Molitaris Consulting

Strategy Recap, June 9

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Ambrosia · June 9 strategy recap

Where we are, where we're going

Decisions, alignment, and next steps from this morning's call
The throughline: the foundation gets clean before we ramp. The biggest unforced-error fixes are done. The next three weeks are about strengthening signal quality and adding the campaigns agreed today, then back-weighting spend with a much higher quality bar than the previous setup ever held to.
1

Where we are right now

  • Engagement started Friday June 5
  • Spend pulled back from ~$4,000/day weekday average to ~$1,000/day intentionally
  • Two clean campaigns running: Branded (manual CPC, captures demand cheaply) and General Rehab (with 101 negatives applied across 5 waste categories)
  • All historical campaigns paused (Addiction Landing Page, Ketamine Therapy, Adolescent Search, etc.)
  • Call volume traces back to a mid-April drop when GA4 was connected (per Josh's recall on the call); volume hasn't recovered since, even with reduced spend
Bottom line: we are lighting less money on fire while we strengthen the foundation. Spend ramps as quality of incoming searches gets cleaner. Backweighted toward second half of June.
2

What the previous setup actually looked like

Pre-engagement non-brand performance (favorable estimates, since half of spend was hidden by Google's privacy threshold):

MetricBefore
Cost per non-brand qualified opportunity$3,000-$5,000
Cost per non-brand admit$9,000+
Identified waste (visible portion only)$34K of $135K (25%)
Brand spend cannibalized into general campaigns$17,830 in 90 days
Primary conversion signal60-second phone calls

For context, qualified opportunity means anyone past Missing Info in Salesforce. So VOB on Queue, VOB In Progress, Priority Follow Ups, Follow Ups, Adolescent Follow Ups, Needs Travel/Detox, At Detox, Scheduled for Admission, all the way through Admitted and Alumni.

Bottom line: the previous spend was finding admits, but at a cost per acquisition that was untenable. The path back to healthy unit economics goes through search term quality and signal quality, both of which we are rebuilding now.
3

What we've already changed this week

  • Built a dedicated Branded campaign. Manual CPC, low bids, with 53 clean brand keywords (Ambrosia, Neuroscience Institute at Ambrosia, The Academy at Ambrosia). Stops paying premium prices to reach people who were already coming to you.
  • 101 negative keywords applied to General Rehab. Across 5 waste categories: 29 competitor facility names, 20 wrong-customer patterns (sober living, halfway house, Medicaid, court-ordered), 16 off-menu services, 25 medication research terms, 11 informational queries.
  • Rebuilt the conversion tracking architecture. Salesforce qualified opportunities and admits now feed Google Ads directly via the API. No more optimizing toward 60-second phone calls.
  • 98 historical qualified opportunities and admits pushed back to Google as bootstrap. The bidding model starts with real signal instead of cold.
  • Qualified definition expanded. Aligned on the call that Missing Info should count as qualified for OCI purposes. Covers cases like a family member calling on behalf of a patient or insurance pending a future start date. Next OCI run includes these.
Bottom line: Google's bidding model now knows what a real admit looks like. Every dollar going out from here forward optimizes toward that, not toward whoever picked up a call for a minute.
4

What we found in Salesforce (where admits actually come from)

Pulled the full 365 days of Salesforce admit data. Headline numbers:

  • 1,011 admits last year, ~$10.8M in estimated revenue
  • 82% from Florida, 18% out of state (174 OOS admits, ~$2.17M revenue)
  • Out-of-state patients average $12,454 per case vs $10,580 in Florida

Top out-of-state markets by admit volume (last 365 days)

StateAdmitsAvg case (est)Revenue (est)
Massachusetts15$16,310$244,649
Pennsylvania14$9,833$137,664
Illinois14$11,972$167,603
New York13$12,729$165,471
New Jersey12$9,448$113,382
Texas10$15,275$152,749
Georgia10$16,416$164,157
Maryland9$14,736$132,624
South Carolina9$11,211$100,899
North Carolina7$16,971$118,797

Revenue and case values are pulled from Salesforce's Estimated Revenue field. Actual Revenue is empty across the dataset, so accuracy of these estimates is unverified. Worth validating against collected revenue at some point.

State preferences (Saturday) overlaid against admit data

States flagged on Saturday: GA, TN, IL, IN, MO, NJ, NY. Removing: TX, SC. Open clarification on the "above 90" comment.

StatePreferenceAdmits 365dAvg case (est)Revenue (est)Priority
GAYes10$16,416$164kTier 1
NYYes13$12,729$165kTier 1 (best OOS close rate at 32%)
NJYes12$9,448$113kTier 1
ILYes14$11,972$167kTier 2
TNYes3$14,550$44kTier 2 test
INYes1$10,000$10kSmall historical signal, test market
MOYes1$0$0Small historical signal, test market
TXNo10$15,275$152kRemoving from targeting
SCNo9$11,211$101kRemoving from targeting

States not on the list with significant admit volume (worth discussing)

StateAdmitsAvg case (est)Revenue (est)
MA15$16,310$244k
PA14$9,833$137k
MD9$14,736$132k

MA is the largest OOS market by volume and revenue. We flagged that some preferred states may show low historical admit volume simply because there was no paid presence there. Worth revisiting after OOS expansion launches.

