In 2002 an American with a minor, non-emergency illness usually booked an office visit, went to an urgent-care site or waited until a doctor was free TD1. Telephone advice lines existed, but they did not put a doctor on the call who could treat the problem. Employers and health plans paid for much of this care, yet none could offer their people a widely deployed service with licensed doctors on call, set response times and billing that fit an existing benefit TD1. State licensing rules and reimbursement also limited what a doctor could do for a patient she had never examined in person TD1.
Teladoc
Teladoc sold employers and health plans a finished service, on-call doctors, for a monthly fee on every covered member, widened those accounts and bought new care lines to sell through them, and reached $2.53 billion of revenue and more than 100 million members while Amwell, which sold plans and hospitals telehealth software to run themselves, had about a tenth of its revenue.
How Teladoc won
- 1 · 2002–09On-call national doctor network sold as a finished serviceLicensed physicians answer non-emergency calls around the clock, half of visits on nights and weekends; the buyer runs nothing.Tech-Enabled Services
- 2 · 2009–19Per-member access fees paid by employers and plansAccess fees were 83–85% of revenue in 2014, $463.3M of $553.3M in 2019 and 83% in 2025.Subscription Pricing
- 3 · 2014–20Grow covered lives inside each account104% net dollar retention with 9% of eligible people enrolled (2014); 8.1M members in 2014, 36.7M paid U.S. members in 2019.Land and Expand
- 4 · 2015–25Buy adjacent care lines to sell the same buyersBetterHelp (2015) and Livongo ($18.5B, 2020) added therapy and chronic care; large goodwill write-downs followed.Multi-Product
- 5 · 2020–25Largest contracted base in a commoditizing market$2.53B revenue, 17.1M visits and 101.8M U.S. Integrated Care members in 2025, against Amwell's $249.3M.
Versus Amwell: Amwell sold health systems and plans the software to run telehealth under their own brands, so each client still had to supply doctors and get members to use it. Teladoc sold the finished service for a fee on every covered member, so its revenue grew with contracts rather than calls, and in 2025 it was about ten times Amwell's.
Arena: Market Conditions Before Teladoc
How each step happened
Step 1 of 5 · 2002–09
On-call national doctor network sold as a finished service
What was new was a doctor on call as a finished service. Founded in Dallas in 2002, Teladoc launched its first product in 2005: a member phoned, and a licensed physician from a national network took the consultation and treated the non-emergency problem TDX-1. The physicians work through an affiliated medical group, Teladoc Physicians (now Teladoc Health Medical Group), which must keep each doctor licensed and credentialed in the member's state and cover calls '24 hours per day, 365 days per year' TD1. An employer or plan did not have to build anything, recruit doctors or staff nights; it bought access, and Teladoc delivered the care.
The design matched when people fall ill. About half of visits came on nights, weekends and holidays, when a doctor's office is closed; in 2014 nine visits in ten were by phone TDX-1 TDX-2. A visit cost $45, much of it usually paid by the employer or plan, and Teladoc reported that 92% of problems were resolved on the call TDX-1. Jason Gorevic, who became chief executive in 2009 when the company was still small, describes the business as matching the supply of physicians with patient demand in real time TDX-1 TDX-6. Because Teladoc owned the whole service, it could price it as a benefit, which is step 2.
Rivals American Well (Amwell), incorporated in 2006 by Ido and Roy Schoenberg, sold the technology and services for hospitals and plans to run telehealth programs under their own brands TDX-10 TDX-9. Its marketing chief likened it to the chip supplier inside a branded computer, and trade press described its orientation as fundamentally different from Teladoc's TDX-9.
Step 2 of 5 · 2009–19
Per-member access fees paid by employers and plans
Teladoc charged for access, not for calls. Employers, plans and other clients pay a monthly access fee for each enrolled member, per member or per employee, whether or not that person calls, and pay visit fees on top in some contracts TD1. In 2014 access fees were 83–85% of revenue and brought in $5.37 per member, while only 3.7% of members used the service that year TDX-2. A fixed fee on every covered life made revenue predictable and fit Teladoc into the benefit package the client already bought.
