Various arrangements for performing dynamic content insertion are presented. Content items that have been output for presentation may be tracked across multiple television viewing sessions. One or more insertion rules may be evaluated that are mapped to a content item. The content item may be determined to have met an output rate threshold. An alternative piece of content may be selected for insertion based on the content item having met the output threshold rate. The television receiver may be triggered to substitute the alternative content item into a television channel stream to replace the content item.