Podcast #117

Google’s Performance Max: What Healthcare Marketers Need to Know

In this episode of the Ignite, Cardinal’s Chief Growth Officer, Lauren Leone and Director of Applied Analytics, Alex Kemp explore the intricacies of Google's Performance Max (PMAX) advertising platform. Our hosts discuss the initial challenges marketers faced, best practices for testing new media placements, and how PMAX has evolved over the past year. You’ll also hear actionable advice on how to leverage PMAX as a stepping stone towards full-funnel advertising, ensuring your campaigns are audience-focused and not just keyword-driven. Don’t miss this opportunity to elevate your digital marketing strategy!

Episode Highlights:

Lauren Leone: “One thing we’ve noticed is the mistakes people have made with inventory. You are now buying across a wider set of inventory and using text-only ads and trying to place them inside of something that should be high-impact visual. A lot of groups were making the mistake of not putting the right inventory into the tool as well. 

Alex Kemp: “Yes, definitely. Like a lot of automation, the output is only going to be as good as the inputs that you give it. A lot of mistakes that were made, and are still made now, are when you don’t upload an actual video asset to the campaign. What Google will do is actually Google will make its own video for you… It’s not terrible, but it’s definitely not something you might want to see your brand associated with.”

Episode Overview

In this episode of the Ignite, Lauren Leone, Chief Growth Officer, and Alex Kemp, Director of Applied Analytics, explore Google’s Performance Max (PMAX) platform. Launched in late 2021 and fully rolled out in 2022, PMAX allows marketers to serve impressions across all of Google’s inventory, including Search, Display, YouTube, and Maps. Initially designed for e-commerce, many marketers faced challenges using PMAX for lead generation due to its “black box” nature and lack of control, leading to low-quality leads despite good cost per lead metrics.

Lauren and Alex emphasize that PMAX should complement existing Search campaigns rather than replace them. By leveraging experiments and A/B testing, marketers can measure the lift provided by PMAX in driving conversions. Google’s algorithm uses extensive user behavior signals to serve impressions across its inventory, making PMAX a valuable first step into full-funnel advertising for many clients.

For healthcare marketers, PMAX offers a strategic advantage in brand awareness campaigns but is not recommended for lead generation unless carefully managed. The episode concludes with practical advice on setting up PMAX campaigns for success, highlighting the importance of having the right assets, data signals, and a clear understanding of the media mix’s overall impact on campaign performance. By reconsidering PMAX with these insights, marketers can potentially unlock new levels of scale and growth.

Related Resources

Announcer: Welcome to the Ignite Podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Lauren Leone: Hey, everyone, welcome to Ignite: Healthcare Marketing Podcast. My name is Lauren Leone. I’m our chief growth officer. Today, I have with us Alex Kemp, who is the director of many things. Let’s see, media planning, applied analytics, just to name a few. Alex has worn many, many hats here on our media and analytics teams. Today, we’re going to be talking about something that we’ve tested time and time again. I get asked this in pretty much every sales conversation I have, Google’s Performance Max product. For the sake of this podcast, we’ll affectionately call it PMax when talking about it. Alex, I want to know how has it evolved? How can clients use it?

If they’ve tested it in the past and ruled it out, should they reconsider it? If you are thinking of testing it for the first time, what are some guardrails to make sure that it works for you? Alex, let’s start with just what is PMax?

Alex Kemp: Yes. PMax is basically just a campaign type from Google. It was released late 2021 and rolled out in 2022. The idea is that it’s serving on all of Google’s inventory. That is Search, Display, YouTube, Maps, basically any kind of Google-owned inventory. It allows you to programmatically serve impressions across all of those channels. The idea is that you’re giving it a goal to achieve, usually a specific action you want someone to complete, and Google is going to try to achieve that no matter where that person is within the Google inventory. That’s basically the gist of it.

Lauren: Google’s programmatic product, the downfalls, we’ve seen clients test this when it first came out. It’s a really easy campaign in theory to set up, because you don’t have to necessarily know, “Okay, I’m going to log into this DSP and run this video campaign.” I think because it was a fairly easy barrier to entry, a lot of people did it not knowing what they were doing. What are some of the mistakes we saw people make when they tried PMax for the first time?

Alex: PMax was originally an evolution of the old Shopping campaigns. When it was first came out, it was really more geared towards e-commerce advertisers. Anyone who tried it with lead gen, if you tried it with form submissions or phone calls, you might’ve found that it was driving a really good cost per lead.

Lauren: Looked like, yes.

