Ignite: Healthcare Marketing Podcast
Oct 6, 2026 · 20 min · 10 segments
Google's recent bidding change is creating new challenges for healthcare marketers managing Target CPA and Target ROAS campaigns with limited budgets. In this episode of the Ignite Healthcare…
Evan IlgenfritzGuest
Lauren LeoneHost
For those of you listening, if you're not super clued into this, August seventeenth, Google changed how their target CPA and target ROAS objectives behave for campaigns that are limited by budget.

Now, I know for most of you listening and most of our clients, because we are running hundreds, sometimes thousands of campaigns delineated at the location level, oftentimes limited by budget is one of our biggest challenges.

When you cannot consolidate because you need to have control over budget or where the traffic is going or how much a clinic or a group of clinics is spending, that limited by budget is probably the flag that is on all of your campaigns.

This was something we had to navigate with quite a few of our clients in that situation.

The challenge was, in the past-- Actually, you know what? I'm not even gonna try to take the words out of Evan's mouth.

That change specifically applies to campaigns that are limited by budget, although I would say keep an eye out for kind of all your campaigns.

The main concept is that when you're using target CPA or target ROAS bidding in Google Ads, oftentimes you may have noticed that your campaign performance outperformed your target.

So let's say that you have your campaign and you have your CPA target that you're operating against at, set to a hundred dollars, but you've been seeing that the past thirty days, even several months maybe, it's been delivering at an eighty dollar CPA, so below what you were asking it to deliver.

And I think basically it, it applies to campaigns that are limited by budget because Google is trying to make sure that it is distributing the spend as best it can.

So ultimately, what's gonna happen is, in that scenario, if you have a campaign target CPA set to, say, one hundred, your performance has been over-performing your target and delivering a lower CPA.

After this change, now the campaign is going to start leaning towards your actual target that you're requesting.

Now it will start delivering right at where your target is, around a hundred dollars for a CPA.

Which is a challenge because who doesn't want the platform to over-deliver, right? Who doesn't want it-

... to come in lower? So what are some of the controls that we have as the people managing or that our clients have in advocating to whomever is managing their campaigns to ensure that, okay, I had a eighty dollar CPA, and my target was set to one twenty.

For those of you listening, if you're not super clued into this, August seventeenth, Google changed how their target CPA and target ROAS objectives behave for campaigns that are limited by budget.

Now, I know for most of you listening and most of our clients, because we are running hundreds, sometimes thousands of campaigns delineated at the location level, oftentimes limited by budget is one of our biggest challenges.

When you cannot consolidate because you need to have control over budget or where the traffic is going or how much a clinic or a group of clinics is spending, that limited by budget is probably the flag that is on all of your campaigns.

This was something we had to navigate with quite a few of our clients in that situation.

The challenge was, in the past-- Actually, you know what? I'm not even gonna try to take the words out of Evan's mouth.

That change specifically applies to campaigns that are limited by budget, although I would say keep an eye out for kind of all your campaigns.

The main concept is that when you're using target CPA or target ROAS bidding in Google Ads, oftentimes you may have noticed that your campaign performance outperformed your target.

So let's say that you have your campaign and you have your CPA target that you're operating against at, set to a hundred dollars, but you've been seeing that the past thirty days, even several months maybe, it's been delivering at an eighty dollar CPA, so below what you were asking it to deliver.

And I think basically it, it applies to campaigns that are limited by budget because Google is trying to make sure that it is distributing the spend as best it can.

So ultimately, what's gonna happen is, in that scenario, if you have a campaign target CPA set to, say, one hundred, your performance has been over-performing your target and delivering a lower CPA.

After this change, now the campaign is going to start leaning towards your actual target that you're requesting.

Now it will start delivering right at where your target is, around a hundred dollars for a CPA.

Which is a challenge because who doesn't want the platform to over-deliver, right? Who doesn't want it-

... to come in lower? So what are some of the controls that we have as the people managing or that our clients have in advocating to whomever is managing their campaigns to ensure that, okay, I had a eighty dollar CPA, and my target was set to one twenty.
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