STJ Medical V2 — Ultimate Deep Dive Strategy Deck

Account Health Overview

Total Spend

$141.7K

All-time since Oct 2025

Total Clicks

63,957

14,419 Search + 49,538 PMax

Total Conv.

4,244

All conversions incl. calls

Avg CPA

$33.39

All conversions blended

Form Fills

3,183

Submit lead form #new

Form-Only CPA

$44.52

$141.7K / 3,183 forms

Phone Calls

591

461 website + 130 from ads

Zoho CRM

179

175 leads + 4 qualified

✅

Fixed Today: "Call from Website" removed from bidding. Phone calls no longer inflate conversion counts or influence bid strategy. Campaigns now optimize exclusively for form fills and Zoho CRM conversions.

⚠️

UPDATED SITE campaign paused today — $350 spent with 0 conversions. Conversion tracking on the new site was broken. Killed immediately.

All 17 Campaigns — Complete Performance

Campaign	Type	Status	Budget/Day	All-Time Spend	Clicks	Conv	All Conv	CPA
PMax \| General	PMax	ENABLED	$450	$79,233	32,511	2,282	2,535	$31.26
Search \| Website Form Submission	Search	ENABLED	$200	$41,441	14,419	845	1,069	$38.77
PMax \| Dexcom G7 Specific	PMax	PAUSED	$5	$7,985	2,076	84	121	$65.99
PMax \| General Spanish	PMax	PAUSED	$20	$3,344	6,079	61	81	$41.28
Search \| Website Form Submission Spanish	Search	PAUSED	$60	$1,836	3,310	29	42	$43.72
PMax \| Sock Promo	PMax	PAUSED	$1	$1,880	568	51	62	$30.32
PMax \| Libre 3 Plus Specific	PMax	PAUSED	$5	$1,268	436	28	37	$34.26
Display \| Remarketing	Display	PAUSED	$25	$826	6,131	18	22	$37.55
Search \| All Prospects Custom	Search	PAUSED	$20	$550	119	3	3	$183
Search \| All Patients Custom	Search	PAUSED	$20	$415	90	4	4	$103.75
PMax \| UPDATED SITE (Home Page)	PMax	PAUSED TODAY	$100	$351	176	0	0	∞
PMax \| General - UPDATED SITE	PMax	REMOVED	—	$195	89	0	0	∞
PMax \| Dexcom G7	PMax	PAUSED	$20	$182	59	1	1	$182
PMax \| FreeStyle Libre 3	PMax	PAUSED	$20	$75	20	1	1	$75
PMax \| Generic Remarketing	PMax	PAUSED	$20	$62	37	0	0	∞
PMax \| General Spanish 2	PMax	PAUSED	$20	$15	317	0	0	∞
PMax \| Libre 3 Plus Specific 2	PMax	PAUSED	$20	$9	19	0	0	∞

Bottom line: Only 2 campaigns are enabled — PMax General ($450/day) and Search Website Form ($200/day). Total daily budget: $650/day. PMax drives 2,535 all-conversions at $31 CPA. Search drives 1,069 at $39 CPA. PMax is clearly winning on volume and CPA.

Conversion Action Breakdown (20+ Actions Analyzed)

Conversion Action	Type	Category	All-Time Volume	Biddable?	Status
Submit lead form #new	Webpage	SUBMIT_LEAD_FORM	3,183	YES ✅	PRIMARY
Call from Website #new	Website Call	CONTACT	461	NO ❌ FIXED	OFF TODAY
Zoho CRM Leads/Contacts	Upload Clicks	SIGNUP	175	YES ✅	PRIMARY
Calls from ads (1)	Ad Call	PHONE_CALL_LEAD	130	NO ❌	OFF
Zoho CRM Lead Qualification	Upload Clicks	QUALIFIED_LEAD	4	YES ✅	PRIMARY
STJ-Website purchase	GA4 Purchase	PURCHASE	0	YES	Enabled
STJ-Website CGM_Form_Submission	GA4 Custom	PURCHASE	0	YES	Enabled
STJ-Website fb_thank_you_page	GA4 Custom	ADD_TO_CART	0	YES	Enabled
Lead form - Submit	Lead Form	SUBMIT_LEAD_FORM	0	No	Secondary

🔑

Key insight: 591 phone call conversions (14% of all conversions) were inflating CPA metrics. With calls removed from bidding, Google will now ONLY chase form fills and Zoho CRM conversions. Expect the "reported" conversion count to drop, but actual lead quality will increase dramatically.

