Google Ads & Meta Ads Performance Analysis, June 10 - July 10, 2026. Account: 514-349-3594 (V2)
The account has 8 conversion actions set as "primary for goal", which means a single form submission is likely being counted 3-5 times. This makes the reported 835 conversions and $21.11 CPA unreliable. The real lead count is likely 200-300 range, putting actual CPA at $59-$88.
Fix: Set exactly ONE primary conversion action (CGM_Form_Submission) and make ALL others secondary. This will also fix Smart Bidding, which is currently optimizing for a bloated conversion signal.
The "Demand Gen - 2026-07-10" campaign launched recently and has spent $17.93 with only 2 clicks on 1,251 impressions. CTR is 0.16%, CPC is $8.97, and there are zero conversions. This is YouTube/Discovery inventory, which historically performs poorly for lead gen in this vertical.
Fix: Pause immediately. Demand Gen is wrong for a CGM lead gen campaign unless it is retargeting website visitors with video content. The budget is better allocated to the Search campaign which has only 10% impression share.
The Search campaign has a search impression share of just 9.99%, meaning 90% of relevant searches never see STJ's ads. PMax General NEW SITE has 13.5% and PMax General #2 has 16.3%. At a $120/day budget, the Search campaign is severely budget-constrained despite being the highest-intent campaign.
Fix: Increase Search campaign budget from $120/day to $180-200/day by reallocating from Demand Gen and/or the old PMax General (which is paused but has $20/day budget sitting idle).
Despite "coupon" being in the shared negative list, search terms show active spending on discount-related queries that indicate non-qualifying traffic:
Fix: The negative keywords are all EXACT match. Change critical negatives like "free", "coupon", "discount", "price", "cheap" to PHRASE match so they catch variants. Add "discount card", "savings card", "free sample", "rebate" as phrase negatives.
The shared negative keyword list ("Master Negative Keyword List") has 36 keywords, all in EXACT match. This means "coupon" blocks the exact word "coupon" but NOT "dexcom coupon", "libre coupon code", etc. The Search campaign also has its own negatives (comparison, review, sell, tutorial, cost, coupons, free sample, etc.) set as BROAD, which is correct, but the shared list is not.
Shared List Keywords (all EXACT): free, career, coupon, reviews, ideas, cheap, hiring, news, complaints, tips, guide, customer service, blog, salary, youtube, repair, stock, tutorial, phone number, how does it work, ebay, walmart, near me, directions, address, what is, explained, training, application, definition, lawsuit, headquarters, wiki, vs, competitor, manual
Fix: Convert all shared negatives to PHRASE match. "walmart", "near me", "ebay" as exact are useless; nobody searches just "walmart" and triggers a CGM ad. They search "freestyle libre walmart" which the exact match will NOT block.
"PMax | General | NEW SITE" ($250/day) and "PMax | General #2" ($200/day) are both ENABLED and running simultaneously with the same Maximize Conversions strategy. They are likely competing for the same audience pools, driving up CPCs and fragmenting the algorithm's learning.
PMax #2 has 56% higher CPA than PMax NEW SITE. Unless they serve different asset groups or audiences, consolidation should be tested.
Per the previous deep dive (April 2026), STJ was generating "Bad Ineligible State" leads from states where patients don't qualify. The geo targeting still shows: All US minus only North Dakota. If there are additional states where STJ cannot serve patients, those should be excluded to avoid wasted spend.
| Campaign | Type | Budget/Day | Spend | Clicks | Impr. | Conv. | CPA | CTR | CPC |
|---|---|---|---|---|---|---|---|---|---|
| PMax | General | NEW SITE | PMax | $250 | $6,213 | 2,237 | 41,800 | 365 | $17.04 | 5.35% | $2.78 |
| PMax | General #2 | PMax | $200 | $5,939 | 1,653 | 27,241 | 223 | $26.60 | 6.07% | $3.59 |
| Search | Website Form Submission | Search | $120 | $5,421 | 1,315 | 24,161 | 245 | $22.15 | 5.44% | $4.12 |
