Medical Agency SEM White Label

31% churn alert to 3.1% in 3 quarters

Google Ads · 9 months

In short

A medical marketing agency serving local practices across the United States and Canada brought Cosmo Californie Media in as its white-label search team in April 2025, starting with 10 accounts and running the whole Google Ads MCC by June. Its churn indicator flagged 22 of 71 accounts as red, a 31% rate, based on real patient inquiries rather than dashboard conversions. By January 2026 the red accounts were down to 3, a 3.1% rate, while the book grew to 98 accounts.

Client: Medical marketing agency, white-label partner (not named)
Industry: Healthcare marketing, local medical practices in the US and Canada
Services: White-label Google Ads management across the agency's MCC
Period: April 2025 to January 2026 (9 months)
Tools: Google Ads MCC, internal data warehousing and performance frameworks

Challenges/Opportunities

This agency supports local medical practices across the United States and Canada with patient acquisition through paid search and seo.

We started working together in April 2025, initially supporting 10 accounts. By June, we were managing their entire Google Ads MCC.

The agency uses an internal risk indicator to monitor account health and predict churn. One of the most important metrics in that framework is “Getting Leads” status, which is based on MQLs—real potential patients contacting the practice—not Google Ads dashboard conversions.

This status is evaluated at the beginning of each quarter using results from the previous quarter.

When we stepped in, the numbers told a clear story.

Starting Point (April 2025)

Total accounts: 71

Accounts labeled “Red” (at risk of churn): 22

Red account rate: 31%

The Work We Did / Lessons We Learned

By January 2026, both performance and scale had changed signifcantly.

Results (January 2026)

Total accounts: 98
Accounts labeled “Red”: 3
Red account rate: 3.1%

Put more simply:

We reduced red-labeled accounts from 22 to 3 in 9 months
The client base grew from 71 to 98 accounts during the same period
Performance was maintained while onboarding 27 additional accounts

How We Did It

We built internal data warehousing and performance frameworks that we could reuse across accounts within the same medical niches. That gave us the ability to quickly diagnose underperformance, compare struggling accounts directly against top performers, and apply changes based on patterns that were already working elsewhere.

Results & Lasting Benefits

Because we could see what good looked like across similar practices, we were able to move with precision. Underperforming areas of accounts were addressed faster, improvements stuck, and the agency gained a foundation they could continue scaling on while reducing their churn risk.

Today, the agency sits in a strong place both operationally and financially, and we’re excited about what 2026 will bring.

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FAQ

Questions about this case study

What does white-label SEM mean here?

Cosmo Californie ran the paid search accounts behind the scenes, under the agency's brand. The agency's account managers kept the client relationship, and we owned performance, reporting and the infrastructure across the whole Google Ads manager account, which grew from 10 accounts in April 2025 to the full MCC by June.

How was churn risk measured?

The agency uses an internal risk indicator evaluated at the start of each quarter. Its most important input is a "Getting Leads" status based on MQLs, meaning real potential patients contacting the practice, rather than Google Ads dashboard conversions. In April 2025, 22 of 71 accounts were red, a 31% rate. In January 2026, 3 of 98 were red, 3.1%.

How did performance improve across so many accounts at once?

We built internal data warehousing and reusable performance frameworks for accounts in the same medical niches. That let us compare a struggling account directly against the top performers, diagnose the gap quickly and apply changes that were already working elsewhere, while 27 new accounts were onboarded in the same period.

Can Cosmo Californie white-label paid search for other agencies?

Yes. This is one of three agencies we supported as a behind-the-scenes SEM team in 2025 across Google Ads and Microsoft Ads, alongside a restoration-industry agency for which we built a Looker Studio reporting system. Reporting frameworks are built so the agency's account managers can present them to clients directly.