Client: American Society of Health-System Pharmacists (ASHP)
Challenge: A decade of strong membership growth masking emerging vulnerabilities — churn reaching 30%, retention slipping among students and new practitioners, employer subsidies declining, and short-term tactics papering over structural problems
Outcome: A 10-point membership growth strategy delivered to CEO and COO; retention rebalanced against acquisition; communication overload addressed; member value gaps identified and mapped to a concrete execution roadmap
The Situation
Most associations call Sequence when something is wrong. Membership is falling. Revenue is contracting. A board is asking hard questions. The call comes from a place of urgency, sometimes crisis, and the work begins with triage.
ASHP was different.
When Hannah Vanderpool, VP of Member Relations at the American Society of Health-System Pharmacists, reached out to Sequence, ASHP wasn’t in trouble. The organization had experienced a decade of steady membership growth. Member satisfaction was high — 72% overall, rising six points year over year. The association had a strong staff, a track record of innovation, and a genuine culture of member intimacy that most organizations can only aspire to.
Vanderpool had read an ASAE article about how the American Medical Association had grown membership dramatically — particularly among students, young professionals, and health system groups. Sequence’s Chris Vaughan had been interviewed for that piece. She cold called him.
What followed wasn’t a rescue conversation. It was a strategic one. ASHP had noticed signals — early indicators that the decade-long growth trajectory might not be sustainable — and leadership wanted to get ahead of them before those signals became problems.
“Most people call us when they have a problem,” Vaughan recalls. “Things are going badly and they need help figuring out how to make it better. ASHP didn’t have a problem. They thought maybe they might have a problem soon and they didn’t want that to happen. That really struck me — they were that on top of it and that ahead of things. It was unusual. Super refreshing.”
That decision — to bring in strategic support proactively, with the flexibility to think clearly and act deliberately — is the first and most important thing the ASHP story teaches. As Vanderpool put it at the end of the engagement: “Don’t wait for a crisis to bring them in. You’re kind of frozen then. We had the flexibility to really brainstorm and blue sky and be visionary rather than trying to fix a boat that’s rapidly sinking.”
What We Found
What the data revealed was a picture that looked healthy on the surface but had meaningful cracks underneath.
Growth had peaked — and the engine was showing strain. Total membership had grown steadily from 2013 through 2022, reaching its peak that year. But 2022 and 2023 showed the first meaningful declines. New memberships were holding relatively steady, but defections had risen and renewals were slipping — particularly among the segments that represent ASHP’s future.
Churn had reached its highest level in a decade. The overall churn rate hit 30% in 2023. That number was being masked by strong acquisition — ASHP had been filling the bucket faster than it was leaking — but the strategy was increasingly fragile. Retention among students had collapsed from 53.2% in 2021 to 28% in 2022, recovering only partially to 33.5% in 2023. New practitioner retention was holding below 47%. The industry median retention rate for professional associations is 90%. ASHP was running at 75% — 15 points below the benchmark — and leadership had not been tracking it in those terms.
Short-term tactics were creating long-term problems. ASHP had implemented a range of acquisition and retention tactics — free trials, extended memberships, discounted student programs including “Free P1” — that generated short-term bumps but failed to build lasting loyalty. Many students who joined through free programs failed to transition to paid memberships. Discounted and free memberships had reduced dues revenue. The underlying issue, as Sequence’s analysis identified, was that these efforts were treating the symptoms of churn, not the cause: a value proposition that wasn’t compelling enough to sustain long-term membership, particularly for early-career and student segments.
Satisfaction was high — but satisfaction wasn’t translating to retention. 70% of members reported high satisfaction. 30% were churning annually. These two facts coexisted, and the tension between them was the most important finding in the dataset. Members valued what they got from ASHP — particularly CE, clinical guidelines, and member discounts — but many were joining for specific transactional reasons rather than out of long-term commitment to the organization. When employer subsidies disappeared — the leading reason for non-renewal at 86% of lapsed members — there was no deeper relationship to hold them.