The fee also chose the channel. One contract with a health plan or large employer put access in front of every person it covered, so Teladoc sold to the executives who buy benefits, and health plans promoted the service to their own employer customers TD1. Aetna alone accounted for 25% of members in 2014, and the ten largest clients for more than 40% of revenue TDX-2. Teladoc listed in 2015 TDX-1, and by 2019 access fees were $463.3 million of $553.3 million in revenue TDX-3. In 2025 they were still 83% TD1.
Rivals Amwell charged plans a fee per member with access to its software, not to its doctors, and billed its own doctors' visits separately; visits were 21% of its revenue in the third quarter of 2019 and, with COVID, 51% in the first half of 2020 AWL55 TDX-11. In 2019 it had $148.9 million of revenue and an $88.4 million net loss TDX-10, against Teladoc's $553.3 million TDX-3. Doctor On Demand charged $40 a visit with no subscription TDX-2.
Subscription PricingDistribution PartnershipsTop-Down Selling
Step 3 of 5 · 2014–20
Grow covered lives inside each account
Once a client signed, Teladoc grew by adding more of its people. In 2014 only 9% of eligible people in existing accounts had enrolled, and existing clients spent 104% of what they had spent the year before TDX-2. Members rose from about 6.2 million in 2013 to 8.1 million in 2014 and 12.2 million in 2015, and visits nearly doubled to 575,000 in 2015 TDX-2 TDX-1. By 2019 Teladoc had 36.7 million paid U.S. members, plus 19.3 million who paid only per visit, and completed 4.1 million visits TDX-3.
Covered lives were only worth selling if a doctor could treat members in every state. The Texas Medical Board barred prescribing without a prior in-person exam, and Teladoc sued it in 2015 TDX-5. In 2017 a new state law made Texas the last state to drop that requirement, and Teladoc withdrew its suit TDX-5. The change opened Texas to every telehealth vendor, but Teladoc's access-fee contracts turned the added reach straight into revenue.
Rivals By 2020 Amwell reached 150 million covered people through 33 Blue Cross Blue Shield plans, UnitedHealthcare, more than 240 health systems and 36,000 employers TDX-11. It was paid mainly as those clients' patients booked visits, so its revenue depended on use rather than enrollment TDX-11.
Step 4 of 5 · 2015–25
Buy adjacent care lines to sell the same buyers
With the same buyers under contract, Teladoc bought more care to sell them. It added BetterHelp in 2015, an online therapy service that consumers pay for themselves, and in August 2020, at the height of pandemic demand, agreed to buy Livongo, a chronic-condition company, in a deal valued at $18.5 billion TD1 TDX-4. The merger plan targeted revenue synergies of $500 million a year by 2025 TDX-4. Gorevic's aim was whole-person care: one entry point for a member's urgent, mental and chronic needs TDX-7. Integrated Care, the business sold to employers and plans, now spans 'preventive care, primary care, 24/7 urgent care, mental healthcare, chronic care' for more than 100 million members TD1.
Breadth came at a high price. Teladoc wrote down acquired goodwill in 2022 and 2023 and again by $790.0 million in 2024; by 2025 its accumulated deficit was $16.4 billion TD1. BetterHelp grew outside employer channels through paid advertising on Google, Facebook and Instagram TD1. In 2023 it paid $7.8 million to settle FTC charges that it had shared users' mental-health data with Facebook and Snapchat for advertising after promising privacy TD2, and in 2025 its revenue fell 9% to $950.4 million TD1.
Rivals Amwell raised $742 million in its September 2020 IPO TDX-11. By 2025 it had sold its APC unit and narrowed its focus to its technology platform TDX-12. In chronic care Teladoc now faces Omada Health and Virta TD1.
