Rand Fishkin | Founder & CEO
Healthcare Search
& SEO in 2019
The forces changing search, searchers, and search engine optimization
(with a focus on the health vertical)

Bit.ly/healthseo2019

5 Crucial Topics in Healthcare SEO
2: Voice search & voice answers: hype vs. reality
1: How Google’s future changes what works in SEO
3: Amazon and product search
4: Why 1% of content works, and 99% falls flat
5: When & how to use ads vs. organic

Google’s Future

Here’s Why That Should Scare
Web Creators…

Google Needs Growth, & It’s Not Coming From New
Searchers (at least in developed countries)
-
5,000,000,000
10,000,000,000
15,000,000,000
20,000,000,000
25,000,000,000
30,000,000,000
35,000,000,000
40,000,000,000
U.S. Searches by Month (web browsers only)
Google Desktop Google Images Desktop Google Mobile Google Images Mobile

So, What’s Google Doing to
Get Growth?

Solving Searchers Faster to Create More Search
Addiction

They Do This Through Web Result Replacements…

Content Scraping that Precludes a Click-Through

Giving Their Own Properties Preferential Treatment

And More Telepathic, Direct-to-the-Answer Results.

In Ads, the Focus is a Little
Different…
#1: Larger numbers of
more subtle ads
#2: More kinds of ads

Google’s Desktop CTRs
March 2018 (US):
Paid: 6.1%
Organic: 65.3%
Zero Click
Searches: 34.7%
*Note:Sumsaregreaterthan100%assomesearchersclickmultipleresultsperquery

Google’s Mobile CTRs September 2018 (US):
*Note:Sumsaregreaterthan100%assomesearchersclickmultipleresultsperquery
Paid: 9.5%
Organic: 38.4%
Zero Click
Searches: 61.6%

How Do These Changes Affect Searcher Behavior?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Desktop Organic CTR, Paid CTR, and Zero Click Searches (2016-2019)
Desktop Organic Clickthroughs Desktop Paid Clicks Desktop Zero Clicks
Desktop Zero-Click Searches
Up ~12% in 3 Years

On Mobile, Those Effects Are Magnified
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Mobile Organic CTR, Paid CTR, and Zero-Click Searches (2016-2019)
Mobile Clickthroughs Mobile Paid Clicks Mobile Zero Clicks
Mobile Zero-Click Searches Up
~20% in 3 Years

Google’s 2019 ABCs:
Biasing Visibility & Clicks to Paid Results
Answering Queries in SERPs & Sending Out Less Traffic
Competing Directly with Publishers
(and ranking their own properties ahead of anyone else’s)

How Can Marketers
React?

Control Your Brand with On-SERP SEO
ID sites that rank in
your space, & build
profiles on them
Claim Your Panels
Leverage the Rich
Snippets Google
Offers

When KWs Show
Aggregated Answers,
Influence the Publishers
Below to Get Listed
To Get Into These…
Get Mentioned + Listed In These

Double Down on Branded Demand Creation

e.g. Elvie’s #FreeTheFeed
campaign got Londoners
searching and sharing to
create brand awareness
(and bias future
searches/clicks)

If Other Sites Can Rank, But
You Can’t (Yet);
Use Barnacle SEO
Every one of these sites
enables user-submitted or
guest editorial contributions

Shift SEO-Focused Content to KWs
Google Is Less Likely to Cannibalize
ViaAhrefs
40%+ of all searches get <100
searches per month. The long tail is
still a gold mine for SEO.

500-30,000+ searches/month, and
hyper-competitive
ViaKeywordExplorer

But scroll down, and the long tail still
looks mighty attractive
ViaKeywordExplorer

Use CTR % Estimates in Your KW Research
This metric uses clicksteam data to
estimate the % of searchers who’ll
click on the standard, non-paid,
organic SERPs

Amazon & Product
Search

Is Anyone Else Taking Google’s Market Share?
-
10,000,000,000
20,000,000,000
30,000,000,000
40,000,000,000
50,000,000,000
60,000,000,000
Desktop Share of Searches by Month
Google Google Images Google Maps YouTube Bing Yahoo Facebook
Amazon Twitter Pinterest DuckDuckGo AOL Ask Wikipedia
ViaJumpshot’sclickstream panelof10mm+devicesintheUS,browser dataonly(noapps)