Ad Group Performance (Search Campaign)

Ad Group	Spend	Clicks	Impr	Conv	All Conv	CPA	CTR
Main Ad group	$24,566	9,890	129,839	447	612	$40.14	7.6%
Non Performing Keywords	$16,875	4,529	44,573	398	458	$36.84	10.2%

💡

Irony alert: The "Non Performing Keywords" ad group actually has a BETTER CPA ($36.84 vs $40.14) and HIGHER CTR (10.2% vs 7.6%) than the Main Ad group. The name is misleading — these keywords are performing well.

Keyword-by-Keyword Analysis (All 40+ Keywords)

Every enabled positive keyword with KEEP / CUT / WATCH / TEST verdicts

✅ KEEP — Proven Winners

Keyword	Match	Ad Group	Spend	Clicks	Conv	CPA	Verdict
continuous glucose monitoring	Broad	Main	$6,667	2,699	208	$32.05	KEEP ✅
libre freestyle 3	Broad	Non Perf	$3,198	736	75	$42.64	KEEP ✅
libre 3	Broad	Main	$2,131	642	46	$46.33	KEEP ✅
continuous glucose monitoring	Phrase	Main	$1,788	497	36	$49.68	KEEP ✅
order Freestyle Libre sensors	Broad	Non Perf	$1,324	341	38	$34.85	KEEP ✅
libre 3 sensor	Broad	Non Perf	$1,191	341	35	$34.04	KEEP ✅
glucose monitor without pricking	Broad	Non Perf	$1,024	373	19	$53.89	KEEP ✅
glucometer	Broad	Non Perf	$934	244	28	$33.35	KEEP ✅
cgm sensor	Phrase	Main	$840	294	14	$60.03	KEEP ✅
blood sugar test strips	Broad	Non Perf	$828	214	17	$48.72	KEEP ✅
best glucose monitor	Broad	Non Perf	$803	227	17	$47.24	KEEP ✅
glucose monitoring device	Broad	Non Perf	$622	169	14	$44.43	KEEP ✅
cgm	Broad	Main	$578	233	10	$57.81	KEEP ✅
St Joseph Medical	Broad	Main	$276	157	43	$6.42	KEEP ✅ BRAND
continuous glucose	Broad	Non Perf	$517	135	11	$47.03	KEEP ✅
GCM	Broad	Non Perf	$452	121	11	$41.09	KEEP ✅
blood sugar testing devices	Broad	Non Perf	$304	81	7	$43.42	KEEP ✅
glucose check	Broad	Non Perf	$227	51	5	$45.49	KEEP ✅
continuous glucose monitoring system	Broad	Non Perf	$110	26	3	$36.67	KEEP ✅

❌ CUT — Pausing / Removing

Keyword	Match	Spend	Clicks	Conv	CPA	Why Cut
freestyle libre 3 coupon	Broad	$2,813	558	69	$40.77	Coupon seekers — not real leads. $2.8K on people looking for discounts
diabetes management	Broad	$2,586	1,361	40	$64.66	Too broad — 64% above avg CPA. Matches diet, apps, tips content
g7	Broad	$1,614	496	25	$64.54	Dangerously generic — matches BMW G7, G7 summit, etc.
freestyle libre 3 app	Broad	$629	169	8	$78.68	App downloaders, not CGM leads. 86% above avg CPA
diabetic health	Broad	$521	192	2	$260.50	Informational query — $260 CPA is 6x the avg
diabetes treatment	Broad	$450	132	3	$150	Way too broad — matches medications, insulin, diets
diabetes test kit	Broad	$224	62	2	$112	Product shoppers looking for Amazon/Walmart purchases

💸

Total CUT savings: $8,837 from keywords with CPAs 2-7x above account average. The "freestyle libre 3 coupon" keyword alone burned $2,813 on people looking for coupons — these aren't leads, they're bargain hunters.

