Case Study
From $291 to $206 per signup on Google Ads
Rupa Health | Scaling practitioner acquisition through its acquisition by Fullscript.
Rupa Health helped healthcare practitioners order, track and manage more than 3,000 laboratory tests in one place. Four15 Digital began working with Rupa in December 2023 to improve Google Ads efficiency and reach more practitioners who could become active lab-ordering customers.
The before/after review recorded 4,668 signups at approximately $206 each in its 2024 snapshot, compared with 2,315 at $291 in its 2023 snapshot. Recorded activations increased from 873 to 1,826, while cost per activation fell from $771 to $527.
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Google Ads / Metabase
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2023 snapshot
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2024 snapshot
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|---|---|---|
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Cost per signup
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$291
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$206
|
|
Signups
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2,315
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4,668
|
|
Cost per activation
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$771
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$527
|
|
Activations
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873
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1,826
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Ad spend
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$672,877
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$962,730
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The supplied before/after deck labels these “2023 vs 2024 MTD Performance” but does not specify exact date cutoffs. These are reported snapshots, not a verified matched full-year comparison. Cost per signup fell approximately 29%; cost per activation fell approximately 32%.
A signup was only the beginning. Practitioners still needed to activate and begin ordering tests, and their commercial value accumulated over time. Consumer searches could resemble practitioner searches, while different clinics and lab tests had very different revenue potential. The account needed both broader reach and better ways to judge the quality of that reach.
The audit found an activation import that was not functioning, inconsistent tracking parameters, weak nonbrand quality scores and gaps in keyword coverage. Rupa had a large catalog of tests and lab partners, but its paid search program was not making full use of that catalog.
We organized coverage around lab companies, individual tests, sample types and broader practitioner needs. The before/after review shows keyword coverage expanding from 123 to 515, with terms such as “order lab tests” and “functional medicine labs” among the leading signup drivers. Dynamic Search Ads added a way to discover demand across Rupa’s extensive site, with query reviews and exclusions helping control relevance.
We tested the homepage against catalog and test-specific destinations, refined ad assets and developed more relevant ad copy for individual lab-test groups. The review records 20 experiments in 2024. Testing informed the decisions: early notes show the homepage outperforming some alternatives, rather than assuming a more specialized landing page would always win. Later work included hero messaging and layout iterations with Rupa’s team.
We worked with Rupa’s data team on offline conversion imports and reporting for signups, activations and paid orders. As clinic-size information became available, optimization discussions shifted toward practitioners with patients and meaningful activation potential. Metabase remained the reporting source of truth, while Google’s conversion signals supported bidding. Reconciliation continued as definitions and data availability evolved.
A recent signup cohort had less time to generate orders than an older one. Four15 pushed for reporting that separated signup month from the months in which value accrued, so cohorts could be compared at similar ages. Cost per signup provided an earlier efficiency measure; activation and cohort-level GMV helped assess whether those signups developed into valuable users. The result is an acquisition-efficiency story, not a claim of proven profit growth.
Fullscript announced its acquisition of Rupa Health on October 10, 2024, bringing Rupa’s lab platform together with Fullscript’s whole-person care platform. Four15’s work continued with the Rupa/Fullscript team into May 2025, including campaign optimization, reporting alignment and signup-quality discussions. The acquisition was a business milestone during the engagement; the evidence does not attribute the transaction to advertising performance.