Stop Pitching Telehealth — Start Building a Real Business What we learned at a high cost is that telehealth is not just about video visits, but about establishing a scalable revenue model.
By Zachary Dorf Edited by Micah Zimmerman
Key Takeaways
- Employer and payor models bring long-term stability and revenue growth in telehealth.
- Ancillary services turn low-margin visits into high-LTV patient journeys.
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Before founding Bask Health, my brother and I once pitched a telehealth startup idea to a VC with a 40-slide deck and a "disrupt healthcare" tagline. He stared at us like we were pitching a smoothie truck. Turns out, nobody cares how "virtual" your care is if you can't explain your revenue model in under 30 seconds. That was a $22,000 lesson in developer costs, regulatory hurdles and hubris. So here's what we wish someone had told us on day one: you're not selling video calls, you're building a real business.
In 2025, that means more than convenience. It means unit economics that hold up, multiple buyers beyond just patients and infrastructure that doesn't implode at scale. Below, we'll break down the four core revenue pillars in modern telehealth and how to stress-test each one before you burn through your seed round.
The Nut Graf
Telehealth businesses built for 2025 and beyond can't survive on DTC visits alone. The ones that scale combine four revenue streams: Direct-to-Consumer, Employer, Payor and Ancillary, into a model that balances margin, compliance and demand. Here's how to structure yours and how to kill what isn't working, fast.
1. Don't just sell to patients: Land the employer account
When we built our first virtual clinic, we assumed individuals would pay out of pocket for convenience. They did, but not in the volumes needed to cover CAC. The real ROI showed up when we signed our first self-insured employer. That one deal brought in 3x the monthly revenue of our entire DTC base. It was the clearest signal we'd seen: B2B revenue can subsidize your B2C growth.
What works:
- Target companies struggling with chronic care costs or absenteeism.;
- Bundle care options: behavioral health, dermatology, menopause, etc..
- Offer reporting dashboards and custom onboarding.
Watch for:
- Stay HIPAA-compliant and FMLA-aware, especially if you're integrating with existing employer EAPs;
- Procurement cycles that take forever if you don't have a warm intro.
- Expect to hire B2B sales muscle early, or founder-led selling won't scale.
Related: Healthtech Is the New Healthcare
2. Payor reimbursement is a slow game. Play it anyway
We avoided insurance in the early days. Too slow. Too complex. But here's the truth: the payor model is hard to start and impossible to ignore.
Yes, CMS still reimburses for telehealth, but the rules shift constantly. In 2025, audio-only visits are covered under limited conditions. Some CPT codes only apply to rural areas. And even if you're eligible, collecting payment is a marathon of prior auths and claim resubmissions.
What works:
- Start small: pilot with Medicaid MCOs or carve-outs;
- Get surgical with your billing codes (RTM, CCM, POS-10, etc.);
- Hire someone who lives in your state's MAC guidance.
Watch for:
- 60–90 day payment cycles (prepare your burn rate accordingly);
- Denials for bad documentation or misused modifiers;
- Overestimating what "covered by insurance" actually means.
Related: Why Entrepreneurs Can't Rely on Traditional Retirement Plans (And What to Do Instead)
3. Ancillary services make or break unit economics
We once sold $49 telehealth visits with a $120 CAC. It was cute until we looked at our bank account. We fixed it by integrating ancillary services, labs, pharmacy delivery, diagnostics, which turned $49 tickets into $149+.
Patients don't want five apps. They want one seamless care journey. Bundling services increases LTV, improves outcomes, and gives you new margin layers to play with.
What works:
- Partner with compounding pharmacies and lab networks.
- Use API-first infrastructure to automate fulfillment.
- Track where the drop-off happens between consultation and care.
Watch for:
- State-specific lab-direct and prescribing laws;
- Ongoing logistics management (especially for shipping);
- Upfront build time, your developers will hate this unless you buy instead of build.
4. Stress-test your margins with this 4P matrix
Before we launch any new care line, we run it through what we call the 4P Matrix:
Category questions to ask
- Patient: Who pays? Individual, employer, or insurer?
- Payor: Which CPT codes or bundles apply? What's reimbursable?
- Partner: Are there labs, pharmacies, or vendors to integrate with?
- Peripherals: What are the add-ons? (RPM, async care, diagnostics?)
If any one "P" is weak, you'll feel it in your burn rate within 60 days. If two are weak, you're bleeding cash. And if you can't tighten the loop within one quarter, sunset the service.
Don't pitch telehealth. Pitch an economic engine.
Investors don't want to hear about your "care journey." Employers don't care how empathetic your UI is. And patients? They want outcomes, fast.
If you want to build a profitable telehealth company in 2025:
- Get clear on who pays and why.
- Design services that integrate seamlessly.
- Obsess over margin layers, not marketing buzzwords;
- And for the love of Wi-Fi, don't duct-tape your HIPAA compliance.
Telehealth isn't a shortcut; it's infrastructure. But if you build it right, you're not just riding a trend. You're building healthcare's new backbone.