| PMax | General (old, paused) | PMax | $20 | $37 | 13 | 638 | 3 | $14.93 | 2.04% | $2.87 |
| Demand Gen - 2026-07-10 | Demand Gen | TBD | $18 | 2 | 1,251 | 0 | N/A | 0.16% | $8.97 |
| Keyword | Match | Ad Group | Clicks | Impr. | CTR | CPC | Conv. | CPA |
|---|---|---|---|---|---|---|---|---|
| glucose monitor covered by insurance | Broad | General CGM | 387 | 5,942 | 6.51% | $4.22 | 67 | $24.34 |
| how to get freestyle libre | Broad | FreeStyle Libre 3 | 279 | 4,438 | 6.29% | $4.21 | 48 | $24.47 |
| dexcom g7 | Broad | Dexcom G7 | 273 | 5,903 | 4.62% | $4.12 | 59 | $18.97 |
| diabetic medical supplies | Phrase | Main Ad group | 126 | 1,777 | 7.09% | $4.81 | 30 | $20.18 |
| freestyle libre 3 sensor | Broad | FreeStyle Libre 3 | 61 | 2,835 | 2.15% | $3.84 | 14 | $16.48 |
| how to get a continuous glucose monitor | Broad | General CGM | 21 | 267 | 7.87% | $4.27 | 4 | $22.42 |
| continuous glucose monitoring | Broad | General CGM | 5 | 344 | 1.45% | $3.27 | 1 | $16.36 |
| Search Term | Status | Clicks | Spend | Conv. | CTR |
|---|---|---|---|---|---|
| freestyle libre 3 | Added | 54 | $213.92 | 14 | 2.03% |
| free dexcom g7 sensor | Excluded | 8 | $47.36 | 2 | 12.5% |
| freestyle libre 3 sensor | Added | 6 | $42.82 | 1 | 3.30% |
| dexcom coupon | Excluded | 10 | $37.59 | 2 | 9.52% |
| libre 3 plus | Added | 11 | $32.17 | 1 | 1.79% |
| libre 3 discount card | None | 4 | $32.07 | 2 | 8.33% |
| dexcom g7 | Added | 20 | $50.99 | 3 | 1.53% |
| continuous glucose monitor covered by insurance | Added | 5 | $29.52 | 2 | 16.97% |
"free dexcom g7 sensor" and "dexcom coupon" are both marked as EXCLUDED but still accumulated $84.95 in spend during this period. This happens because PMax campaigns ignore campaign-level negatives and can only be controlled via account-level negative keyword lists. If these negatives are only at the Search campaign level, PMax is still showing for them.
| Device | Spend | % of Spend | Clicks | Conv. | CPA | CTR | CPC |
|---|---|---|---|---|---|---|---|
| Mobile | $15,469 | 88.5% | 4,599 | 734 | $21.07 | 6.18% | $3.36 |
| Desktop | $1,847 | 10.6% | 537 | 82 | $22.52 | 3.06% | $3.44 |
| Tablet | $268 | 1.5% | 70 | 17 | $15.77 | 2.47% | $3.83 |
| Day | Spend | Clicks | Conv. | CPA | CTR |
|---|---|---|---|---|---|
| Sunday | $2,605 | 734 | 135 | $19.30 | 5.65% |
| Monday | $2,326 | 658 | 100 | $23.26 | 5.25% |
| Tuesday | $2,198 | 643 | 92 | $23.89 | 5.26% |
| Wednesday | $2,840 | 804 | 162 | $17.53 | 5.58% |
| Thursday | $2,797 | 797 | 130 | $21.51 | 5.60% |
| Friday | $2,628 | 743 | 103 | $25.51 | 5.77% |
| Saturday | $2,234 | 641 | 113 | $19.77 | 5.66% |
| Ad Group | Clicks | Impressions | CTR | CPC | Conv. | CPA | Spend |
|---|---|---|---|---|---|---|---|
| General CGM | 413 | 6,553 | 6.30% | $4.18 | 72 | $23.90 | $1,725 |
| FreeStyle Libre 3 | 374 | 8,495 | 4.40% | $4.15 | 70 | $22.10 | $1,551 |
| Dexcom G7 | 297 | 6,265 | 4.74% | $4.06 | 63 | $19.02 | $1,205 |
| Main Ad group | 231 | 2,848 | 8.11% | $4.07 | 39 | $24.10 | $940 |
| Campaign | Spend | Clicks | Impr. | Purchases | Leads | CPA | CTR | CPC |
|---|---|---|---|---|---|---|---|---|
| General | Sales Campaign V3 | $335 | 747 | 21,506 | 43 | 8 | $6.56 | 3.47% | $0.45 |
| HMO Match | [Look Alike] | $331 | 366 | 9,846 | 27 | 0 | $12.25 | 3.72% | $0.90 |
| Just Turned of Age | [Suggestion] | $338 | 308 | 8,281 | 22 | 0 | $15.38 | 3.72% | $1.10 |
| Bad DOB Match | [Suggestion] | $332 | 384 | 9,824 | 20 | 0 | $16.60 | 3.91% | $0.86 |
| HMO Match | [No Suggestion] | $340 | 154 | 6,477 | 8 | 0 | $42.47 | 2.38% | $2.21 |
This campaign has the worst metrics across the board: lowest CTR (2.38%), highest CPC ($2.21), and only 8 conversions at $42.47 each. Every other campaign averages $6-$17 CPA. This campaign should be paused and its $7/day budget reallocated to the General V3 campaign which is the clear winner at $6.56 CPA.
The Meta campaigns are structured around CRM audience segments (Bad DOB, HMO, Just Turned of Age) uploaded as custom audiences. All use Advantage+ Audience OFF, age 60-65, excluding North Dakota, optimizing for PURCHASE events on the Meta Pixel. This is a solid structure for a healthcare lead gen campaign.