Competition was becoming a strategic threat. 40% of lapsed members reported joining another organization — ACCP or APhA — that they felt better met their needs. This wasn’t just attrition. It was market share loss to direct competitors. And with fewer students entering pharmacy school overall, ASHP’s historically significant student membership base faced a structural headwind that acquisition tactics alone could not solve.
The communications problem was hiding in plain sight. Sequence went further than most consultants — enrolling as ASHP members themselves to experience the membership firsthand. What they found: “You guys are overwhelming us with communications. You’re so excited to share everything that you’re doing that you’re actually killing us with information.” ASHP had grown complex and developed communication habits to match — but volume without relevance was producing disengagement rather than connection. Open rates were suffering. The “more is more” assumption was wrong.
There was a generational gap in the value proposition. The pharmacy profession was changing. Fewer students were entering pharmacy school. The needs of early-career practitioners and students — student loan debt, financial management, wellbeing, work-life balance — were meaningfully different from the needs of established practitioners who had been loyal members for decades. ASHP had historically resisted broadening its programming beyond “professional with a capital P” services. Sequence’s diagnosis was direct: you have to look at these members as whole people, not just as professionals with scientific practice needs.
“They pointed out new service offerings that ASHP should make that I historically had resisted,” Vanderpool said. “What our students and new practitioners are struggling with was student loan debt or how to manage finance or wellbeing and resilience. And Sequence was really good to say — you’ve got to look at these people like whole people. That really made me pause.”
The Approach
Priority strategies addressed the most urgent vulnerabilities:
Going deeper into member data and tracking retention by segment monthly — giving ASHP the discipline to manage retention as actively as it managed acquisition. The shift from monitoring annual totals to tracking segment-level retention in real time was itself a meaningful organizational change.
Strengthening ASHP’s position as the definitive clinical hub for health-system pharmacists — conducting a content audit, launching a branded identity campaign, and expanding sub-specialty navigation to make ASHP feel essential and irreplaceable rather than convenient and interchangeable.
Revising the organizational and group membership model to appeal to employers and health systems — shifting the membership sale from individual pharmacist to institutional buyer, creating organizational reasons for health systems to invest in ASHP membership for their pharmacy staff. This mirrors the model Sequence designed for the AMA that drove record membership through health system group enrollment.
Re-evaluating the members-only content strategy — auditing what was freely available versus genuinely exclusive, considering gating high-effort content like podcasts, and reassessing open access to clinical guidelines. Like the ADA, ASHP had significant resources accessible to non-members that diminished the value of the membership decision.
Identifying and targeting at-risk members using behavioral data — defining early warning indicators (no login activity in 60+ days, missed renewal window, no section or CE engagement) and using automation to intervene before members lapsed rather than after.
Reducing communication overload through a comprehensive audit of all outbound communications — delivering the kind of disciplined, relevant, well-timed messaging that drives engagement rather than the high-volume approach that was producing disengagement.
Mid-term strategies built the foundation for sustained growth:
Developing tailored career pathway toolkits for each career transition — student to new practitioner, new practitioner to established practitioner, practitioner to pharmacy executive — so ASHP felt like a longitudinal professional partner rather than a point-in-time resource.
Expanding personal and financial support offerings to serve whole-person member needs — partnering to deliver wellbeing and financial tools that serve early-career members where their real needs are, not just where ASHP had historically been comfortable.
Building a student-to-young-professional pipeline strategy — strengthening the connection during school, capturing personal email addresses before graduation, and sustaining the relationship through the critical transition when employer subsidies often disappear.
Promoting ASHP’s sections more effectively — leveraging the data showing that section participation significantly boosted member satisfaction and retention, but that awareness of sections was low and their value was undersold.
The Result
The strategy is now in execution. Detailed action plans have been shared with ASHP’s internal working teams across each of the ten strategic priorities.
