Teladoc Health (TDOC) Q3 2026 earnings call transcript

Thank you and good afternoon. Today, after the market close, we issued a press release announcing our third quarter 2026 financial results. This press release and the accompanying slide presentation are available in the Investor Relations section of the Teladoc Health. com website. On this call to discuss the results will be Chuck DeVita, Chief Executive Officer, and Mike Grasher, Chief Financial Officer.

During this call, we will also discuss our outlook, and our prepared remarks will be followed by a question and answer session. Please note that we will be discussing certain non-GAP financial measures that we believe are important in evaluating our performance. Details on the relationship between these non-GAP measures to the most comparable GAP measures and reconciliation thereof can be found in the press release that is posted on our website.

During this call, we will make forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. Examples of forward-looking statements include, without limitation, statements regarding our financial and operational outlook, the timing, availability, market response, and performance of new products, including Teladoc 1, expected better health insurance revenue and exit run rate, expected cash pay trends, provider network capacity, advertising and marketing spending and efficiency, the timing and impact of our better health insurance rollout, and the expected benefits of the actions we are taking.

Such statements are based on management's current expectations and assumptions and are subject to risks and uncertainties that could cause actual results to differ materially. Please refer to the cautionary statement in today's earnings release and the risk factors in our most recent Form 10K and Form 10Q, including risks relating specifically to each of our reporting segments. I would now like to turn the call over to Chuck.

Thanks, Mike. This quarter reflected solid execution across the business and underlying traction on initiatives supporting our strategic priorities. There's more work ahead, but we're encouraged by the progress made in the quarter.

Before I get started, I would like to welcome Mike Rasher, our new Chief Financial Officer, to the call. Mike joined in late August and brings over 12 years of CFO experience at both publicly traded and privately held companies.

We're excited to have him on board, and you'll hear from Mike in a moment when he covers our third quarter results in more detail and our outlook. So as we look at the business today, we remain highly focused on advancing the priorities we believe are most important to the long-term success of the company. With respect to the third quarter results, consolidated revenue came in near the upper end of our guidance range and adjusted EBITDA above guidance with both segments contributing to the quarter's performance.

Integrated care delivered revenue near the high end of the guidance range and adjusted EBITDA margin above guidance. Better health's revenue was also in the upper end of the guidance range driven by strong insurance revenue growth and better than anticipated cash pay performance.

We do continue to expect ongoing challenges in cash pay going forward for the reasons we've spoken about previously. As we consider the market more broadly as a company, we continue to see opportunities for virtual care to play an increasing role in addressing key challenges in health care. By helping address rising health care costs and affordability challenges through solutions designed to lower costs, increase access, and deliver outcomes.

By leveraging our services, clinical breadth, and technology to improve the health and well-being of people, including those impacted by chronic disease.

By championing the importance of mental health to overall health and creating access to services at scale through both of our segments. And by helping alleviate pressure on the health care delivery system, extending provider capacity, and deploying purpose-built technology to support virtual care. We believe we are well positioned against this backdrop, and these themes underscore our organizational focus and the four key strategic priorities we're advancing to drive market differentiation and performance.

I'll touch on each priority and provide an update on progress since our last earnings call. Our first priority is enhancing our integrated care solutions for the U. S. market to deliver greater value and impact for clients and the people we serve.

This has been a key driver of our innovation agenda, and in July, we announced Teladoc 1, a first-of-its-kind offering and comprehensive care model that goes beyond condition-specific programs to help detect health risks earlier, engage individuals more comprehensively, and scale outcomes across populations. The underlying care model is delivered through a multidisciplinary care team, complemented by adaptive AI-driven insights from our pulse intelligence engine, and uniquely leverages our clinical breadth, technology, engagement, and support capabilities.

During the quarter, we moved from announcement towards execution, including activating initial launch partners, beginning to engage patients in the new care model, and preparing for broader market availability in 2027. As with any new offering, we expect the pipeline and commercial momentum to build over time.

We are encouraged by the level of client engagement and member feedback on Teladoc 1 at this point, reinforcing our view that clients are looking for solutions that can deliver a more connected experience, address more care needs, and demonstrate greater accountability for outcomes and impact.

We also continue to advance initiatives to increase consumer awareness of our services and make it easier for people to access them. This includes enhancements to our Teladoc health app and digital experience, sunsetting legacy platforms, and expanding our presence with other consumer-facing organizations.

The overarching goal is to broaden our reach and further support the ability for people to benefit from our services.

Taken together, we believe these and other initiatives will further our ability to create greater value for clients and members and serve to further strengthen our competitive differentiation.

Another key priority is to build on our global position to serve unique market needs, including through our hybrid care models within integrated care that I've spoken about before. Hybrid care, which has been an important source of growth outside the U. S. , supports local care delivery organizations by bringing virtual clinical services to physical care settings through our technology.