-
500,000,000
1,000,000,000
1,500,000,000
2,000,000,000
2,500,000,000
Search Volumes by Month Under 2.5B
Bing Yahoo Facebook Amazon Twitter
Pinterest DuckDuckGo AOL Ask Wikipedia
-
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
Search Volumes by Month Under 350M
Twitter Pinterest DuckDuckGo AOL Ask Wikipedia
ViaJumpshot’sclickstream panelof10mm+devicesintheUS,browser dataonly(noapps)

Amazon’s Searched ~1/30th as Much as Google, But…
50,000
500,000
5,000,000
50,000 500,000 5,000,000
GOOGLESEARCHES
AMAZON SEARCHES
Search Volumes for Top 1K Branded and Nonbranded Amazon Keywords on Google and Amazon
(2018)
Nonbranded Terms Branded Terms Nonbranded Avg Branded Avg
nintendo switch
laptop
headphones
kindle
ps4
bluetooth headphones
prime video
external hard drive
paper towels
iPhone 7 case
cbd oil
water bottle
iPhone charger
food
lingerie
dog
iPhone
adidas
aa batteries
roku
mens socks
monitor
christmas
audible
sheets

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1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
TotalSearchVolume
50/50
100% Google / 0%
Amazon
100% Amazon /
0% Google
E.G. iPhone-Related Searches on Google vs. Amazon

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1,000,000
2,000,000
3,000,000
4,000,000
TotalSearchVolume
50/50
100% Google / 0%
Amazon
100% Amazon /
0% Google
Health Searches Happen on Google.
Generic CPG Searches on Amazon.

What About Search on Instagram?
-
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Instagram Hashtag Clicks by Month (Desktop)
IG’s grown ~2.5X on desktop (at a time when desktop overall
shrank). Still <0.1% of Google’s desktop search volume.

Voice Search
Hype vs. Reality

Voice Search & Mobile Apps Are Probably Cannibalizing
Some Queries
ViaPerficientDigital’s2019Surveyof1,719people

Does Voice Search Change Anything?
Not
Really.

Do Voice Answers Change Anything?
Yes!
“That is called the
Achilles Tendon.”

ViaHigherVisibility’s2018Surveyof
2,017SmartphoneOwners
Unfortunately, we don’t yet have real data, just surveys
(which, historically, are poor representations of how people
actually behave).

Why Most Content
Fails

For 15 Years, Content Marketing Worked
Great Like This…

Content
Flywheel
2001-2016
KW Research +
Industry Intuition
Publish
Content
Promote via Social
Channels
Push to email +
RSS subscribers
Earn Links +
Amplification
Grow social, email, RSS,
& WoM channels
Grow Authority &
Brand Recognition
Earn Search &
Referral Traffic
Rank Higher, Get
More Traffic

But, in 2019, Four Forces Work Against This Model
#2 Demands for monetization and growth have pushed tech
monopolies to become publishers’competitors
#1 Search Engine & Social NetworkAlgorithms Have Become
Winner Take Most Platforms
#3 Amplifiers are overwhelmed by requests and more skeptical than
ever before
#4 Traffic quantity correlates less & less with conversions

How Can Marketers
React?

Successful Content Targets Topics that Resonate with
Amplifiers, Not Just Customers
What Your
Customers Care
About
What Influential
Publications & People
Your Customers
Listen To Care About
Topics with high
potential reach

The Most Visited Piece the NYT Ever Published?
Dialect Quiz Map via NY Times
Grabs you fast, then demands
engagement
Plays to the psychological
desire for categorizing oneself
& others
Creates a viral loop (through
sharing & seeing friends’
answers)

Content as Product
This interactive piece from Typeform isn’t
just “good content;” it delivers:
Unique value
Reference-worthiness
A view into Typeform’s
competitive advantage
Rise of the Conversational UI via Typeform

Content → Email Subscriber → Conversion
“A visitor who reaches us via search is 1/19th as likely to
subscribe as one who comes in from a newsletter; a
reader coming in from Facebook is 1/12th; and a reader
coming in from Twitter is 1/6th.”
-Nicholas Thompson, Editor in Chief
Via Wired

VS.
Visitor
Email
Subscriber
Conversion
~2% ~10%
Visitor Conversion
~0.2%

Visitor Conversion
+
Visitor
Email
Subscriber
Conversion
~0.2%
~2% ~10%
These are additive, not
competitive!

