What clinical infrastructure costs from pre-launch to 1,000 patients: a runway model
Most seed decks show one line for clinical costs, and it is usually wrong in the same direction. This is a month-by-month model of what the clinical layer costs between signing nothing and serving 1,000 patients, under three approaches, with every assumption written down so you can replace it with your own.
Lithos StaffIn this worked model, per-visit clinical infrastructure costs a seed-stage telehealth startup $199,515 over ten months to reach 1,000 patients. A fixed-fee platform costs $227,100. Building your own practice costs $300,900 and reaches only 330 patients, because entities, a medical director and licensing push launch to month six. Net of patient contribution, the build path ends about $543,000 behind: 3.6 months of runway at a $150,000 monthly burn. Per-visit pricing is cheapest while demand is unproven.
Per-visit pricing costs the least runway
Over ten months to 1,000 patients, per-visit clinical infrastructure costs $199,515, a fixed-fee platform $227,100 and building your own practice $300,900. The build path also launches four months later, in five states, and ends about $543,000 behind: 3.6 months of runway at a $150,000 monthly burn.
Every number is an illustrative assumption. Swap in your own quotes and demand forecast.
| Months 1–10 | A: per-visit (Lithos) | B: fixed-fee platform | C: build your own practice |
|---|---|---|---|
| Clinical spend before first patient | $0 | $22,500 | $142,400 |
| First patients | Month 2, nationally | Month 2, nationally | Month 6, five states |
| Active patients in month 10 | 1,000 | 1,000 | 330 |
| Clinical cost, ten months | $199,515 | $227,100 | $300,900 |
| Net after patient contribution | $348,885 | $321,300 | −$194,100 |
| Runway lost against A | 0 | 0.2 months | 3.6 months |
The assumptions
The company has just raised $3 million and burns $150,000 a month excluding clinical costs. That is 20 months of runway before the clinical layer is added. It runs a cash-pay program on asynchronous visits.
| Assumption | Value used |
|---|---|
| Visits per active patient | One completed async visit a month |
| Contribution per active patient | $120 a month after medication, pharmacy, shipping and payments, before clinical cost |
| Ramp, live nationally | 60, 150, 260, 380, 500, 620, 740, 860, then 1,000 patients |
| Ramp, live in five states | 40, 100, 170, 250, then 330 patients |
If your patients renew quarterly, scale the visit lines down. The comparison holds.
The three options
A: per-visit infrastructure. No setup, implementation or platform fee. Lithos’s async rates are graduated, so each band is billed at its own rate: $45 for the first 499 visits a month, $40 for visits 500 to 999, $30 from the 1,000th. Live in month two.
B: fixed-fee platform. An illustrative contract, not anyone’s price list: $15,000 to implement, $7,500 a month from signing, plus $30 a visit. Live in month two.
C: build your own practice. Two entities (see PC/MSO structures), a medical director, a nurse practitioner, five state licenses, malpractice cover, an EHR with e-prescribing and counsel.
| Build line | Assumed cost | When |
|---|---|---|
| Corporate counsel and entity formation | $35,000 | Months 1–2 |
| Healthcare regulatory counsel | $25,000 | Months 3–4 |
| State licensure and registration | $8,000 | Month 3 |
| EHR and e-prescribing setup | $5,000 | Month 4 |
| Medical director | $8,000 a month | From month 2 |
| Nurse practitioner | $11,000 a month | From month 4 |
| Malpractice insurance | $1,200 a month | From month 4 |
| EHR subscription | $1,500 a month | From month 4 |
| Clinical operations hire | $7,000 a month | From month 5 |
| Compliance retainer | $3,000 a month | From month 5 |
A first patient in month six is optimistic. Finding a physician owner can take five months on its own.
Month by month
Monthly clinical cost climbs with patients under A, starts high and grows slowly under B, and runs about $31,700 a month under C once its team is hired. Month ten under A: 499 visits at $45 ($22,455), 500 at $40 ($20,000) and one at $30, for $42,485.
