Building on Lithos, Part 4: adding one clinical service at a time

Add the one service you’re missing

You can add clinical services to a live telehealth program one at a time. Send Lithos only the renewals in states you don’t cover, or only the prior authorizations, and keep everything else where it is. Each service is billed per use, with no setup, implementation or monthly platform fee and no minimums.

Picture a program at 1,200 encounters a month with clinicians licensed in 30 states. It declines every patient in the other 20, and prior authorizations get filed when someone has a free afternoon.

A full move is a different project, covered in migrating a live patient base without a refill gap. This post is for plugging one hole.

Renewals run on one care plan and one webhook

Renewals are the most common first add: a patient moves to a state you don’t cover, and an earned renewal becomes a cancellation.

On Lithos, every encounter belongs to a care plan. The plan moves pending_review → in_review → active, or ends as ineligible or canceled. Treatment lines on an active plan carry refill_due_at. When that date passes, Lithos sends care_plan.refill_due.

For one patient:

1. POST /v1/patients with the demographics you already hold.
2. POST /v1/care_plans with the patient and a category such as weight_management.
3. POST /v1/encounters with patient_id, care_plan_id, intake_form and requested_treatments. This first encounter is a full review, because a licensed provider working through Lithos needs their own clinical basis to prescribe. Schedule it before the next refill date.
4. On encounter.completed, fetch the encounter. orders[] and patient_message are populated, and the order routes to your preferred pharmacy or a Lithos direct pharmacy partner.
5. From then on, care_plan.refill_due is your trigger. Send a short check-in, then create the follow_up encounter.

Webhooks are signed and arrive at least once, in no guaranteed order, so fetch the resource and keep the handler idempotent (Part 3 on event-driven webhooks has the pattern). Give one state its own screen: an encounter at escalated with patient_information_required is waiting on the patient, and an unseen pause becomes a late refill.

Renewals in uncovered states cost $45 each

Assume 1,500 active patients on monthly renewals, and 220 of them in the 20 states you don’t cover. Today those 220 are declined or lapse.

Month one is 220 first encounters at $45, or $9,900. Every month after is 220 renewals at $45, another $9,900. Medication passes through at pharmacy cost, plus a small flat fee on mail-order orders. Fixed cost added: $0.

Don’t compare $45 with your own clinicians’ cost per renewal; where they have slack, keep renewals in-house. Compare it with what those 220 patients are worth, or with licensing and staffing 20 more states.

As of late 2026, pricing is graduated by monthly volume, each band at its own rate: $45 async up to 499 visits, $40 from 500, $30 from 1,000 and $25 from 2,500. A volume commitment gets a flat rate from month one.

Benefits checks cost about $11.70 each in-house

A benefits check answers two questions before anyone prescribes: does the plan cover this medication, and what will the patient owe? You hold coverage on the insurances resource and request the check as an add-on. The result tells your flow which path to offer: branded with coverage, branded pending prior authorization, or cash-pay.

In-house, assume 20 minutes per check at $30 an hour, plus $500 a month in tooling, at 300 checks a month:

• Staff: 100 hours × $30 = $3,000
• Tooling: $500
• Per check: $3,500 ÷ 300 ≈ $11.70, before supervision and rework

Put Lithos’s per-check rate next to that figure, and remember the step cost: the day volume needs a full-time hire, your fixed cost jumps.

Prior authorization costs $40 of staff time each

Prior authorization is the service most programs underestimate: after the submission come follow-ups, payer requests, denials and appeals. On Lithos it attaches to the patient, their coverage and the encounter where a licensed provider made the decision. With benefits checks, it’s how branded prescriptions such as Wegovy are supported.

Assume 45 minutes to submit and 30 more for follow-up and appeals, at $32 an hour: $40 per authorization. At 100 a month that’s 125 hours, about 0.8 of a full-time role. Billing per completed authorization turns that role into a line that grows with branded volume.

AI care agents cover the work between visits

The Lead-to-Purchase Agent recovers abandoned intakes and carts. The AI Care Coordinator runs adherence check-ins, side-effect questions and refill coordination, and escalates to a licensed provider when something needs clinical judgment. AI prepares and coordinates; a licensed provider makes every clinical decision.

Assume 1,000 active patients, each due a 6-minute monthly check-in: 100 staff hours, about $3,000. Busy teams skip some, and skipped check-ins become missed refills (the refill lapse problem). Judge the usage-based price against both.

Add first wherever you say “no” today

A declined patient costs more than any per-unit price, so start there. After that, add a service only where your loaded cost per unit beats the per-use price, and run it for a month.

Engineers can wire the next service in the free sandbox while the first runs in production. Protocols and compliance review come before go-live: integrate in days, live in weeks.

Your brand, patients and data stay yours

Patients keep paying you through your own merchant account. Every service writes to the same patient record, so a patient renewed through Lithos in one state and by your clinician in another is still one patient, and your data stays exportable. The same approach covers whole new categories in adding a second vertical without a second stack. If you’re weighing full consolidation instead, see what your vendor stack actually costs.

Frequently asked questions