Which Telehealth Pricing Models Maximize LTV? (A CEO & Investor’s Guide)

Introduction: Why Pricing Makes or Breaks Telehealth

In every boardroom I’ve been in, one question comes up again and again: “Are our unit economics defensible?”

For telehealth companies, that question almost always comes down to pricing models. CAC (customer acquisition cost) is rising, competition from Big Tech is intense, and regulators keep tightening the rules. In that environment, the only lever that really protects margins is LTV (lifetime value).

And LTV is shaped by pricing.

The difference between a telehealth company stuck at $20M ARR and one scaling past $100M isn’t better ads or bigger budgets — it’s smarter pricing and revenue architecture. Companies with recurring, diversified revenue get premium multiples. Companies with fragile, one-off consult pricing stall.

This guide breaks down the telehealth pricing models that matter, their impact on CAC and LTV, and what investors actually reward.

Section 1: The Pricing Models in Telehealth

There are four dominant models telehealth companies use today. Each has different implications for growth, compliance, and valuation.

1. Pay-Per-Visit (Transactional Model)

• Patient pays per video visit or consult.
• Examples: urgent care telehealth platforms.
• Pros: Fast to launch, easy for patients to understand.
• Cons: High churn, low LTV, constant CAC pressure.
• Investor View: Fragile — looks like a slot machine dependent on ad spend.

2. Subscription / Membership Model

• Patients pay a monthly or annual fee for access to care.
• Examples: mental health therapy platforms, concierge telehealth.
• Pros: Recurring revenue, higher LTV, smoother CAC payback.
• Cons: Requires strong retention + outcomes to justify ongoing cost.
• Investor View: Premium multiples — recurring revenue = predictable.

3. Insurance Reimbursement Model

• Telehealth services billed to insurance via CPT codes.
• Examples: chronic care management, virtual primary care.
• Pros: Increases trust and access, reduces patient friction.
• Cons: Complex setup, slower reimbursement cycles, state-by-state variability.
• Investor View: Attractive if integrated, but fragile if reimbursement rules shift.

4. Employer / Payer Contract Model

• B2B deals with employers, payers, or health systems covering entire populations.
• Examples: GLP-1 telehealth with payer subsidies, employer-sponsored mental health.
• Pros: Low CAC, high-volume contracts, defensible distribution.
• Cons: Long sales cycles, requires outcomes data and enterprise credibility.
• Investor View: Very attractive — signals scalability and durability.

CEO Takeaway:

The most successful telehealth companies layer these models. Ads may drive patients, but subscriptions, insurance, and B2B contracts maximize LTV.

Section 2: How Pricing Impacts CAC & LTV

Pricing isn’t just a revenue decision. It directly changes the math on CAC and LTV.

1. CAC Payback Period

• Pay-per-visit: CAC rarely pays back in one visit.
• Subscription: CAC pays back faster because revenue compounds monthly.
• Employer contracts: CAC almost disappears (one deal = thousands of patients).

2. Retention & Churn

• Pay-per-visit churn is 70–80%.
• Subscriptions can reduce churn to 10–30%.
• Employer contracts create “built-in” retention (employees auto-enrolled).

3. Multiples in Diligence

• Transactional models: 1–3x revenue multiples.
• Recurring subscription: 5–7x.
• Employer contracts: 7–10x, if durable.

Boardroom Lens:

Investors don’t buy revenue, they buy predictability. Pricing models that create recurring, defensible revenue add multiples to valuation.

Section 3: Subscription Models That Work (and Fail)

Not all subscription models are created equal.

Winning Subscriptions

• Clear value proposition (“Unlimited mental health visits for $99/month”).
• Bundled benefits (care + labs + pharmacy delivery).
• Outcomes-driven retention (patients actually improve).

Failing Subscriptions

• Ambiguous access (“better care online”).
• No differentiation (same as competitors).
• Weak retention → churn wipes out CAC gains.

CEO Takeaway: Subscriptions only work if retention is engineered into the model.

Section 4: Employer & Payer Contracts as Growth Leverage

The most undervalued pricing model in telehealth is B2B2C.

Why It Works

• One contract = hundreds or thousands of patients.
• CAC plummets because you’re not paying per-click.
• Creates stickiness (harder for employers/payers to switch vendors).

What You Need to Win Contracts

• Outcomes data (prove cost savings or better health results).
• Enterprise credibility (HIPAA, HITRUST, compliance maturity).
• Ability to scale multi-state quickly.

Investor View: Employer and payer distribution signals durability. It shifts your story from “telehealth startup” to “infrastructure player.”

Section 5: Hybrid Pricing Models — The Winning Combination

The strongest telehealth companies layer models.

• DTC Ads → Subscriptions (CAC-funded entry, recurring retention).
• Subscriptions → Insurance Reimbursement (adds trust + coverage).
• Insurance → Employer Contracts (scales distribution).

This “laddering” creates both growth and defensibility. Ads spark, subscriptions compound, and B2B contracts create moats.

Section 6: Case Example — The Fragile vs Defensible Pricing Plan

Company A (Fragile):

• Pay-per-visit model only.
• Dependent on Meta ads.
• CAC $180, visit revenue $120.
• Churn 75%.
• Investors haircut valuation to 2x revenue.

Company B (Defensible):

• $99/month subscription + bundled pharmacy.
• Published outcomes data → landed employer contracts.
• CAC $200, LTV $1,200.
• Payback period: 2 months.
• Investors rewarded with 8x revenue multiple.

Lesson: Pricing isn’t a line item. It’s the business model.

Section 7: The Telehealth Pricing Audit Checklist

Here’s how to test if your pricing model is defensible:

1. Does CAC pay back within 12 months?
2. Do you have recurring revenue (subscriptions or contracts)?
3. Is churn below 30%?
4. Are employer/payer deals in the pipeline?
5. Can you prove outcomes that justify pricing?
6. Would investors call your model predictable or fragile?

If you answered “no” more than twice, your pricing is a valuation risk.

CTA: Why Pricing Strategy Isn’t an Afterthought

Too many CEOs hire growth leaders after launch, when CAC is already spiking and churn is already killing LTV.

The right time to design pricing isn’t after the board meeting. It’s now.

That’s why I built the Growth Clarity Diagnostic™.

In one focused session, we’ll:

• Audit your pricing model and LTV assumptions.
• Identify opportunities to add recurring revenue.
• Build a roadmap that lowers CAC, raises multiples, and survives diligence.

👉 [Book your Growth Clarity Diagnostic™ here.]

Because in telehealth, pricing is the strategy.

FAQ

What’s the most common telehealth pricing mistake?

Relying only on pay-per-visit models. It creates low LTV, high churn, and fragile CAC payback.

Do subscription models always work?

No. They only work if value is clear, retention is engineered, and churn is managed.

Are employer contracts realistic for early-stage companies?

Yes, if you have outcomes data and a credible compliance story. Early pilots can lead to big contracts.

How do investors evaluate telehealth pricing?

They look at CAC payback, LTV, churn, revenue mix, and durability of contracts. Predictability earns premium multiples.

What’s the fastest path to defensible pricing?

Start with DTC acquisition, layer subscriptions, then expand into employer/payer contracts.

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