We believe the market dynamics supporting the adoption of our hybrid care models in other countries are also increasingly prevalent with hospitals and health systems in the U. S. , including healthcare workforce and capacity challenges, financial pressures, and the need to improve access for underserved and rural communities. As a result, we see an opportunity to leverage our experience in hybrid care within the U. S. to support future growth. To advance our position, last week we completed the acquisition of Teladigm Health, which provides virtual clinical services to U. S. hospitals and health systems, including leveraging Teladox technology to deliver virtual services in physical settings.

This acquisition expands our ability to provide services to this part of the healthcare market in addition to the technology products we are offering them today.

We are excited to work with the Teladigm team in this more strategic manner as we build our hybrid care business in the U. S. We also continue to innovate the underlying technology utilized in this area. For example, earlier this month, we introduced new AI-powered capabilities integrated within our solo platform that bring contact-free vital sign measurement and ambient clinical documentation directly into clinical workflows.

These capabilities are designed to help reduce administrative burden, improve efficiency, and support patient care. Our third priority is leveraging our scale position in mental health in integrated care and better health to address the unmet need and underlying demand for these services.

With respect to better health, the business continues to undergo an important pivot towards more of an in-network model in the U. S. , given ongoing pressure in the cash pay market. And we believe expanding insurance access can help create a more durable position for better health over time.

As discussed in the second quarter earnings call, we are executing important actions to lean into this insurance opportunity and scale that part of the business, including building on the national footprint we established during the second quarter. These include initiatives to expand network capacity, evolve better helps advertising and marketing approach to increasingly reflect insurance objectives, and reduce near-term emphasis on non-US markets to realign resources.

While there is considerable work ahead, we are seeing constructive initial traction from these initiatives in terms of their intended impact.

Insurance revenue for the quarter was $32 million, which exceeded the high end of the range of our expectations. Weekly insurance covered sessions have continued to grow and recently achieved 27,000 sessions per week, representing an annualized insurance revenue run rate of over $140 million on that basis. This compares to the $110 million annualized revenue run rate from weekly sessions referenced in our second quarter earnings call.

We also continue to see the scaling of insurance reflected in overall business metrics, including 36% of acquired US users in the third quarter coming from insurance, up approximately 8 percentage points from the second quarter.

From a capacity perspective, over 3,000 therapists were added to the network during the quarter, bringing the aggregate number that had been credentialed to over 11,000. And while early, other metrics reflecting available capacity have generally trended positively since the second quarter, including levels of capacity on a market and payer basis, as well as therapists active on the platform and those accepting new patients.

We are also making improvements to our platform, including scheduling and matching capabilities, streamlining provider workflows, and new technology and AI enabled tools to reduce administrative burden. In addition, local market dynamics are being continuously assessed and targeted adjustments made to support long-term network capacity and expansion, including respective therapist compensation models.

As we saw in the third quarter, better help continues to adapt its advertising and marketing approach to reflect insurance priorities. And although cash pay performance was better than anticipated for the quarter, we expect ongoing pressure in the cash pay market, including as we further evolve better helps approach to advertising and marketing and continuing to lower overall spending levels going forward.

This includes a further reduction in the fourth quarter. While we typically see reduced spending due to holiday advertising dynamics, we expect a more meaningful sequential quarterly reduction compared to prior years for the reasons I mentioned.

And finally, our fourth strategic priority is driving operational excellence to more consistently deliver results, strengthen performance, and improve efficiency.

We've made considerable progress on this priority over time, including streamlining the organization, managing our cost structure, improving the efficiency of our operations, and advancing technological capabilities.

For example, we've seen a 30% increase in member self-service interactions over the last year in the U. S. for integrated care through AI enabled digital experiences and other enhancements. And we are also leveraging AI assisted quality assurance and operational controls to achieve high levels of accuracy for client configuration and onboarding, improving both efficiency and implementation quality.

These and other initiatives are helping us deliver strong adjusted EBITDA margin, despite the gross margin pressure we've seen over recent years. And we've also made progress in areas such as stock based compensation, rationalizing CAPX, and improving other measures. As such, operational excellence will continue to be an area of focus for us. As we look towards the remainder of 2026 and end of next year, we see the healthcare environment remaining dynamic as health plans adjust to business uncertainties, regulatory changes, and medical cost drivers, employers grapple with rising healthcare costs and priorities to support their business objectives, and care delivery organizations address workforce needs, technology advancements, and other factors.

And we continue to see these areas reflected in the current operating environment, the selling season, and conversations with clients, and how we are advancing our value proposition.

And while decisions are still being made, overall bookings through the third quarter have generally progressed in line with our expectations.

We will continue to focus on pursuing the business opportunities ahead of us and navigating challenges to drive performance of the company. And integrated care, these include factors such as broader macroeconomic conditions, healthcare market trends, and the competitive environment. And we believe our innovation agenda, including new offerings such as Teladoc 1, our comprehensive approach to virtual care, the expansion of hybrid care models, and increasing the awareness, access, and usage of our services will contribute to our long-term market position.

Within better help, we also continue to see opportunities in mental health given the unmet need and demand for these services.

