Category: Telehealth

Teladoc wrapped up a bumpy Q1 with the acquisition of virtual therapy provider Uplift, a move that it hopes will help turnaround its persistently problematic BetterHelp segment.

UpLift provides virtual therapy, psychiatry, and medication management services – all crucially covered by most major commercial payors, as well as Medicare and Medicaid.

• The deal adds over 100M covered lives and a network of 1,500 mental health clinicians, which Teladoc plans to integrate with BetterHelp to give its customers access to in-network treatment options.

The $30M acquisition shores up one of the most glaring weaknesses of BetterHelp’s cash-pay-only DTC mental health offerings, with Teladoc citing out-of-pocket costs as one of the primary barriers preventing potential customers from signing up.

• UpLift generated $15M of revenue last year – a drop in the bucket compared to the $1B that BetterHelp brought in – but it’s anyone’s guess as to how much of a lift Teladoc will see from the “significantly higher conversion rates” it expects for new members.

In the wake of the pandemic, BetterHelp has eroded from one of Teladoc’s most promising assets to a constant pain point on investor calls, including a $790M impairment in Q2 2024.

• Setting aside the scathing short report that accused BetterHelp therapists of using ChatGPT to respond to patients during sessions, the segment’s also been facing pressure from rising ad costs that have made it difficult to keep user growth steady.

• Teladoc now expects BetterHelp revenue to fall between 7.5% to 11.25% next quarter, before returning to form later in the year thanks to stickier relationships courtesy of Uplift.

It’s also interesting to see Teladoc pick up another company at a 2X revenue multiple after paying the same rate for Catapult Health back in February.

• Not exactly a lofty valuation for an established company with real revenue, especially considering the fairytale multiples we’re seeing startups command in AI Land.

The Takeaway

Acquiring Uplift’s existing payor partnerships should definitely accelerate BetterHelp’s ability to start accepting insurance, a much needed move given its recent difficulty wrangling new customers. Although an immaculate M&A track record isn’t something that Teladoc has going for it, this particular acquisition seems to make a lot of sense on paper.

Provider organizations are hungry for more hybrid care, but new research in NEJM Catalyst highlights a notable gap between their interest and infrastructure.

A survey of the NEJM Catalyst Insights Council – made up of clinical leaders and executives from care delivery orgs across the globe – showed that a majority of the 730 respondents believe hybrid care improves overall quality (74%).

• 55% of respondents’ organizations already offer hybrid care (68% for U.S. orgs)
• 42% offer primarily in-person care
• Only 3% offer primarily virtual care

Hybrid was ranked as the preferred mode of care delivery for the usual areas like primary care and chronic condition management, largely because of the convenience it offers patients, but several barriers still stand in the way of supplementing in-person care with virtual services.

Provider organizations are also facing their own set of challenges.

• Only 58% report adequate technological infrastructure to enable hybrid care.
• Even fewer report sufficient tech support for troubleshooting during virtual visits (27%).
• Just 38% agree they give providers sufficient training to deliver hybrid care effectively.

Although technology barriers are a common scapegoat for limiting access to hybrid/virtual care, the authors point out that digital literacy and clinician support are the bigger culprits. They also suggest a practical solution: dedicated digital navigators.

• Dr. John Torous, Digital Psychiatry Director at Beth Israel Deaconess Medical Center, believes embedding trained digital health navigators within health systems is “the missing link” to bridge the gap between clinical care and digital tools.

• BIDMC has reportedly seen significant benefits from using digital navigators to help facilitate both patient engagement and clinical utilization, yet only 21% of organizations currently employ such specialists.

The Takeaway

Technology access is a constant barrier for hybrid care delivery, but this survey shows that digital literacy for patients and support for clinicians could be the actual limiting factors. Luckily, as the authors put it, digital navigators and training programs are also “low-hanging fruit.”

In a move that surprised basically no one, the DEA is extending pandemic-era telehealth prescribing flexibilities for controlled substances through the end of 2025.

The “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” was officially published on November 19th, ending a months-long stalemate among regulators.

The third time’s the charm (hopefully). The extension gives providers another year to prescribe Schedule II-V medications for conditions like ADHD and opioid addiction without first conducting in-person evaluations.

• The move maintains the status quo that’s been in place since COVID hit, while effectively punting the decision on formal legislation to the new White House.

• Both the DEA and the HHS will have fresh leadership, and it remains to be seen how the two agencies will work together to address the matter.

The policy hot potato just got passed to the Trump administration, so telehealth companies and patients will both have to prepare for another year of regulatory limbo.

• By failing to issue a final rule, the DEA at least gains time to revise its most recent draft rules that sparked nearly 40k comments worth of industry pushback.

• Those rules included requirements that half of a provider’s controlled substance prescriptions be written for patients seen in-person, and that every patient must be checked against drug monitoring programs in all 50 states. 

It’s a classic tension in healthcare: balancing legitimate access against potential abuse.

• While the extension acknowledges the “urgent public health need” for access to addiction treatment meds like buprenorphine, the lack of legislation still leaves telehealth in a bucket of “stopgap measures” instead of “absolute necessities.”

• Punting the decision should also mean better guardrails can be developed to prevent abuse at a time when the founders of pandemic-era pill mills are either fleeing the country or forking over millions in fines.

The Takeaway

The telehealth prescribing can has been kicked down the road for another year, and the industry will now be watching to see whether the Trump administration decides to repeal it. It’s more likely than not that the extension will stick – this isn’t exactly a hot button issue like raw milk.

University of Michigan researchers just delivered some compelling evidence that telehealth doesn’t increase wasteful care, and may actually reduce it in several key areas.

This wasn’t a small study. The analysis in JAMA Network Open leveraged Medicare FFS claims data spanning 578k beneficiaries across 2,552 primary care practices between 2019 and 2022.

The researchers tracked eight measures of “low-value care” – services that provide little clinical benefit while racking up costs – across four categories: office-based, laboratory, imaging, and mixed-modality services.

The practices with the highest telehealth usage (top third) showed:

• Significant reductions in unnecessary cervical cancer screenings (-2.9 per 1,000 beneficiaries)
• Lower rates of low-value thyroid testing (-40 per 1,000 beneficiaries)
• No increase in wasteful imaging or other diagnostic services

Low-value care costs the healthcare system close to $100B annually, and while wasteful services have been extensively looked at using Medicare data, this was the first study to do so within the context of telehealth.

• On one hand, virtual visits eliminate chances for clinicians to perform low-value services that need to be performed in-person.

• On the other, it’s hard to imagine that the inability to conduct a physical examination won’t lead to more clinical uncertainty and low-value diagnostic testing, although that’s exactly what this research seems to disprove.

The Takeaway

This study tackles one of telehealth’s most persistent criticisms head-on, and the lack of a clear link between telehealth and low-value care should reassure policymakers weighing how to finance and regulate the segment going forward.