👀 WATCH — Monitor Closely

Keyword	Match	Spend	Conv	CPA	Notes
dexcom g7	Phrase	$528	8	$66	Above avg but brand-specific — monitor
cgm sensor	Phrase	$840	14	$60	Higher CPA but solid intent
glucose monitor without pricking	Broad	$1,024	19	$54	Good intent, borderline CPA

Search Term Waste Report

Zero-conversion search terms that burned the most budget

Search Term	Spend	Clicks	Status
doihaveprediabetes org	$194	52	EXCLUDED
stelo glucose biosensor	$91	36	EXCLUDED
do i have prediabetes	$84	27	EXCLUDED
doihaveprediabetes	$78	16	EXCLUDED
do i have prediabetes com	$78	27	EXCLUDED
libre 3 sensor coupon	$72	17	NOT EXCLUDED
do i have prediabetes org	$69	23	EXCLUDED
freestyle libre 3 reader	$62	8	NOT EXCLUDED
libre 3 sensor price	$57	16	NOT EXCLUDED
freestyle libre 3 sensor price	$55	15	NOT EXCLUDED

💸

"doihaveprediabetes" variations alone burned $882 with zero conversions. These were people visiting a quiz website, not looking for CGM devices. All prediabetes terms are now excluded. The remaining coupon/price/reader terms need to be added as negatives.

Top Converting Search Terms

Search Term	Spend	Clicks	Conv	All Conv	CPA
freestyle libre 3 coupon	$1,877	372	48	50	$37.54
libre 3	$2,029	606	34	44	$46.12
freestyle libre 3 sensor	$382	126	12	13	$29.40
freestyle libre 3 coupon with insurance	$204	45	9	9	$22.71
st joseph medical	$191	104	8	29	$6.57
freestyle libre 3 app	$519	163	8	8	$64.88
freestyle libre 3	$686	197	8	14	$48.98
libre 3 plus coupon	$209	41	7	7	$29.83

Negative Keyword Audit

✅ Already Protected (Search Campaign)

25 negatives added today:

sensorreceiveramazonwalmartcvswalgreenscustomer servicetech supportcontact numberphone numberpricecostreviewstelosellapple watchpatient assistancecopaymanufacturer couponprediabetesdietappsupplies by mailbiosensornovo nordisk

❌ Still Need to Add

readercouponhow to usetutorialinstructionsrefurbishedusedalternativevscomparisonside effectsrecalllawsuit

PMax | General negative keywords: abbott (broad+exact), freestyle (exact), accu check/chek variants (exact), caregivers for the elderly, us med, a1c test kit — these are good and protect PMax from brand/competitor waste.

Ad Copy Analysis

📌

4 headlines pinned to H1 position: "Dexcom G7 Real-Time CGM", "St Joseph Medical", "Continuous Glucose Monitoring", "{Keyword:Glucose Monitoring System}". Pinning 4 headlines to H1 forces Google to rotate through only these 4 in position 1, severely limiting optimization. Unpin at least 2.

Main RSA Headlines (15 total):

📌 Dexcom G7 Real-Time CGM • 📌 St Joseph Medical • 📌 Continuous Glucose Monitoring • 📌 {Keyword:Glucose Monitoring System} • Get A CGM Today • No More Finger Pricking • Take Quick Survey • Get Your CGM Today • See If You Qualify • Real-Time Glucose Monitor • Best CGM System - Hassle Free • No Pricked Fingers • Check If You Qualify • No Pricking Blood Sugar Test • Continuous Glucose Monitor

Main RSA Descriptions (4 total):

Monitor your glucose in real time without finger pricking • Get a continuous glucose monitor and check your levels anytime • Track blood sugar 24/7 with a painless, easy-to-use CGM • Switch to continuous monitoring — no more painful finger sticks

👍

Descriptions are solid — pain point focused (no pricking), benefit-driven (real time, 24/7, painless). Headlines need work: too many generic ones, 4 pinned to H1 limits Google's ability to find winning combinations.