Two clarification questions:
  1. The "states above 90" comment — what does the 90 refer to? Insurance reimbursement above 90%? Some other operational metric?
  2. Texas shows $152k revenue and $15k avg case in Salesforce. What's making it a "no" state in practice? Worth understanding so we apply the same lens to other states.

Current out-of-state spend reality

Last 120 days of Google Ads spend, by where the user actually was:
  • Florida: $239,744 (99% of all spend)
  • Every other state combined: ~$2,500
  • Illinois specifically: $217. Georgia: $28. New Jersey: $14. Massachusetts: $0.
The current campaign is targeted to Florida and gets occasional spillover. There is no meaningful paid presence in any out-of-state market today. Whoever is bringing in those 174 out-of-state admits per year is doing it through referrals, organic, and direct.

Proposed OOS launch plan

Phase 1 launch (tier 1): NY, GA, NJ. Highest admit volume, highest case value, and zero current paid presence. NY has the best historical close rate of any out-of-state market.

Phase 2 expansion (tier 2): IL, TN.

Probe markets (low historical signal): IN, MO. Small budgets, watch quality.

Open question for this call: MA, PA, MD — high admit volume but not on the Saturday list. Decision needed on inclusion.

5

Admit priority order and Ambrosia's differentiators

Admit priority order (agreed on the call)

  1. Detox — business priority to keep 7-8 of 8 beds filled for staffing economics. We capture detox demand via the General Rehab campaign rather than dedicated detox bidding (detox is the most expensive and competitive search segment).
  2. Residential and mental health — the volume backbone.
  3. Adolescent (Academy) — 45-60 day stays vs ~30 for adults. Higher revenue per admit.

Ambrosia's differentiators (worth working into ad copy + landing pages)

  • Psychiatrist/physician-owned facility, led by Dr. Allam (psychopharmacology expertise)
  • 18-20 clinical research studies running simultaneously; partners include NIMH and Eli Lilly
  • Active studies: treatment-resistant depression, schizophrenia, opioid use disorder
  • IV ketamine infusions, TMS, high-dose vitamin detox
  • Rapid detox option (weekend timeline, self-pay)
  • "Neuroscience" framing resonates with mental-health searchers who use ChatGPT-era language
6

Insurance picture (where the high-value admits come from)

  • BCBS-FL: 446 admits, 44% of total volume, $8,874 avg case. The dominant payer.
  • United Healthcare: 92 admits at $14,352 avg.
  • Out-of-state BCBS plans: BCBS-IL ($14,274), BCBS-PA ($12,634), BCBS-TX ($12,903), BCBS-MA ($23,886). All above $12k/case.
  • BCBS-MA averages $23,886/case, the highest of any payer.
  • Coming in-network: Curative and Seminole Tribe of Florida. Insurance logos to go on landing pages as new contracts close.
Estimated revenue caveat: the dollar figures above use Salesforce's Estimated Revenue field, which is Josh's manual estimate rather than billing-system actuals. Manual revenue upload coming. Longer-term we'd explore the billing-software API for true closed-loop ROAS by campaign and level of care.
Bottom line: the OOS expansion isn't just about volume. It's a margin lever. Florida BCBS pays $8,874 average. Out-of-state BCBS averages $12-24k. Same patient acquisition effort, higher revenue per admit.
7

Campaign structure — agreed

Currently running 2 campaigns: Branded + General Rehab. Agreed on three non-brand campaigns total, plus Branded.

CampaignTargets365d admits in this category
BrandedAmbrosia + Neuroscience Institute + The Academy brand termsexisting
General Rehab / SUDDrug + alcohol addiction, detox, residential, substance use disorder. Vague intent that doesn't identify MH or adolescent.~440 (Detox + SUD Res + SUD PHP)
Mental HealthDepression, anxiety, dual diagnosis, residential mental health.~535 (largest program category, 53% of admits)
Adolescent (The Academy)Teen / adolescent residential. Their highest case value ($17,919 avg).162 (Academy)

Why no more than 3 non-brand campaigns

  • At ~$1,000/day total, 3 non-brand campaigns equals ~$333/day each. Adding more dilutes budget below the level Google's algorithm needs to learn.
  • Within each campaign we still get program-level flexibility via ad groups. Ad groups don't get separate budgets, but they all optimize toward the same CPA target. With our SF Qualified Lead and Admit conversions now feeding the algorithm, ad-group-level optimization happens automatically.
  • Every additional campaign added trades efficiency for control. We want enough control to push budget where it matters (Mental Health vs SUD vs Academy) without sacrificing the algorithm's signal-density advantage.

