Running your own telehealth vendor stack vs Lithos: the real cost per visit
Most programs at volume didn’t choose their stack; they accumulated it, one contract per problem. Each invoice looks reasonable, and nobody owns the total. Here it is, next to what the same program costs on Lithos.
Lithos StaffIn our worked model, a program doing 1,200 visits a month on seven separate vendors spends $72,367 a month, or $60.31 a visit, before medication. The clinician fee is only $40.83 of that; about $12 a visit is engineering and vendor management that no invoice shows. The same program on Lithos costs about $49.50 a visit on pay-as-you-go pricing, or $38.71 with a volume commitment, and its fixed monthly overhead falls from $16,167 to about $4,000. Your clinician rate drives most of the gap, so run the comparison with your own invoices.
Run it yourself or run it on Lithos?
A program doing 1,200 visits a month on seven separate vendors spends about $60 a visit on its telehealth stack before a single dose of medication ships. The same program on Lithos costs about $49.50 a visit on pay-as-you-go pricing, or $38.71 with a volume commitment. The difference is less about any one invoice and more about everything around them: integrations, minimums and the people managing it all.
Every number below is an illustrative input. Swap in your own.
| At 1,200 visits a month | Run it yourself (7 vendors) | Lithos |
|---|---|---|
| Monthly cost, before medication | $72,367 | ≈ $59,350 pay-as-you-go · $46,447 with a commitment |
| Cost per visit | $60.31 | ≈ $49.50 · $38.71 |
| Fixed monthly overhead | $16,167 | ≈ $4,050 |
| Contracts and BAAs | 7 | 2 (Lithos and your help desk) |
| Integrations to maintain | 7 | 2 |
| Adding a state | Check clinician licensure, pharmacy shipping and state rules across vendors | Covered: licensed providers and compliance in all 50 states |
| State compliance and board filings | Yours to track | Handled by Lithos |
| Prescription stuck? | Up to three vendors to chase | One team, one Slack channel |
The rest of this post shows where those numbers come from, and when switching is worth it.
What running it yourself really costs
Assume 1,000 asynchronous visits and 200 live video visits a month. The seven vendors are the usual set: a clinician network, e-prescribing, a pharmacy, an intake tool, scheduling and video, benefits checks and prior authorization, and support tooling.
| Line | Assumption | Monthly cost |
|---|---|---|
| Clinician network | $35 per async, $60 per live visit, plus a $2,000 admin fee | $49,000 |
| E-prescribing | $1,500 platform plus $2 per script on 1,000 scripts | $3,500 |
| Pharmacy account fee | Flat | $500 |
| Intake and forms | HIPAA tier | $1,000 |
| Scheduling and video | Seats and minutes | $1,500 |
| Benefits checks and prior auth | $1,200 of usage against a $1,500 minimum | $1,500 |
| Support tooling | Seats and messaging | $1,200 |
| Engineering upkeep | 7 integrations × a tenth of a $200,000 engineer | $11,667 |
| Vendor management and compliance | A quarter of a $120,000 operations hire | $2,500 |
| Total | $72,367 | |
| Per visit | ÷ 1,200 | $60.31 |
The clinician fee works out to $40.83 a visit, and it’s the number most teams quote when asked what a visit costs. The real cost per encounter is $60.31.
The last two lines never arrive as an invoice. Every integration needs someone to absorb API changes, failed webhooks, credential rotation and incidents, and that work scales with vendor count, not visits. Every vendor also means a BAA, a security review at renewal and another row in the next partner’s security questionnaire.
The invoices hide costs too:
- HIPAA tiers. Many tools only sign a BAA on a higher plan.
- Minimums. Slow months still pay the floor.
- Seats. Per-prescriber and per-agent pricing grows with headcount, not visits.
- Uplifts and exit fees. Annual increases compound, and leaving costs money.
Send us your last three months of vendor invoices and we’ll build this comparison with you on a call, line by line, at your own visit mix. Book a call.
