The Challenge
What They Were Dealing With
A health tech startup had built a genuinely innovative telehealth platform but was invisible in search. Their primary keyword — the one their entire business model depended on — had them buried on page 3 at position 27. Their previous agency had quoted "12 months minimum" to reach page 1 and recommended a content strategy that involved publishing weekly blog posts about general health topics. The startup was burning runway and couldn't afford to wait a year for organic search to start contributing to customer acquisition.
The Approach
What We Actually Did
The previous agency's "12 months minimum" estimate was based on a generic SEO playbook: build domain authority slowly through content marketing, acquire backlinks gradually, and wait for Google to reward the effort. That playbook works for established businesses with time and budget. For a startup burning $80K/month with 10 months of runway, it's a death sentence.
We took a different approach. Instead of trying to build domain authority broadly, we focused everything on one keyword cluster. The primary term, four closely related long-tail variants, and the comparison terms ("[client] vs [competitor]"). Total focus, zero distraction.
The page targeting their primary keyword was the main problem. It was a feature overview page that read like an investor pitch deck — full of vision statements and market-size statistics, completely devoid of the practical information that people searching for telehealth platforms actually want. We rewrote it as a comprehensive resource: what the platform does, who it's for, how it works, pricing transparency, integration details, and a comparison table against the three main competitors.
The technical wins were quick and impactful. The page had no schema markup — we added MedicalBusiness and SoftwareApplication schema. The page title was the company tagline instead of the target keyword. Meta description was auto-generated by their CMS. Internal linking to the page was nonexistent — we added contextual links from every other page on the site. Page speed was 4.1 seconds on mobile — we cut it to 1.8 seconds by removing an autoplay video and lazy-loading below-fold images.
For the comparison pages, we built dedicated "[competitor] vs [client]" pages — aggressive, sure, but these terms were already being searched and the competitor pages were ranking for them by default. We gave Google a better answer.
The War Story
How It Actually Happened
The startup's founder had a specific frustration that we hear constantly: "We built something genuinely better than the competition, but nobody can find us." The product was legitimately superior — better UX, better clinical integration, better pricing. But Google doesn't rank products by quality. Google ranks pages by relevance, authority, and technical accessibility. Their page was failing on all three.
Day one was a full teardown. We identified 11 specific issues suppressing the page's ranking potential. The three highest-impact items: no keyword optimization in the page title or H1 (they used their tagline "Healthcare, reimagined" instead of the target keyword), the page was orphaned from the rest of the site with zero internal links pointing to it, and the content didn't match search intent — it was written for investors, not for the healthcare administrators who actually search for telehealth platforms.
The rewrite went live on day 4. Same page URL, completely different content. We kept the branding elements but restructured around what searchers actually need: a clear explanation of the platform, transparent pricing, feature comparison, integration details, and customer outcomes with specific metrics. The page went from 800 words of vision statements to 2,200 words of practical, searchable content.
Day 8: the page jumped from position 27 to position 19. Google had recrawled and recognized the dramatically improved content relevance. This is what people misunderstand about SEO timelines — if a page is already indexed and the domain has some authority, content improvements can move rankings within days, not months. The "12 months minimum" timeframe assumes you're building authority from zero. This site had authority — it was just pointed at the wrong content.
Day 15: position 14. The internal linking changes had been crawled. Every page on the site now linked to the target page with relevant anchor text, and Google was consolidating the site's authority toward that page. The comparison pages were starting to get impressions too, which reinforced the topical cluster.
Day 30: position 6 — page 1. The founder sent us a message at 11pm: "We're on page 1. I can't believe it." We sent back: "We're not done. Position 6 isn't position 1."
Days 30-45 were about consolidation. The comparison pages started ranking on page 1 for their respective terms, which drove additional traffic and backlinks to the main page. We submitted a PR piece to a health tech publication that linked back to the platform page — one high-quality, topically relevant backlink that moved the needle more than the 40 low-quality directory links the previous agency had built.
Day 52: position 2. Day 58: position 1. Sixty days from engagement start to the #1 ranking for their primary keyword. The previous agency's "12 months minimum" had been based on a generic playbook applied without diagnosis. The actual problem was specific, the solution was specific, and the timeline reflected the specificity of the approach.
The business impact was immediate. Demo requests from organic search went from 2-3 per week to 15-20 per week. The startup extended its runway by six months because customer acquisition costs dropped by 70%. They closed their Series A three months later, with the organic growth trajectory as a key metric in the pitch deck.
From buried on page 3 to the #1 spot in 60 days. Our previous agency quoted "12 months minimum." Underdog did it in two. No bullshit, no excuses, just execution.
Tom Reilly
Founder, Health Tech Startup
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