Full audit of both accounts (2132096417 + 5143493594) from March 11 — April 28, 2026. Linked to CRM data showing 35% non-insulin waste and 13% ineligible state rate.
The ad engine generates plenty of volume — 983 form submissions since March 11 on the V2 account alone. But the CRM shows only 0.7% of our prospects become patients vs Helix's 4.3%.
The root cause is in the ads, not the back-office. The keywords, targeting, and campaign structure are attracting non-insulin diabetics, coupon seekers, product shoppers, and people in states where STJ can't service them.
Below are 9 specific changes — ordered by impact — that we can execute immediately. Combined estimated savings: $6,725/month redirected from waste to qualified prospects.
Formerly the main account. Managed by Leads to Sales.
$1,079 spent since Mar 11. Only 19 conversions. Every campaign is paused. No money being spent here.
Active account where the $500/day budget runs.
$16,695 spent since Mar 11. 983 conversions. $320/day on PMax General + $10/day Search + $10/day PMax New Site.
| Campaign | Status | Budget | Spend | Clicks | Conv | CPA | Conv Rate |
|---|---|---|---|---|---|---|---|
| PMax | General | ENABLED | $320/day | $12,210 | 5,494 | 926 | $13.18 | 16.9% |
| PMax | General | NEW SITE | ENABLED | $10/day | $3,706 | 1,860 | 30 | $123.55 | 1.6% |
| Search | Website Form Submission | ENABLED | $10/day | $779 | 233 | 27 | $28.86 | 11.6% |
| TOTAL | $340/day | $16,695 | 7,587 | 983 | $16.98 | 13.0% |
Key insight: PMax General does 94% of the volume at $13 CPA. But PMax NEW SITE burns $3,706 at $124 CPA — 9.4x worse. And the Search campaign has toxic keywords driving non-insulin traffic.
The "Search | Website Form Submission" campaign has BROAD match keywords that should never exist in a CGM lead gen campaign:
Toxic — Must Remove Immediately
sell (BROAD) coupons (BROAD) weight loss (PHRASE) symptoms (BROAD) watches (BROAD) walgreens (BROAD) diet (BROAD) g7 (BROAD) abbott (EXACT) freestyle (EXACT) accu chek (EXACT) one touch ultra (EXACT) blood sugar levels (EXACT) blood sugar control (EXACT)Acceptable — Keep These
freestyle libre 3 freestyle libre continuous glucose monitor dexcom dexcom g7 cgm libre 3 libre 3 plus st joseph medical supplyA BROAD match keyword like "sell" can match to literally anything — "sell my car", "best selling books", "sell diabetic test strips". Same with "watches" (Apple Watch, Samsung watch), "diet" (keto diet, diet pills), and "symptoms" (cold symptoms, flu symptoms). These are why 35% of CRM prospects are non-insulin.
| Search Term | Campaign | Spend | Clicks | Conv | Problem |
|---|---|---|---|---|---|
| freestyle libre 3 coupon card | Search | $17.12 | 4 | 0 | COUPON SEEKER |
| freestyle libre 3 coupon | L2S Search | $15.22 | 4 | 0 | COUPON SEEKER |
| free blood glucose meter by mail | Search | $14.23 | 3 | 1 | FREEBIE SEEKER |
| dexcom sensors coupon | Search | $12.79 | 1 | 0 | COUPON SEEKER |
| libre 3 plus | L2S Search | $11.25 | 7 | 0 | PRODUCT RESEARCH |
| dexcom g7 savings card | SJC Dexcom | $10.11 | 1 | 0 | COUPON SEEKER |
| dexcom g7 app | Search | $10.42 | 1 | 0 | APP/TECH SUPPORT |
| libre 3 discount card | Search | $8.03 | 1 | 0 | COUPON SEEKER |
| assistance dexcom com | Search | $7.72 | 2 | 0 | SUPPORT REQUEST |
| how to put on a dexcom g7 | Search | $5.95 | 1 | 0 | HOW-TO / EXISTING USER |
Coupon/discount/savings/free search terms alone = $87+ wasted in the visible data. These people already HAVE a CGM — they want a cheaper way to buy supplies. Not our prospect.
CRM shows 13.1% of our leads are from ineligible states vs Helix's 1.5%. Here's where the V2 account is spending:
| State | Spend | Clicks | Conversions | CPA | Efficiency |
|---|---|---|---|---|---|
| South Carolina | $1,663 | 645 | 109 | $15.26 | BEST |
| Florida | $1,058 | 462 | 58 | $18.24 | GOOD |
| New Jersey | $873 | 431 | 64 | $13.64 | BEST |
| North Carolina | $869 | 354 | 50 | $17.38 | GOOD |
| California | $771 | 450 | 45 | $17.14 | GOOD |
| Georgia | $650 | 286 | 32 | $20.32 | OK |
| New York | $631 | 322 | 10 | $63.07 | TERRIBLE |
| Ohio | $611 | 290 | 38 | $16.08 | GOOD |
| Rhode Island | $583 | 269 | 48 | $12.15 | BEST |
New York: $631 spent, only 10 conversions = $63 CPA — that's 5.2x worse than Rhode Island ($12.15). If NY is an ineligible state in the CRM, that's $631 burned. We need the exact ineligible state list from Zoho to create geo exclusions.
130K impressions but only 1,860 clicks = 1.4% CTR (vs PMax General's 8.9%). This campaign is burning budget on Display Network and YouTube placements where nobody converts. The 30 conversions at $124 each are likely Display-network form fills from low-quality traffic — exactly the kind that shows up as non-insulin in the CRM.