PMax Asset Group Audit

Asset Group	Campaign	Status	Spend	Clicks	Conv	All Conv	CPA
With Keywords	PMax General	LIMITED	$50,368	21,189	1,427	1,570	$32.08
Free Audience	PMax General	LIMITED	$11,454	7,189	312	350	$32.73
Website Visitors	PMax General	LIMITED	$5,789	1,356	164	181	$31.98
Interest Based (paused)	PMax General	PAUSED	$11,622	2,777	378	434	$26.79

⚠️

All 3 active asset groups show LIMITED status. This means Google thinks the creative assets are insufficient or the audience signals are too narrow. Check if all required asset types are present (images, logos, headlines, descriptions, videos).

💡

The paused "Interest Based" group had the best CPA ($26.79). Consider re-enabling it — it outperformed all active groups.

Device Performance

Mobile

75.9%

of spend

Mobile CPA

$30.63

Best performer

Desktop

22.3%

of spend

Desktop CPA

$39.42

29% more expensive

Mobile

$107.7K — 3,226 conv

Desktop

$31.6K — 801 conv

Tablet

$2.3K

Mobile is king — 76% of spend, 80% of conversions, and the lowest CPA. This aligns with CGM users who are likely researching on their phones. Consider increasing mobile bid adjustments and ensuring landing pages are mobile-optimized.

Day-of-Week Analysis

Monday

$21.0K — 641 conv — $32.80 CPA

Tuesday

$21.7K — 690 conv — $31.41 CPA ⭐

Wednesday

$21.2K — 672 conv — $31.56 CPA ⭐

Thursday

$20.2K — 571 conv — $35.37 CPA

Friday

$19.2K — 536 conv — $35.87 CPA

Saturday

$17.8K — 495 conv — $35.99 CPA

Sunday

$18.5K — 539 conv — $34.28 CPA

Tuesday & Wednesday are the best days — lowest CPAs ($31.41 and $31.56) with highest conversion volume. Weekend CPAs are 10-15% higher. Consider bid adjustments: +10% Tue/Wed, -5% Sat/Sun.

Monthly Performance Trends

Month	Spend	Clicks	Impr	Conv	All Conv	CPA	Trend
Sep 2025	$15	317	8,270	0	0	—	Ramp up
Oct 2025	$11,195	25,431	699,006	194	220	$50.89	High CPA
Nov 2025	$28,922	8,056	128,714	597	697	$41.50	↓ 18%
Dec 2025	$26,460	7,083	98,628	670	784	$33.75	↓ 19%
Jan 2026	$51,811	14,043	494,886	1,375	1,482	$34.96	Peak spend
Feb 2026	$16,318	4,554	87,133	433	615	$26.53	↓ 24% ⭐
Mar 2026 (MTD)	$3,178	1,163	29,642	121	155	$20.50	↓ 23% ⭐⭐

📈

CPA has improved by 60% — from $51 in October to $20 in March. The account is learning and getting better. The algorithm is finding cheaper form fills month over month. This is a strong positive signal.

Ad Network Performance

Network	Spend	Clicks	Conv	All Conv	CPA
Google Search	$114,572	28,544	3,042	3,517	$32.58
YouTube (PMax)	$5,079	12,840	72	75	$67.72
Content/Display (PMax)	$500	1,797	5	5	$100.02
Search Partners	$518	3,747	6	6	$86.33

⚠️

Search Partners CPA is 2.6x higher than Google Search ($86 vs $33). For the Search campaign, consider opting out of Search Partner network. That's $518 spent on 6 low-quality conversions. PMax YouTube and Display are also expensive but you can't opt out of those in PMax.

Landing Page Strategy

V2 uses a single domain — much cleaner than the primary account

URL	Used In	Status
stjosephmedicalcorp.com	PMax General (all asset groups), Search campaign	ACTIVE — Main LP
stjosephmedicalcorp.com/freestyle-libre-3/	PMax FreeStyle Libre 3 (paused)	PAUSED
stjosephmedicalcorp.com/dexcom-g7-cgm/	PMax Dexcom G7 (paused)	PAUSED

✅

V2 is much cleaner than the primary account. Single domain (stjosephmedicalcorp.com), no survey microsites, no conflicting landing pages. This helps Quality Score and conversion tracking consistency.