Step 5 of 5 · 2020–25
Largest contracted base in a commoditizing market
Teladoc ended with a far larger contracted base than Amwell. In 2025 it completed 17.1 million visits and had revenue of $2.53 billion, 2% below 2024 as BetterHelp shrank; Integrated Care revenue rose 3% to $1.58 billion, and U.S. Integrated Care members grew 9% to 101.8 million TD1. Gorevic counts about one in four Americans as covered, with 15–20% of revenue from outside the U.S. TDX-6.
Nothing in that base keeps rivals out. After the first term, many contracts let clients leave, typically on three months' notice; the five largest clients bring 31% of Integrated Care revenue; and the share of members on higher-margin paid access has fallen TD1. By 2021 membership had stalled near 52 million for three quarters, and analysts described telehealth as turning into a commodity TDX-8.
What made Teladoc win
Teladoc won through steps 1 to 3 in order: a finished doctor service that a benefits buyer could simply switch on, a fee on every covered member rather than every call, and steady growth inside accounts and across states. That base funded the care lines of step 4 and made Teladoc a $2.5 billion business, about ten times Amwell by revenue.
Rivals Amwell had $249.3 million of revenue and a $95.0 million net loss in 2025, and guided to $195–205 million for 2026 TDX-12.
Key dates
- 2002Teladoc founded in Dallas TDX-1
- 2005First product: doctors on call by phone TDX-1
- 2006-06American Well incorporated TDX-10
- 2009Jason Gorevic becomes CEO TDX-1 TDX-6
- 2014$44M revenue Full year, +119%; 8.1M members TDX-2
- 2015IPO; BetterHelp acquired TDX-1 TD1
- 2015Sues Texas Medical Board over in-person exam rule TDX-5
- 201512.2M members 575,000 visits, +92% TDX-1
- 2017-11Texas drops in-person exam rule; suit withdrawn TDX-5
- 2019$553.3M revenue Full year, +32%; $463.3M from access fees TDX-3
- 2019$148.9M revenue Amwell, full year; $88.4M net loss TDX-10
- 2020-08Agrees to buy Livongo for $18.5B TDX-4
- 2020-09Amwell IPO raises $742M TDX-11
- 2023-03FTC order against BetterHelp, $7.8M TD2
- 2024$790.0M goodwill write-down TD1
- 2025$2,530.0M revenue Full year, -2%; 17.1M visits TD1
- 2025101.8M U.S. Integrated Care members Paid and visit-fee-only, +9% TD1
- 2025$249.3M revenue Amwell, full year; $95.0M net loss TDX-12
Sources
Oldest first.
- TDX-2 Deconstructing the Teladoc IPO and S-1. Outside analysis of S-1
- TDX-1 Teladoc CEO Is Leading a Virtual Health Care Revolution. Trade profile with CEO interview
- TDX-5 Teladoc drops lawsuit against Texas Medical Board following amended telemedicine regulations. Trade press
- TDX-3 Teladoc Health Reports Fourth-Quarter and Full-Year 2019 Results. Company results release
- TDX-4 Teladoc Health and Livongo Merge to Create New Standard in Global Healthcare Delivery. Company press release
- TDX-10 American Well Corporation Form S-1. IPO registration
- TDX-9 Amwell, the 'Intel Inside' Telehealth Company. Trade interview
- AWL55 In first report since IPO, Amwell sees revenue up 80% year over year. Trade press
- TDX-11 How does Amwell make money?. Outside analysis of filings
- TDX-8 As the telehealth market shakes out, Teladoc, Amwell feeling pressure from new entrants. Trade press with analyst quotes
- TDX-7 Teladoc Health CEO Jason Gorevic on the new model of whole-person virtual care. CEO interview
- TD2 BetterHelp proposed FTC order. Regulator action
- TDX-6 Jason Gorevic, CEO, Teladoc Health (interview). CEO interview
- TDX-12 Amwell Announces Results for Fourth Quarter and Full Year 2025. Company results release
- TD1 2025 Form 10-K. Annual report