Decisions on Ketamine, Outpatient, Detox, Spravato, Ibogaine

  • Ketamine: tabled. Search terms from the previous setup were the worst-performing of any paused campaign. Ketamine handled as a post-admit upsell by the internal team, not paid acquisition.
  • Spravato: tabled. Insurance authorization timeline (3-4 weeks) doesn't match the ~30-day average stay, so it would only ever be self-pay. Not the right fight right now.
  • Ibogaine: confirmed off-menu. Hard negative across all campaigns.
  • Detox: lives inside General Rehab / SUD as an ad group, not its own campaign. Detox is the most expensive and competitive segment; we capture demand via broader rehab terms.
  • Outpatient: not in Phase 1. Virtual outpatient is discharge follow-up only; new outpatient is self-pay only. Revisit later if volume justifies.
Bottom line: we are sacrificing some efficiency with every additional campaign we build, since we're diluting the budget. The algorithm gets smarter with concentration, not spread. We want the smallest number of campaigns that gives you the program-level visibility you need.
8

Timeline for the next 4-6 weeks

This week

  • Launch Mental Health campaign + landing page tomorrow. Targets the largest program category by admit volume. Separate LP, no addiction language, neuroscience framing.
  • Daily negative-keyword cleanup as new search terms surface
  • Brand bid sweep underway: 9 competitors in auction insights, 26% absolute top impression share at current bid. Bumping max CPC $8 to $15 and reassessing by end of week.
  • Expand OCI feed to include Missing Info opps now that those are agreed as qualified.

Next 2-3 weeks

  • Ramp spend incrementally as search-term quality holds
  • Build rapid-detox and Academy landing pages; send to Natalia, Josh, Kendrud (and general counsel where claims are involved) for review
  • Find USP pages on the Ambrosia site for rapid detox, IV infusions, TMS, ketamine therapy — will inform campaign-level messaging and LP positioning
  • Monitor signal quality from new conversion tracking; first real read on cost per qualified opp from clean attribution

After Florida is stable

  • OOS expansion paused until Florida foundation is stable. Each new geo requires fresh negative keyword cleanup, so launching OOS before search-term quality is solid undercuts the work.
  • When ready: launch OOS cluster targeting agreed states (NY, GA, NJ tier 1; IL, TN tier 2; IN, MO probe).
  • Explore billing-software API for true closed-loop ROAS by campaign and level of care.
  • First monthly retrospective with cost per qualified opp + cost per admit on the new tracking.
9

Resolved on the call

  • Ketamine: tabled.
  • Spravato: tabled (self-pay only due to insurance auth timing).
  • Ibogaine: confirmed off-menu / hard negative.
  • Virtual IOP: confirmed off-menu (discharge follow-up only).
  • TX and SC: removed from targeting.
  • Detox: ad group inside General Rehab, not a standalone campaign.
  • Landing page review cycle: Natalia, Josh, Kendrud, and general counsel for claims review. Proceed if no feedback.
  • Qualified definition for OCI: includes Missing Info.

Still open

  • "States above 90" meaning — Natalia following up.
  • Manual revenue upload timeline — Josh confirming.
  • MA, PA, MD inclusion in OOS launch list (Phase 2 conversation).
10

Action items

Molitaris Consulting

  • Launch Mental Health campaign and landing page tomorrow
  • Ramp spend incrementally over the next few days as search-term quality holds
  • Expand OCI feed to include Missing Info opps (Salesforce → Google Ads)
  • Add a leads layer (calls + forms) to the reporting dashboard, above qualified opps, for full-funnel view
  • Build rapid-detox and Academy landing pages; send for review
  • Find USP pages on the Ambrosia website for rapid detox, IV infusions, TMS, ketamine therapy
  • Explore billing-software API for closed-loop ROAS by campaign and level of care

Ambrosia

  • Clarify the "states above 90" reference (Natalia)
  • Confirm manual revenue upload timeline (Josh)
  • Coordinate Curative + Seminole Tribe in-network announcements when contracts close
11

Reporting dashboard

Live dashboard pulling from Salesforce and Google Ads simultaneously. Current view: spend, qualified opps, admits, cost per qualified opp, cost per admit, and a daily spend trend. Each lead and admit row links out to the corresponding Salesforce record.

Open the performance dashboard → Live data, last 30 days. Click any lead to open it in Salesforce.

Planned upgrades: leads (calls + forms) layer added above qualified opps, then a polished v2 within the next ~2 weeks.

Revenue figures use Salesforce's Estimated Revenue field, which is currently Josh's manual estimate. A revenue upload is coming, and longer-term we'd connect the billing-software API for true closed-loop ROAS.