10 Critical Issues — Priority Ranked

Call from Website was PRIMARY — FIXED TODAY. Was counting 461 phone calls as conversions, inflating metrics and misdirecting bid strategy. Now OFF.
"freestyle libre 3 coupon" keyword: $2,813 spent on coupon seekers. These people want a discount code, not a CGM through STJ. High click volume but misleading conversions — many likely bounced after realizing it's not a coupon site. PAUSE this keyword.
"diabetes management" at $64 CPA (64% above avg). Too broad — matches diet tips, treatment articles, medication queries. Burning $2,586 on informational traffic. PAUSE.
"g7" as Broad match: $1,614 spent. Matches BMW G7, G7 summit, G7 countries. Only 25 conversions. Should be "dexcom g7" Phrase match instead. PAUSE Broad "g7".
4 headlines pinned to H1 — Google can only test 4 of 15 headlines in position 1. This dramatically limits RSA optimization. Unpin at least "St Joseph Medical" and "{Keyword}" from H1.
Search Partners burning money — $518 for 6 conversions ($86 CPA) vs Google Search at $33 CPA. That's 2.6x more expensive. Opt out.
UPDATED SITE PMax: $350 spent, 0 conversions. Conversion tracking was broken on the new site. PAUSED TODAY.
"Interest Based" asset group paused — had the BEST CPA in the account ($26.79). Should be re-enabled and tested.
All 3 active PMax asset groups show LIMITED. Google says creative assets are insufficient. Need to check required asset types (especially video).
Only 10% Search impression share — losing 90% of available searches. Budget is there ($200/day) but the algorithm isn't spending it aggressively enough. May need Target CPA bidding to force more spend.

3-Phase Strategy Plan

🔴 Phase 1: Immediate Cleanup (This Week)

DONE ✅ Remove phone call conversions from bidding
DONE ✅ Pause UPDATED SITE campaign ($350 waste stopped)
DONE ✅ Add 25 negative keywords to Search campaign
Pause "freestyle libre 3 coupon" keyword (saves ~$470/mo)
Pause "diabetes management" keyword (saves ~$430/mo)
Pause "g7" Broad keyword — replace with "dexcom g7" Phrase (saves ~$270/mo)
Pause "diabetic health" keyword ($260 CPA — saves ~$87/mo)
Pause "freestyle libre 3 app" keyword (saves ~$105/mo)
Pause "diabetes treatment" keyword (saves ~$75/mo)
Pause "diabetes test kit" keyword (saves ~$37/mo)
Add 13 more negatives: reader, coupon, how to use, tutorial, instructions, refurbished, used, alternative, vs, comparison, side effects, recall, lawsuit
Unpin 2 headlines from H1 position

Estimated monthly savings: $1,474/mo ($17,688/year)

🟡 Phase 2: Optimization (Weeks 2-4)

Re-enable "Interest Based" PMax asset group ($26.79 CPA — best in account)
Opt out of Search Partners on Search campaign
Add video assets to PMax to fix LIMITED status
Test Target CPA bidding ($40 target) on Search to increase impression share
Add bid adjustments: +10% Tue/Wed, -5% Sat/Sun, +5% mobile
Test ad schedule: reduce bids midnight-5AM (highest CPA hours)
Create dedicated "Brand" ad group for "st joseph medical" (currently in Main — deserves its own)
Add new keywords: "libre 3 plus", "freestyle libre 3 sensor", "cgm for diabetes", "blood glucose monitor no prick"

🟢 Phase 3: Scale (Month 2+)

If form CPA stays under $50, increase Search budget from $200/day to $350/day
If PMax keeps improving, increase from $450/day to $600/day
Launch dedicated Libre 3 Plus PMax campaign (was paused at $34 CPA — strong enough to scale)
Test Dexcom G7 PMax campaign (was $66 CPA — may improve with better assets)
Consider Spanish campaigns if Hispanic market shows volume (previous Spanish campaigns had $41-44 CPA)
Set up Zoho CRM offline conversion import for V2 (only 4 qualified leads tracked — likely many more unreported)
Coordinate with primary account to avoid keyword overlap

V2 vs Primary Account Strategy:

V2 should focus on PMax (broad reach + remarketing) and generic CGM Search terms. The primary account (2132096417) should own brand-specific Search (Libre, Dexcom, brand terms) since it has the L2S campaign structure optimized for those. This prevents cannibalization between the two accounts.

St. Joseph Medical V2