The same program on Lithos
Lithos replaces the clinical layers with one per-visit price: licensed providers, prescribing, pharmacy routing, intake via the API, scheduling for live visits, and state-by-state compliance. There’s no setup fee and no monthly platform fee.
Pay-as-you-go pricing is graduated, so each volume band is billed at its own rate: under 500 visits a month at $45 async and $70 live, 500 to 999 at $40 and $60, and 1,000 and up at $30 and $50. At this mix, 1,200 visits come to about $52,900. Add benefits-check usage ($1,200, no minimum), the same support tooling ($1,200), two integrations to maintain ($3,333) and a lighter vendor-management load ($714), and the month is about $59,350, or $49.50 a visit.
A volume commitment flattens the rate. Commit at the 1,000-visit band and every visit is $30 async and $50 live from month one: $40,000 for the visits, $46,447 for the month, or $38.71 a visit.
The bigger change is the shape. Running it yourself carries $16,167 of fixed cost every month, at 800 visits or at 1,600. On Lithos, about $4,000 is fixed and the rest moves with visits, which is why margins improve as you grow. Our post on unit economics at scale explains why that matters more than the total.
Three things that can shrink the gap
- Your clinician rate. It’s most of the self-run total. If you pay less than the $35 and $60 assumed here, the gap narrows.
- Pharmacy fees. Lithos passes medication through at pharmacy cost, with a small flat fee on mail-order orders. Compare that directly with the dispensing, shipping and account fees you pay now.
- Switching cost. Moving a live patient base takes planning and some engineering. Spread it over the first year. Our guide to switching telehealth infrastructure covers what it involves.
When is switching worth it?
Run the numbers first; it takes an afternoon. Pull three months of invoices and the signed contracts, count integrations, estimate engineering and vendor-management hours, and divide by completed visits. Then price Lithos at your real volume and visit mix.
If the gap is a few dollars a visit, stay put and use the exercise to renegotiate minimums and seats. If it’s $10 or more, you know what consolidation is worth each month and how fast a migration pays back. For the wider picture, see our telehealth platform pricing guide.
Lithos replaces a stitched-together stack with one API and one invoice: licensed providers (MDs, DOs, NPs, PAs and RDs), protocols, prescribing and pharmacy routing, and compliance in all 50 states, with no setup or platform fee. You keep your brand, pricing and patients. Send us your current volume and visit mix and we’ll price it on a call, then plan the move state by state if the numbers work. Book a call.
Frequently asked questions
How do I calculate the true cost of my telehealth tech stack?
Add every vendor invoice for a typical month, the fees that only appear some months (overages, minimum shortfalls, annual uplifts averaged monthly), an engineering allocation per integration, and staff time spent on vendor management and compliance reviews. Divide the total by completed visits. That per-visit figure is the number to compare against any consolidated price.
What hidden fees show up in telehealth vendor contracts?
The usual ones are a higher plan tier required before a vendor will sign a BAA, monthly minimums charged in slow months, per-seat pricing for prescribers or support agents, per-message and per-minute telephony charges, overage rates, annual price uplifts, and early-termination or data-return fees. None is unusual alone. Together they can be a meaningful share of the bill.
How much engineering time does each telehealth integration need?
Every integration needs someone to handle API version changes, webhook failures, credential rotation, field-mapping fixes and incidents. A planning assumption of a tenth of an engineer per vendor is a reasonable starting point, but measure it from your own ticket history. The cost grows with the number of vendors, not with visit volume.
Is one per-visit price always cheaper than separate telehealth vendors?
No, and the comparison shouldn’t assume it. Your clinician rate drives most of the result, and lines such as support tooling, payments and medication stay in both columns. The fair test is the per-visit cost of everything that goes away when you consolidate against the consolidated per-visit price at your real volume and modality mix.
What should I leave out of a telehealth vendor cost comparison?
Leave out medication cost, payment processing and acquisition spend, because you pay them whichever stack you run. Keep them in your unit economics. Do compare pharmacy dispensing, shipping and order fees on both sides, because those differ between setups.
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