From month seven, B is cheaper per month than A. By month ten, C has the lowest bill of all. It also has a third of the patients.
Launching late is what costs runway
Net each option’s clinical cost against $120 of contribution per patient-month. A and B serve 4,570 patient-months ($548,400). C serves 890 ($106,800).
Very little of C’s $543,000 gap is counsel or salaries. Most of it is four months with no patients, then a five-state footprint that caps growth. That can decide whether you raise your Series A with a growing program or with a deadline.
A and B end $27,585 apart, but B’s extra spend lands early. Through month three, B has spent $34,350 more than A, when you know least about demand. Run the ramp at half speed and the fixed fee weighs more.
Send us your demand ramp, even a rough one, and we’ll run it through this model at our graduated rates with you on a call. Book a call.
When does a fixed fee or your own practice win?
- Steady, high volume. Fixed costs win on monthly rate, as B does from month seven. The question is whether you reach that volume before fixed costs eat the runway.
- A volume commitment. On Lithos, an optional commitment gets a flat rate from month one, and async falls to $25 from 2,500 visits a month. Put that quote next to any fixed fee. Our telehealth platform pricing guide compares the structures.
- The practice is the product. A clinical founder, employed clinicians or payer contracts under your own entity are good reasons to build. They tend to be Series B reasons. What it costs to launch a telehealth product itemizes the build.
- Sync visits. If some states need live video, model those at the sync rate ($70 pay-as-you-go on Lithos) and add scheduling cost to a build.
What investors check in the model
- Clinical cost per visit, by visit type, not one blended line.
- A credible launch date: who the physician owner is, or whether the date is in the contract.
- State coverage that matches the go-to-market plan.
- Medication as a pass-through, not margin.
- A downside case at half-speed demand.
- Clinical cost as a share of revenue at 1,000 and 5,000 patients, falling as you scale.
Our model of cost per encounter at scale shows how the per-visit line behaves past 1,000.
Build your own version
Use one row per month: active patients, initial and renewal visits, sync and async split, clinical cost under each option, contribution, net and cumulative cash against your raise. Add one demand-scaling cell to run the ramp at 50%, 100% and 150%.
Then find the month each option breaks even on a cumulative basis. If it lands after your next raise, that option costs more than it looks.
Lithos is the licensed clinical infrastructure underneath your own care experience: licensed providers, protocols, prescribing and pharmacy routing, and compliance in all 50 states, behind one API, with no setup or platform fee and pay per completed visit. Bring your ramp and we’ll model it month by month with you, then commit to a launch date on the first call. Accelerator companies can apply for up to $2,500 in credits through the Lithos Startup Program. Book a call or get sandbox access.
Frequently asked questions
How much runway does a telehealth startup need before launch?
It depends mostly on how you source the clinical layer. Building your own practice means months of counsel, entities, a medical director and licensing before the first patient; in one illustrative model that is $142,400. On per-visit licensed infrastructure, pre-launch clinical spend can be close to zero.
Is per-visit pricing or a fixed platform fee better for a seed-stage telehealth company?
Per-visit pricing is usually better while volume is uncertain, because cost tracks patients and nothing is spent before launch. A fixed fee can cost less per month once volume is steady and high. Compare cumulative cash through the month you expect to raise again.
What does it cost to build your own telehealth medical practice?
The lines are counsel, entity formation, a medical director, clinician salaries, licensure fees, malpractice insurance, an EHR with e-prescribing, compliance upkeep and clinical operations staff. In one illustrative model they come to about $142,000 before the first patient and about $32,000 a month after. Replace every figure with real quotes.
How many months of runway does building your own telehealth practice cost?
In a worked model with a $150,000 monthly burn, building ended ten months about $543,000 behind per-visit infrastructure, roughly 3.6 months of runway. Most of the gap came from launching four months later in fewer states, not from salaries or legal fees.
What do investors look for in a telehealth startup financial model?
Clinical cost modeled per visit by type, a realistic launch date, state coverage that matches the marketing plan, medication as a pass-through rather than margin, and a downside case with demand ramping half as fast.
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