In an era of seismic change in healthcare — marked by rising costs, fierce competition, workforce shortages, and patients demanding seamless, digital-first access to care — the role of the Chief Marketing Officer has never been more complex or consequential.

Today’s healthcare CMOs are not just brand stewards; they are strategic architects. They are responsible for building trust, driving growth, navigating reputational risk, and ensuring their organizations remain both human-centered and digitally fluent.

So, what keeps them up at night? It’s not just market share or media metrics. It’s the pressure to prove ROI, the race to adopt AI responsibly, and the challenge of engaging diverse audiences in ways that are authentic, data-driven, and deeply personal.

The fast, fierce pace of change

“One of our greatest challenges is navigating the rapidly evolving landscape — whether it’s shifting regulations, new executive orders, or forthcoming legislation — and effectively communicating these changes across the organization while preparing for what lies ahead,” said Paul Matsen, Chief Marketing and Communications Officer at Cleveland Clinic.

For Blake Long, Vice President of Brand and Marketing at Allina Health in Minneapolis, the challenge is broad and deeply unpredictable. “It’s the whole stew of things,” he says. “It comes down to uncertainty — and how we’re going to chart our success moving forward.”

Financial pressures and structural deficits

Nearly every CMO interviewed acknowledged that financial strain is a persistent stressor — and that the pressure to do more with less is intensifying.

“The way reimbursement rates are set up is not keeping up with the rising costs of care,” Long says. “You have to be conservative with finances as a result, and yet you can’t cut your way out of financial headwinds — you also need to find a way to grow.”

Erin McDonough, Executive Vice President and Chief Marketing & Communications Officer at Memorial Sloan Kettering Cancer Center, puts it more bluntly: “We’re in the most competitive cancer market in the country, and yet we face annual budget reductions while needing to drive brand awareness to capture patients actively seeking care following a devastating diagnosis,” she says.

“Most hospitals experience an annual structural deficit,” McDonough adds. “And one of the first places CFOs look for savings is the marketing budget — often without fully understanding the value those dollars drive. A CMO’s challenge is to be good stewards of the organization while continuing the work that connects patients to the best possible care and outcomes.”

Measuring what matters

CMOs also face increasing expectations to demonstrate marketing’s impact with precision — an area where healthcare has historically lagged.

Long is leading Allina’s efforts to build smarter measurement systems. “When it comes to reporting, we can track down to the number of patients within specific guidelines,” he explains. “If a patient clicks an ad, logs into their portal, or fills out a form, we can capture that data. But if they take a different path — say, call a number or come in through an untracked referral — it becomes harder to measure. So while we’re reporting on performance, we’re not always seeing the full picture.”

McDonough reflects on the shift in skillsets that today’s healthcare marketers need: “When my career began, you didn’t need to be a data analyst or understand SEO—those concepts barely existed in our world,” she says. “Today, hard skills are imperative. You need the technical expertise to optimize performance, measure impact, and continuously evolve to stay ahead of the curve.”

The expanding scope of the CMO role

The modern healthcare CMO wears many hats—collaborator, strategist, convener, and sometimes even mediator.

“It’s essential to be someone who can build strong relationships across the organization—from administrative to clinical leadership—while also bringing deep marketing expertise,” says Matsen. “Staying on top of the latest technology trends is equally important. To succeed, you need the ability to translate complex clinical strategies into clear, impactful marketing plans.”

Long agrees. “CMOs bring a unique perspective because they operate across the entire organization, while most executives are focused on specific domains,” he says. “A big part of the job is bridging gaps between leaders and departments—there’s certainly a strong element of diplomacy in the role.”

Deb Pappas, Vice President and Chief Marketing & Communications Officer at Connecticut Children’s, adds: “You need vertical and horizontal skills. It’s really understanding the business—financially and clinically. You’re often the one helping to break down silos.”

Building an AI roadmap

Hospital CMOs are also increasingly responsible for leading the charge on AI integration — and the experimentation phase is well underway.

“We’ve gained valuable experience using a wide range of AI tools—for social media, podcasting, editing, and content versioning,” says Matsen. “For instance, once we’ve developed a core piece of content, AI enables us to adapt it into different formats, like turning a full article into a script or short-form video.”

Many CMOs cited Paul Roetzer, founder and CEO of the Marketing AI Institute and co-host of The Artificial Intelligence Show, as a key resource for keeping up with rapid advances in AI.

At Connecticut Children’s, Pappas has already seen AI’s effect on her team’s digital strategy. “We’ve seen our organic website traffic drop as AI-generated overviews become more prominent in search results, but our content is performing well within those summaries,” she says.