Mobile dominates at 90% of spend. Tablet actually has the best CPA ($16.07). Desktop is 30% more expensive per conversion. Not a major problem — but CTV impressions from PMax NEW SITE confirm it's running on garbage placements.
This campaign has spent $3,706 since March 11 with only 30 conversions at $124 CPA. For comparison, PMax General gets conversions at $13 each — 9.4x cheaper.
The 130K impressions on 1,860 clicks (1.4% CTR) confirms heavy Display/YouTube network placement. These are the junk leads flooding the CRM as non-insulin and ineligible state.
Action: PAUSE this campaign immediately. Reallocate the $10/day budget to PMax General.
REMOVE these BROAD/PHRASE match keywords immediately:
sell (BROAD) — matches "sell my car", "sell test strips"coupons (BROAD) — matches any coupon searchweight loss (PHRASE) — attracts Ozempic/GLP-1 searchers (non-insulin = DQ)symptoms (BROAD) — matches cold, flu, any symptom searchwatches (BROAD) — matches Apple Watch, Samsung Watchwalgreens (BROAD) — matches any Walgreens searchdiet (BROAD) — matches keto, paleo, any diet searchg7 (BROAD) — matches G7 summit, G7 countries, Pontiac G7abbott (EXACT) — company search, not CGM intentfreestyle (EXACT) — matches "freestyle rap", "freestyle dance"accu chek (EXACT) — finger-prick meters, NOT CGM (non-insulin diabetics use these)one touch ultra (EXACT) — another finger-prick meter brand, NOT CGMblood sugar levels (EXACT) — informational, no purchase intentblood sugar control (EXACT) — informational, type 2 diabeticsKEEP these high-intent CGM keywords: "freestyle libre 3", "freestyle libre", "continuous glucose monitor", "dexcom", "dexcom g7", "cgm", "libre 3", "libre 3 plus", "st joseph medical supply"
Add these as NEGATIVE keywords across all campaigns:
Non-Insulin / Type 2 Blockers:
GLP-1 / Weight Loss (attracts non-insulin):
Coupon / Discount / Freebie Seekers:
Product Research / Existing Users:
Support / Existing Customers:
Total: ~75 negative keywords. This is the single biggest lever to cut the 35% non-insulin waste.
CRM shows 13.1% of our leads come from states where STJ cannot service them. Helix is at 1.5% — this week they had ZERO.
We need the exact list of ELIGIBLE states from Zoho CRM. Once we have it, we add every non-eligible state as a geo exclusion on all 3 campaigns.
Based on CRM data, states like New York ($631 spent, $63 CPA — 5x worse than average) may be ineligible. If so, that's $631 burned in 7 weeks.
Ask the client: "Which states can you service patients in? We need the exact list to exclude everywhere else."
Current setup: $320/day PMax General + $10/day Search + $10/day PMax New Site = $340/day.
New setup after killing PMax NEW SITE:
PMax General is already constrained — it has a $320/day budget but the algorithm could spend more on qualified searches. Giving it more budget after we add negatives means it finds more GOOD prospects, not more bad ones.
Current ads don't mention insurance requirements. Anyone with diabetes clicks. The fix is self-qualifying ad copy:
This creates a self-selection filter. Non-insulin diabetics will see "insulin" in the ad and self-exclude. This is how Helix likely keeps their non-insulin rate near zero.
Add a required question early in the form: "Do you currently use insulin?" (Yes / No)
This stops non-insulin leads from ever entering the CRM pipeline. Even if ads leak some through, the form catches them.
Optional addition: "What state do you live in?" dropdown — auto-reject ineligible states with a polite message.
Right now, PMax optimizes for "form submission" — it treats a non-insulin DQ lead the same as a Private HMO golden lead. The algorithm has no idea which leads are good.
Solution: Import Zoho CRM offline conversions back to Google Ads.
Once Google's algorithm optimizes for QUALIFIED prospects instead of raw form fills, it will naturally avoid non-insulin and ineligible state traffic because those leads never become "Qualified" in Zoho.
Note: The primary account (2132096417) already has Zoho offline conversions configured. This same setup needs to be replicated on the V2 account.
Instead of relying on PMax (which we can't fully control), build a dedicated Search campaign with EXACT/PHRASE match keywords that explicitly target insulin-dependent CGM prospects:
"free cgm for insulin users" (PHRASE)"continuous glucose monitor insurance" (PHRASE)"cgm covered by insurance" (PHRASE)"freestyle libre through insurance" (PHRASE)"dexcom covered by insurance" (PHRASE)"cgm for type 1 diabetes" (PHRASE)"free glucose monitor with insurance" (PHRASE)"how to get a cgm through insurance" (PHRASE)[st joseph medical] (EXACT)[st joseph medical supply] (EXACT)Budget: Start at $50/day. These keywords have much higher intent than the broad PMax audience. Expected CPA: $15-25 with near-zero non-insulin waste.
At $500/day ($15,000/month), the current setup generates ~600 prospects/month. But 35% are non-insulin (210 wasted) and 13% are ineligible state (78 wasted). That leaves ~312 potentially viable prospects. At 0.7% patient conversion, that's ~2 patients/month at $7,500 cost-per-patient.
After fixes: Same $500/day generates ~600 prospects, but now only 5% non-insulin (30 wasted) and 1% ineligible (6 wasted). That's ~564 viable prospects. Even at a conservative 3% patient conversion (still below Helix's 4.3%), that's ~17 patients/month at $882 cost-per-patient — matching Helix's economics.
STJ Google Ads Deep Scan — Melleka Marketing
Data: Mar 11 — Apr 28, 2026 | Accounts: 2132096417 + 5143493594