machine is compounding or quietly weakening under its own expansion.
And in regulated healthcare, that truth is worth paying attention to.
References
- Supermetrics. (n.d.). Last-click attribution: What it is and why it matters. Supermetrics. https://supermetrics.com/blog/last-click-attribution
- Shopify. (n.d.). Marketing efficiency ratio (MER): What it is and how to calculate it. Shopify. https://www.shopify.com/blog/marketing-efficiency-ratio
- Triple Whale. (n.d.). Marketing efficiency ratio (MER): What it is and how to use it. Triple Whale. https://www.triplewhale.com/blog/marketing-efficiency-ratio