Alex: Right, compared to your Search campaigns. The quality of those leads were significantly lower compared to Search, so you saw a lot of people probably burn a lot of cash and learn pretty quickly that, “Oh, wow, maybe, this isn’t right for lead generation.” That was the first miss I think when people came out with it, was like, “I’m going to give it the same targets that my Search campaigns have,” which would make sense in theory. Due to the way that some of the inventory that you can serve on within the Google ecosystem and some of the spam you can get there, that led to a lot of low-quality leads.

Lauren: I know a lot of the heartburn around PMax is it is black box. You are giving Google the freedom to look across its inventory and a lot of the mindset might be, “Well, Google is going to do what’s best for them, perhaps what generates the most revenue for them.” What are some of the things, whether it’s inventory, goal setting for the campaigns that we see people doing to help control that?

Alex: The number one thing is just going to be, and we’ll probably mention it a lot of times, the conversion action that you’re telling it that you want. Like I said earlier, if you’re only giving it a lead, that is problematic because it, again, go back to our earlier point, is driving a lot of low-quality. You really need an offline conversion, most likely from an actual sale or revenue or whatever you want that is really the more qualified action there. That will really allow people to use it effectively and not, again, just burn a bunch of your budget on leads that are never going to lead to any kind of revenue.

Lauren: Really simply put, if you’re running a PMax campaign right now and you look at the primary conversion action, if it’s calls from ads, all calls being fed in from a call tracking system, just any call occurred, a form was submitted, a button was clicked, you probably are setting yourself up for failure with PMax.

Alex: Yes, it’s really almost a nonstarter to have that. It’s good for really your whole account. Particularly for Performance Max, you have to be careful with Google’s AI and the automation and the way it’s targeting people. It’s really powerful at finding– that you want. If you tell it to go get you a lot of form submissions, form submissions are sales or revenue.

Lauren: The other thing I think we’ve noticed, mistakes people have made is the inventory. You are now buying across a wider set of inventory and using text-only ads and trying to place them inside of something that should be high-impact visual. A lot of groups were making the mistake of not putting the right inventory into the tool as well. Talk a little bit about that.

Alex: Yes, definitely. Like a lot of automation, the output is only going to be as good as the inputs that you give it. A lot of mistakes that were made, I think, and still make now are when you don’t upload an actual video asset to the campaign. What that will do is actually Google will make its own video for you.

Lauren: From your text ads or what it says on your website.

Alex: Yes, and from any kind of images you upload. It’s not terrible, but it’s definitely not something you might want to see your brand associated with. Always having actual video that you can upload will basically make sure any kind of ads you show on YouTube or any other kind of video inventory won’t be this very generic template that you’ve seen elsewhere for a lot of other brands.

Lauren: Don’t try PMax if you do not have the assets required to upload to the library. You still need great text ads because it does include Search inventory if you buy it that way. You need great video for those YouTube and video placements. Get your display banners uploaded, get your dynamic creative elements so that you can do some of that testing. If you’re not going to do those things, you are going to then feed into Google’s black box concept and give them probably more control than you would like. I did want to ask you a little bit more about the algorithm.

We’re going to get a little bit into how it’s made, but what about Google’s algorithm and PMax. We hear this a lot with broad match too. If you are willing to give some of that control to Google in a tested environment, what other signals are they looking at in the user and how the user behaves that maybe you don’t get in a traditional keyword-based buy?

Alex: I would say a lot of, like you’re saying, the broad match signals that are assigned to that match type, your past searches, and the other landing pages in your account that Google is looking at to see the context of the searches and everything, I think one of the things that is unique with Performance Max, because like you said, once you introduce a new channel, it becomes less about how much do I need to bid in Search, but more about incrementality and marginal ROI and marginal CPA rather than your total average CPA. Google is often looking at not where is the next conversion I can get that will make the entire portfolio CPA low.

It’s about, “Actually, if I serve on these impressions to this person, because I know that they’re lower in the funnel through all the signals that we have, I’m going to serve the impression on YouTube actually instead, because I have a lower marginal ROI or CPA there or higher marginal actually.” That is, I think the unique part about Performance Max, that it’s thinking about incrementality and not just getting the most for your budget.

Lauren: Thinking about PMax in that way, it is for many clients, their first step in the full-funnel. You are going off of, “Hey, I’m buying these super high-intent, best vendors near me keywords,” and you are looking at things like prior search behavior, their demographic, their general usage and browsing history. I know proximity is one of the elements you can look at, not just are they in a zip code, but where are they in proximity to my clinic? Those signals make it much more of an audience-based buy than a search-based buy. How do you think about introducing PMax maybe as the first step into full-funnel?

Alex: Yes. If you’re already running Paid Search within Google Ads, it’s a natural progression or evolution just because it is within the same platform. It’s a lot less lift to stand up rather than going, standing up another platform or another channel. Again, because you’re within the same platform, you already have those same conversion actions. Hopefully, you have offline conversion, so you can allow that to optimize towards campaign. The lift just in terms of getting the assets and everything up is fairly low. Again, because it’s all within Google’s ecosystem, it’s like that unified attribution across all these different channels.

