Adding a second telehealth vertical without a second stack

Sell the second vertical to the patients you have, on the stack you have

A GLP-1 program with 4,000 active patients can add a vertical such as hair loss for a one-time launch cost and no new fixed cost. In our worked model, that brings about 102 new patients in month one and $18,992 of contribution from that cohort over a year. Build a second stack for it and $6,000 a month of new overhead uses up that year in about three months.

Those patients have already signed up, finished an intake, entered a card and received a shipment. A second vertical sold to them skips most of what that cost the first time.

Our breakdown of what a stitched vendor stack costs shows what the left column does per visit.

Pick the vertical your patients already ask about

Three filters work faster than market sizing:

1. Overlap. Read your intake answers, support tickets asking “do you also treat…?”, and what clinicians hear at follow-ups.
2. Workflow fit. A vertical that runs async in most of your states slots into an async renewal program. Live visits, labs or a controlled substance make it a bigger build.
3. Coverage. If your current providers, protocols and pharmacy routing cover the category, launch is mostly configuration. If not, you’re adding a vendor.

Two have their own guides: adding TRT to a GLP-1 brand and launching a sexual health program.

Spend the effort on clinical work, not operations

These need clinical and compliance review before the first patient:

• Protocol: eligibility, contraindications, escalation and follow-up cadence. See what goes into a clinical protocol.
• Intake: ask only what’s new; reuse what the patient already told you. See telehealth intake design.
• State rules: modality and prescribing rules vary by category as well as state.
• Controlled substances: federal telemedicine rules apply and have been changing. Build for today’s rules and expect revisions.
• Labs: where the protocol calls for them, decide how the requisition reaches the patient and results reach the provider.
• Pharmacy: the new medication may need a different pharmacy. Compounded prescriptions must be patient-specific and documented.
• Consent and claims: new consent language, and marketing checked against what the evidence supports.

Everything else stays put: integration, contracts, BAA, patient record, checkout, support tooling and analytics definitions. If the vertical touches one, ask why.

On Lithos, the new vertical is a second care plan with a different category on the same patient. Its encounters belong to that care plan, and the webhook events your app already handles keep working.

How much is a cross-sell worth?

Assume 4,000 active GLP-1 patients, more than 1,000 visits a month already, and hair loss priced at $59 a month. All figures are illustrative.

Per patient-month: $15 for medication, dispensing and shipping; 3% payments ($1.77); and one $30 async follow-up a quarter ($10 a month). The visit is $30 because Lithos pay-as-you-go pricing is graduated, so every visit past 1,000 a month is billed at the $30 async rate. Contribution is $32.23 per patient-month.

At 90% monthly retention, 102 patients produce about 732 patient-months in a year.

Against a $15,000 launch cost (intake build, landing pages, protocol and compliance review), the cohort pays back in month nine. Each later month adds another cohort.

Put the same launch on its own stack, with $6,000 a month of fixed cost and eight weeks of engineering first. The cohort’s whole year now covers a bit over three months of overhead, and the next vertical repeats the problem.

On a shared stack, both categories count toward one monthly volume, so extra visits can push you into a lower band. Model it at your real volume; don’t count on it.

The launch checklist

1. Pick the vertical and confirm your clinical infrastructure covers it in your states.
2. Approve the protocol and map state and controlled-substance rules.
3. Confirm the pharmacy path and compounding documentation.
4. Build intake as a delta, and review consent and claims.
5. Add the product to your existing checkout and extend support macros.
6. Instrument the funnel with today’s definitions, plus category.
7. Soft-launch to a segment, then open it at onboarding.

Launch to a segment first

Clinical review sets the pace; on infrastructure that already covers the category, the operational work takes days. The usual mistake is launching to every active patient at once, before checking that intake completion and approval match the model. Start with a segment and let the numbers decide when to widen it.

Frequently asked questions