Introduction: Why One-Off Consults Don’t Scale
Most telehealth startups launch with the simplest model: pay-per-visit consults. Patients pay once, see a provider, and move on.
It’s fast to launch. Easy to understand. But it’s also a growth trap.
- CAC (customer acquisition cost) is high.
- Churn after a single visit is even higher.
- LTV (lifetime value) barely covers acquisition spend.
That’s why most consult-only telehealth companies plateau at $10–$20M ARR and stall.
The companies that scale — and attract premium multiples — are the ones that shift from transactional visits to recurring care models.
Recurring care is more than a subscription. It’s a retention engine built on outcomes, trust, and integrated services. It’s the difference between fragile growth and a defensible business.
Section 1: The Fragility of One-Off Telehealth
One-off consults look attractive on a pitch deck:
- “10 million potential patients.”
- “$100 average revenue per consult.”
- “$1B TAM.”
But here’s what happens in reality:
1. CAC Doesn’t Pay Back
- Average CAC: $150–$300 per patient.
- Average visit revenue: $100–$120.
- Negative unit economics.
2. Churn Is Immediate
- Patients don’t return unless forced by condition.
- 70–80% churn after one visit.
3. Investor Lens
- Looks fragile in diligence.
- Multiples capped at 1–3x revenue.
CEO Takeaway: One-off consults are an on-ramp, not a growth engine.
Section 2: What Recurring Care Models Look Like
Recurring care models turn telehealth into a compounding business.
1. Subscription-Based Access
- Unlimited visits for a flat fee.
- Example: therapy sessions, concierge primary care.
- Drives predictable revenue.
2. Chronic Condition Management
- Continuous care for diabetes, hypertension, mental health, weight loss.
- Bundled services: provider check-ins, labs, remote monitoring.
- Creates stickiness through outcomes.
3. Medication + Coaching Bundles
- GLP-1 weight loss → prescriptions + lifestyle coaching.
- TRT → labs + medication + monthly consults.
- Adds recurring pharmacy revenue.
4. Employer / Payer Integration
- Employees auto-enrolled through benefits.
- Recurring revenue built into contracts.
Boardroom Lens: Recurring care isn’t just subscription — it’s care designed for continuity.
Section 3: The Economics of Recurring Care
Recurring care transforms the CAC/LTV equation.
1. Higher LTV
- Patients stay 6–12 months, not 1 visit.
- LTV rises 3–5x.
2. Faster CAC Payback
- CAC recovered in 2–3 months, not 12–18.
- Surplus reinvested into growth.
3. Multiples Like SaaS
- Investors reward recurring models with 6–9x multiples.
- Consult-only companies stuck at 2–3x.
Section 4: Case Example — Fragile vs. Defensible Models
Company A (Fragile):
- DTC urgent care visits.
- CAC $200, revenue per visit $120.
- 75% churn after one consult.
- LTV barely above CAC.
- Valuation multiple: 2x.
Company B (Defensible):
- Women’s health subscription ($99/month).
- Includes consults, labs, and 24/7 messaging.
- CAC $220, but patients stayed 9 months.
- LTV $900+.
- Valuation multiple: 7x.
Lesson: Retention is valuation.
Section 5: How to Design a Recurring Care Model
Step 1: Pick the Right Specialty
- Mental health, women’s health, men’s health, weight loss, chronic conditions.
- Areas where patients need ongoing care.
Step 2: Bundle Services for Continuity
- Visits + labs + prescriptions.
- Coaching + follow-ups + remote monitoring.
Step 3: Engineer Outcomes Into Retention
- Prove patients improve.
- Use outcomes data to justify subscriptions.
Step 4: Build Employer/Payer Hooks
- Position recurring care as cost-saving.
- Land contracts that scale patient retention.
Step 5: Price for Predictability
- Flat fees, transparent pricing.
- No surprises — builds trust.
Section 6: The Investor Perspective on Retention
When investors review a telehealth brand, they ask:
- What % of revenue is recurring?
- What’s the average patient lifespan?
- Is churn <30% annually?
- Is CAC payback <12 months?
- Do employer contracts add durability?
Weak answers = fragile multiple.
Strong answers = SaaS-like valuation.
Section 7: The Recurring Care Audit Checklist
- Do patients stay beyond one visit?
- Do you offer bundled or subscription services?
- Is your average LTV at least 3x CAC?
- Do you track and publish outcomes data?
- Do you have employer/payer channels in pipeline?
If you answered “no” to more than two, your care model is fragile.
CTA: Why You Need Recurring Care Architecture Early
Most CEOs discover churn only after millions in CAC are burned. Most boards discover retention gaps only when valuations collapse.
The right time to design recurring care isn’t after launch. It’s now.
That’s why I built the Growth Clarity Diagnostic™.
In one focused session, we’ll:
- Audit your current care model.
- Identify retention levers to increase LTV.
- Build a roadmap to subscription, bundled, and contract-driven revenue.
👉 [Book your Growth Clarity Diagnostic™ here.]
Because in telehealth, retention is the new growth.
FAQ
Why don’t one-off consults scale in telehealth?
Because CAC is too high and churn is immediate. Unit economics collapse.
What’s the best specialty for recurring care?
Areas with ongoing needs: mental health, weight loss, chronic care, men’s/women’s health.
Do patients trust subscriptions?
Yes — if value is clear, outcomes are proven, and pricing is transparent.
How does recurring care affect valuation?
It increases LTV, lowers churn, and earns SaaS-like multiples.
Can small telehealth startups use recurring models?
Yes. Even early-stage brands can design bundled care for continuity.