The most immediate measurable impact came from the communications diagnosis. ASHP moved quickly — engaging a communications consultant to redesign its email strategy — and early results showed higher open rates. Less frequency, more relevance, better results. The principle Sequence identified translated directly into measurable improvement within the engagement window.
The rebalancing of acquisition and retention focus — from an almost exclusive emphasis on new member acquisition to genuine investment in retention — gave Vanderpool and her team a fundamentally different framework for where to direct resources. “I learned that I really focused more on acquisition to fill the bucket of total membership,” she said. “And I wasn’t as balanced in looking at retention. The data showed you’ve been doing great with acquisition, but if you really want to bump up total membership consistently, you need to put as much attention on retention. So it helped me rebalance my efforts.”
The engagement also produced something harder to quantify but equally important: organizational clarity. “Working with Sequence on our membership trends over the past many years really clarified for me where we were doing well and where we really need to pivot. I have a much clearer path now on what I need to focus on — whether it’s recruitment or retention, which membership constituencies, or what IT strategies I need to continue to have a really strong membership trajectory. I don’t think I would have had the discipline to do that myself.”
“Don’t wait for a crisis to bring them in. You’re kind of frozen then. We had the flexibility to really brainstorm and blue sky and be visionary rather than trying to fix a boat that’s rapidly sinking. I feel very fortunate that we were in that position. I feel like we’ve come out even stronger and even more optimistic.” — Hannah Vanderpool, VP Member Relations, American Society of Health-System Pharmacists
What This Means for Your Association
Most associations engage strategic consultants reactively. Something has gone wrong. Membership is declining. Revenue is falling. A major initiative has failed. The board is asking questions that staff can’t answer. In those situations, consulting can absolutely help — but the work starts under pressure, with fewer options, and with less time to be thoughtful.
ASHP shows what’s possible when an organization engages proactively. Because Vanderpool and her team came to Sequence before the trends became a crisis, Sequence could do something most clients can’t afford: go deep. Analyze data going back a decade. Identify the structural causes rather than just the surface symptoms. Design a 10-point strategy rather than a 2-point intervention. And give the organization the time to implement deliberately rather than reactively.
The signals ASHP saw — churn creeping up, student retention collapsing, early-career members treating the organization transactionally, employer subsidies declining — are not unique to pharmacy. They appear across professional associations in medicine, law, engineering, accounting, and dozens of other fields. The question isn’t whether those signals will appear. It’s whether your organization will notice them early enough to respond thoughtfully.
Three things the ASHP engagement makes clear:
Satisfaction and retention are not the same thing. ASHP had 72% member satisfaction and 30% annual churn. Those numbers coexisted because members can genuinely value what they receive from an association while still not renewing when the transactional reason for joining disappears. If your retention strategy assumes that satisfied members renew, you’re likely losing a cohort of satisfied members every year that you don’t know you’re losing.
Acquisition can mask retention problems for a long time. If you’re filling the bucket fast enough, you may not notice how quickly it’s leaking. ASHP had masked below-benchmark retention with strong acquisition for years. The risk is that acquisition tactics have costs — financial, organizational, and in the case of free trials and discounted memberships, structural — that compound over time even as they disguise the underlying problem. Getting below the acquisition numbers to track retention by segment is the diagnostic move that changes everything.
The best time to engage strategic support is before you need it. This is the lesson ASHP’s Hannah Vanderpool put most directly, and it deserves to be taken seriously. The associations that get the most from a Sequence engagement are the ones that come with room to think, not the ones that come with their hair on fire. If the signals are there — and for most associations, they are — the question is whether you’re willing to look at them honestly enough to act.
About Sequence Consulting Sequence Consulting works exclusively with professional and trade associations to grow membership, strengthen revenue, and clarify strategy. Founded in 2001 by Chris Vaughan, PhD and Lisa Vaughan, Sequence brings the rigor of Big Strategy consulting to mission-driven organizations. Trusted by 12 of the top 20 U.S. associations.