“That forces us to rethink everything — from our SEO and website strategy to how we’re optimizing online scheduling. And what happens when, one day, an AI agent is the one scheduling care? That’s a real question.”

Pappas led a full-day department retreat entirely focused on AI. The result? Pilot programs exploring content ideation, name generation for new services, competitive analysis, and deeper integration of AI into research and analytics.

“Like many health systems, we’re in the early adoption phase,” she says. “But the big question is: how do we move from experimenting with AI to fully transforming our strategy and execution?”

Supertargets are everywhere

As people live longer and baby boomers form a large and aging patient base, demand for care at adult hospitals is surging. Major academic medical centers are focused on serving patients across the full continuum, from primary care to advanced surgical procedures. Some, like the Cleveland Clinic, also attract patients willing to travel for specialized care. That level of demand brings its own marketing challenge: helping patients access the right care quickly and seamlessly in a crowded, often backlogged system.

But while many hospitals are overrun, others face the opposite problem. Pediatric hospitals, for instance, are grappling with a shrinking pipeline of patients. “The pediatric population is declining—a national trend,” says Deb Pappas, Vice President and Chief Marketing & Communications Officer at Connecticut Children’s. “And on top of that, there’s a shortage of pediatric subspecialists across the country, which creates access to care and longer appointment wait time challenges, making my role as a CMO even more complex.”

With fewer babies being born, Pappas says it’s increasingly difficult to compete for what they call “new-to-system” patients. That means marketing must work harder to position Connecticut Children’s as the preferred provider for a lifetime of care.

Patient experience and consumer expectation

While the patient experience isn’t always under the CMO’s direct oversight, nearly every marketing executive interviewed listed it as a top concern.

“The entire experience needs to feel seamless — from the website to the operating room,” Long says. “Patients shouldn’t feel like they’re navigating a maze of silos, which is all too common in healthcare. That’s where marketing can play a powerful role in creating a more cohesive and human-centered journey.”

Megan Mahncke, Chief Marketing and Communications Officer at Intermountain Health, adds that consumers today bring expectations shaped by retail, travel, and e-commerce. “Over the past decade, consumers have gone from being relatively passive to expecting everything instantly,” she says.

“So how do you bring an industry as deeply personal as healthcare along to meet people where they are — whether that’s through online scheduling or access close to home? They look at everything from a consumer lens, and they bring that same mindset to healthcare.”

She adds, “People and consumers are often not limited by geography, and yet healthcare is very much defined by sites and places that receive care. It’s a challenge for us to meet those kinds of consumer expectations. But I do think, as an industry and with the addition of technology, we are starting to catch up and provide more for patients everywhere.”

In response, Connecticut Children’s has launched several innovative initiatives. Two years ago, the system opened a Fetal Care Center and previously formed pediatric care alliances with adult health systems in Connecticut and New York. Their neonatologists now staff multiple NICUs and well nurseries, including two of their own NICUs. Additionally, the system entered into a joint operating agreement with The Village for Families and Children, allowing behavioral health clinicians to integrate into the Connecticut Children’s Care Network of clinically integrated primary care practices.

At Intermountain, change management has been key. The system shifted its mindset from “Here’s how we work” to “How can we simplify this for the patient?”

Real-time feedback matters more than ever

Mahncke is also focused on capturing feedback faster — and acting on it.

“We have a couple of different avenues for what I call real-time feedback,” she says. “We send out a lot of surveys, but the lag time can be significant. And when someone has an experience — whether it was incredible or didn’t meet their needs — if we don’t respond within 24 hours, we’ve missed an opportunity to say thank you or to make things better. That’s where we’ve made a big leap forward.”

Innovation — and the lack of time to think

When asked what never gets enough attention on their to-do lists, CMOs consistently gave the same answers: learning new skills and having time to think about innovation.

“There’s not quite enough time,” says Matsen. “We have so many different areas to be knowledgeable about and are responsible for. So I think keeping all of that in balance, finding and setting new priorities is always something we work on.”

Looking beyond the healthcare sector is another priority for Pappas. “One area I know I need to focus on more is identifying best practices outside of our industry,” she says. “Finding the time to explore what other sectors are doing—and spotting relevant examples we can apply to healthcare—is always valuable.”

As the role of the healthcare CMO continues to evolve, one thing is clear: success requires more than just marketing expertise. It demands agility, cross-functional leadership, digital fluency, and the vision to anticipate what’s next. Whether it’s navigating financial headwinds, harnessing AI, or reimagining the patient journey, today’s CMOs are at the center of healthcare transformation—balancing the pressure to deliver results with the imperative to build trust and drive meaningful, lasting impact.

The post What keeps healthcare chief marketing officers up at night appeared first on Becker’s Hospital Review | Healthcare News & Analysis.