Again, as soon as you go into Meta or programmatic or whatever your other platform is, you’re dealing with other walls, gardens that you would have to have some other tool to loop them all together. The advantage with Google is that you’re already in that channel, you can just layer this onto your Search campaigns, and everything is talking to each other.

Lauren: That’s a good question for everybody listening. Do you layer PMax on as a test? Do you pause your Search and Search as part of your PMax? How are you actually setting this up just so people know where to start?

Alex: It’s recommended that Search– You have your base Search campaigns, and Performance Max is purely augmenting your Search campaigns or complimenting your Search campaigns. They’re really the best way to go about it because the ultimate question is if I run Performance Max and it performs better than my Search campaigns, question is would I have gotten those same conversions for my Search campaigns? You don’t know exactly where just due to the limited visibility of PMax.

What you can do is actually they have experiments now with Performance Max where you can actually run an A/B test to see the lift on people who’ve been exposed to just a Search campaign versus people who’ve been exposed to just Performance Max campaign.

Lauren: Then came through Search ultimately, right? Did that influence them? Did they convert at a higher rate?

Alex: Right, exactly. You’re basically able to see a control group that was never exposed to anything other than a search ad and then a group that was also exposed to all of Google’s inventory there. The idea is, what was the lift I saw on that experiment group?

Lauren: In successful deployments of PMax, and we’ve certainly seen plenty of non-successful ones, what is that lift? What might you expect to see if it works well?

Alex: Google pushes a number of about an 18% increase in leads for the same budget. [unintelligible 00:10:34] you want to read that, basically 18% lift that you wouldn’t have gotten elsewhere. Now, of course, that is Google’s stat they throw out there.

Lauren: Sounds good.

Alex: We do see, a lot of times, the clients we’ve tested on, it’s even more pronounced sometimes. We’ve actually seen Performance Max outperform non-brand search, which is pretty impressive. Once you get to that point, it’s almost more about how do I scale this efficiently? Again, under the right conditions, it can be really powerful.

Lauren: Yes, you mentioned leads. The key is that those leads are a signal that matters and is indicative of quality for your business. An 18% lift in leads that are garbage means nothing. It’s about feeding that.

Alex: Exactly. Google is the first party to tell you don’t give it form submissions and phone calls, so we’re not the only one saying it. It’s definitely recommended to have not just your lead output, but your sale or revenue or appointments, whatever it is.

Lauren: On a closing note, you talked about scale. I think it’s a great way to test if exposure to your brand throughout the consideration funnel can ultimately generate a lift. It just opens the door to then going on to Meta, looking at programmatic DSPs, other inventory. It’s just a baby step in the right direction. We’re not saying PMax is your answer for full-funnel. Have you seen groups– You mentioned somewhere, it’s actually produced a bigger lift. What is the next step beyond that?

Alex: Again, going back to the advantage of PMax is that it’s already talking to your Search campaign. As soon as you get outside to another platform or another channel, it poses some challenges. I think it’s about understanding where is– Again, going back to marginal CPA and marginal ROI. is my dollar best spent in Performance Max, or have we tapped that out and scaled it? Now, we need to shift to Meta where we think we can have a lower marginal CPA or higher marginal ROI. I think that’s the next step.

Then, ultimately, again, one thing we haven’t mentioned is, even though we’re talking about Paid Search and PMax and the lift between the two, you still want to be thinking about all this holistically across all of your channels, because the reality is that YouTube and Display and Discover and all these other channels are still getting people to come through your website, just lots of other–

Lauren: Yes, organic [crosstalk]

Alex: Ultimately, people don’t click on paid ads that often, so that organic is also where a lot of that traffic goes.

Lauren: You’re looking at and monitoring conversion rates, click-through rates on activity there as well, expecting to see a lift, and maybe branded search queries in Search Console and maybe, people converting at a higher rate, even if they come up non-brand, are things to be on the lookout for. Awesome. Thanks, Alex. Appreciate it. If you all have tested PMax a year or two ago and maybe you made some of the common mistakes we talked about, don’t totally rule it out, get with your agency, talk about putting the right conditions in place, and setting it up as an experiment, not just throwing it in there and assuming it’s going to work.

It could be a way to unlock scale and growth for you. Thanks for listening to Ignite, and we hope to see you next time.

Announcer: Thanks for listening to this episode of Ignite. Interested in keeping up with the latest trends in healthcare marketing? Subscribe to our podcast and leave a rating and review. For more healthcare marketing tips, visit our blog at cardinaldigitalmarketing.com.

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