There are 10+ paused campaigns including: Denied By Patient Match [Look Alike], Denied By Patient Match [Suggestion], P Match [Suggestion], No Contact Match [Suggestion], Just Turned of Age [Look Alike], P Match [Look Alike], No Contact Match [Look Alike], HMO Match [Suggestion]. Some of these may have been paused prematurely. Consider reactivating the Look Alike versions one at a time since they use Lookalike audiences which could reach new qualified prospects.
| Conversion Action | Type | Category | Primary? | Issue |
|---|---|---|---|---|
| CGM_Form_Submission | GA4 Custom | Purchase | YES | Keep as only primary |
| fb_thank_you_page | GA4 Custom | Add to Cart | YES | Duplicate of form submission |
| sweetspot___form_submission_thank_you_pa | GA4 Custom | Add to Cart | YES | Duplicate of form submission |
| l_p_form_submitted | GA4 Custom | Add to Cart | YES | Duplicate of form submission |
| Call from Website #new | Website Call | Contact | YES | Keep as primary (unique signal) |
| Calls from ads | Ad Call | Phone Call Lead | YES | Keep as primary (unique signal) |
| Calls from ads (1) | Ad Call | Phone Call Lead | YES | DUPLICATE of Calls from ads |
| Zoho CRM Lead Qualification | Upload Clicks | Qualified Lead | YES | Consider secondary (downstream) |
| Zoho CRM Leads/Contacts | Upload Clicks | Signup | YES | Overlaps with form submission |
Based on search term analysis and competitor research, these terms should be added as negative keywords (PHRASE match) to block irrelevant traffic:
Set CGM_Form_Submission + Website Calls + Ad Calls as the ONLY 3 primary conversions. Make fb_thank_you_page, sweetspot form, l_p_form_submitted, Calls from ads (1), Zoho CRM Leads/Contacts all secondary. Zoho CRM Lead Qualification can stay primary IF it represents a unique downstream signal. This will reduce reported conversions by 50-60% but give Smart Bidding an accurate optimization target. Expect a 2-3 week learning period afterward.
$18 spent with 0 conversions, 0.16% CTR. Demand Gen (YouTube/Discovery) is not the right channel for CGM lead gen. Reallocate that daily budget to the Search campaign.
Search has only 10% impression share, meaning we are missing 90% of relevant searches. This is the highest-intent traffic. Source the extra $80/day from Demand Gen + old PMax General budget ($20/day) + potential reduction of PMax #2.
Convert all 36 shared negative keywords from EXACT to PHRASE match. "walmart" as exact is useless; "freestyle libre walmart" won't be blocked. Add the missing negatives identified in Section 11 (type 2, discount card, savings card, amazon, metformin, ozempic, etc.).
PMax #2 has 56% higher CPA ($26.60 vs $17.04). If both campaigns target overlapping audiences, they are cannibaling each other. Consider pausing PMax #2 for 2 weeks and giving its $200/day to PMax NEW SITE (or Search). Monitor if consolidated performance improves.
$42.47 CPA (3.2x worse than the General campaign). Redistribute its $7/day to the General V3 campaign which is crushing it at $6.56 CPA. Also consider testing reactivation of one paused Lookalike campaign.
The Search campaign has strong ad groups but limited keyword coverage. Add: "dexcom g7 prescription", "freestyle libre 3 covered by insurance", "free cgm for medicare", "cgm for type 1 diabetes", "continuous glucose monitor no cost", "how to get a cgm with insurance", "dexcom g7 for seniors". These target high-intent, insurance-related searches.
Currently only North Dakota is excluded across both Google and Meta. If STJ cannot service patients in other states, those need to be excluded to prevent "Bad Ineligible State" leads. Check with the client for the full list of ineligible states.
Wednesday is 45% more efficient than Friday. After fixing conversion tracking and waiting 3-4 weeks for clean data, apply: Wednesday +15%, Thursday +10%, Friday -15%, Monday -10%. This only applies to the Search campaign (PMax does not support bid modifiers).
10 paused campaigns include Lookalike audience variants. Test reactivating "HMO Match [Lookalike]" or "No Contact Match [Lookalike]" one at a time at $5/day to see if they can scale efficiently. The Look Alike versions use 1% Lookalike audiences which could unlock new qualified prospects.
In April, the account was 100% PMax with no Search campaigns. Now "Search | Website Form Submission" is running at $120/day with 4 well-structured ad groups (General CGM, FreeStyle Libre 3, Dexcom G7, Main). This was action item #1 from April.
In April, "PMax NEW SITE" was burning $266 with 65% YouTube spend and 0 conversions. The new "PMax | General | NEW SITE" has $250/day budget and is the top performer at $17.04 CPA. Major improvement.
In April there were 5 primary conversion actions. Now there are 8-9 primary actions. Zoho CRM integrations were added (good for downstream tracking), but they should be set as secondary, not primary. The core double-counting problem persists.
April recommended tightening geo to eligible states only. Still all US minus North Dakota. Need client confirmation on which additional states to exclude.