But Rand, How Do I Rank
My Pages in Google?

8 Broad Areas of Google’s Ranking Algorithm
(for classic, ten-blue-links style results):
Links
Authority of
Host Domain
Query
Satisfaction
User
Experience
Personalization
Technical &
Crawl
KeywordsContent

Does the text match what Google’s ML systems
calculate to be relevant, high-quality, & a match
for the searcher’s intent?
Content

Editorially-given, anchor-text-rich, followed links
from high quality sources still matter to Google
(esp. in competitive results)
Links
Via Link Explorer

If Google sees high rates of pogo-sticking or other
signals that your page/site isn’t solving search
queries, they’ll likely rank you lower
Query
Satisfaction
Via WB Friday

Using the searcher’s keywords intelligently on
your page still matters for rankings (and for CTR
in the results)
Keywords
e.g. Ring failed to rank
until they changed their
page title to include
“video doorbell”

Domains accrue signals of quality & value.
Powerful domains may give the pages they host
a boost in ranking ability.
Authority of
Host Domain

Google wants to see sites provide an easy-to-
use, intuitive experience on every device, at
every speed, without impediment.
User
Experience

Speed & accessibility to crawlers still matters, and
Google still doesn’t handle non-text, or non-HTML-link
accessible pages well.
Technical &
Crawl

The geography, device, search history, and
timing of a searcher’s query can all change
Google’s results significantly.
Personalization

Different Result Types Have Other Ranking Inputs

Ads vs. Organic

The Late Adopters Are Finally Crossing the Digital
Marketing Chasm
Via Geoffrey Moore
These players have lots of $$$, entrenched
brands, & are used to overpaying for
untrackable advertising

Venture Dollars Are Also Flooding Ad Markets
Via PWC/MoneyTree

Investment Dollars Aren’t Seeking Profits… Just
Growth
Via Statista

Ad Bids in Many Sectors Go Far Above What’s
Profitable

Thus, Ad Costs Go Up, While ROI Trends Down
Via BusinessInsider

And Ad Tracking Getting Much Harder
Which Will Reinforce Large Quantities of “Dumb
Money” > More Trackable Advertising
The concept of a 90-day look back window is a
wrap. Retargeting beyond 7 days is dead.
Effectively, for a sales cycle of any realistic
length, the whole concept of attribution outside
of last click is over.
Via iPullRank

Hence, Influencer Marketing Is GettingALot ofAttention
ViaGoogleTrends

And That’s Even Harder to Track
Via Linqia

Accountability is a Massive Issue
Via TheDrum
“I do campaigns for brands on a weekly basis
and less than half ever come back for metrics;
less than 50% ever want to know what’s
happened. That makes me think it’s PRs playing
a numbers game and once a campaign has
gone no one is really interested.”

How Should Marketers
React?

The Most FollowedAccount(s) that Match a Keyword Search
Traditional Influencer Marketing Seeks Out:
The Most-ReachableAccount(s) that Match a Keyword Search
OR
But That’s Not Really What We Want…

Targeting on Audience Size > Audience Match
4mm followers
Followed by 19% of profiles
that frequently talk about
“supercars”

What You Really Want: People & Publications YourAudience Engages
With Most
Small overall following, but reaches
exactly who we want to reach!

First: Organic + Brand; Then: Ads + CRO
If you’re not yet known, liked, &
trusted, ad ROI sucks.

Via Wordstream
New to a market? This
happens.
Known & loved? Welcome
to Profitville.

How to Win at Digital Advertising in 2019
Step 2: Earn brand exposure through organic, social, content, SEO,
events, & targeted brand marketing
Step 3: Get >1 organic visit (or a social engagement)
Step 4: Pay to advertise where your audience engages to those who
already know+like you
Step 1: Interview, survey, or use profile data to discover where your
audiences engage (and with whom/what)

Rand Fishkin | Founder & CEO
Thank You!
Bit.ly/healthseo2019