Growing in network access remains our top priority in the segment, and we believe the initiatives we are advancing will support continued growth of the insurance business.

And over time, better helps ability to offer consumers a choice of both insurance and cash pay in the U. S. Together with the longer-term potential we see in non-U. S. markets will support our commitment to improving the durability of the business.

With that overview, let me turn it over to Mike Rassher to go over our financial results. Mike?

Thanks, Chuck. I'd like to start by saying that I'm truly grateful and excited to be joining Teladoc at this pivotal time. I look forward to working with Chuck and the leadership team as a strategic thought partner. Together, we're focused on operational excellence, advancing our key initiatives, and delivering improved financial performance for shareholders.

With that, let's move on to third-quarter results. Consolidated revenue was $605 million, down 3.4% on a year-over-year basis, but towards the high end of our guidance range. A solid performance in integrated care and strong better-help insurance growth was partially offset by ongoing headwinds in better-help's cash pay revenue. Consolidated adjusted EBITDA of $79 million grew 13.5% from the prior year and was above the high end of our guidance range. Consolidated adjusted EBITDA margins increased approximately 200 basis points from the prior year to 13.1%, largely due to approximately 180 basis points of margin improvement in integrated care.

Net loss per share was 15 cents, comparing favorably to the 28 cents per share loss in the prior year period.

2026 results included the following pre-tax impacts, amortization of intangible assets of 49 cents per share, stock-based compensation expense of 6 cents per share, and restructuring costs of 2 cents per share.

Free cash flow was $76 million in the third quarter, bringing year-to-date free cash flow to $85 million. We continue to have a strong liquidity position as we ended the quarter with $850 million in cash and cash equivalents, up $76 million sequentially. Our leverage ratio continues to improve as net debt to trailing adjusted EBITDA declined to 0.5 times at quarter end compared to one time in the year ago quarter.

Looking at the segments, integrated care revenue was $398 million above the midpoint of the guidance range, boosted by better than expected chronic care performance. Year over year growth of 2.3% reflected continued strong international performance, which grew double digits, as well as growth in chronic care and visits revenue, which was partially offset by lower subscription revenue.

M&A completed in the previous four quarters, provided a roughly 30 basis point tailwind to segment growth in the quarter.

U. S. integrated care membership ended the quarter at 100.1 million members in the upper half of our guidance range. Total chronic care program enrollment grew 15% on a year over year basis and was up 6% sequentially, reaching $1.34 million at quarter end. Driven by adoption of our bundled solutions and improvements to our member engagement strategies. Integrated care adjusted EBITDA was $75 million, up 13.3% over the prior year.

Adjusted EBITDA margin of 18.8% came in well above the high end of our guidance range, an increase by approximately 180 basis points year over year.

Importantly, margin expansion occurred despite the ongoing mix shift toward visit-based arrangements, reflecting continued progress on productivity initiatives and discipline expense management.

Better help segment revenue was $207 million in the quarter, reflecting a 12.8% decline from the prior year, still near the upper end of our guidance range, with upside in both cash pay and insurance.

The year over year decline reflected lower cash pay revenue versus the year ago period in both the U. S. and non-U. S. markets.

Insurance revenue of $32 million exceeded the high end of the expectation discussed on our second quarter call and represented a $10 million sequential increase, reflecting continued demand and progress expanding capacity across the network. Average total paying users for better health of $336,000 decline 12% year over year and 3% sequentially, as the expected reduction in cash pay users was partly offset by strong growth in insurance users.

Better help adjusted EBITDA was $4 million in the quarter, representing a margin of 2.2% near the high end of the guidance range. And up 55 basis points versus a prior year period.

Mixed driven gross margin pressure and investments to support the scaling of insurance were more than offset by 27% year over year reduction in advertising and marketing spent.

Turning to guidance on a consolidated basis, we now expect 2026 revenue of $2.39 billion to $2.44 billion. This represents a $13 million increase at the midpoint versus the prior range, driven largely by the updated better help outlook. We expect adjusted EBITDA of $277 million to $303 million, up $3 million at the midpoint versus our prior range, and representing approximately 90 basis points of margin expansion versus 2025. We have narrowed the range for free cash flow, which is now expected to be $135 million to $165 million with the midpoint unchanged.

We continue to expect stock based compensation expense to be below $50 million in 2026, representing a decline of more than 35% from the prior year. The full year net loss per share range has been narrowed to a loss of $0.95 per share to a loss of $0.75 per share, with the midpoint improving modestly. Please note that our cash flow and net loss per share guidance ranges do not incorporate any potential impact from changes to our current debt structure. For the fourth quarter, we expect consolidated revenue in the range of $569 million to $615 million and adjusted EBITDA of $74 million to $100 million.

Moving to the segments, for integrated care, we now expect 2026 revenue growth of 1.1% to 2.1% with the midpoint remaining constant with the prior guidance range. We are raising our 2026 adjusted EBITDA margin range to 16% to 16.6% up approximately 30 basis points at the midpoint versus our prior guidance range and representing approximately 115 basis points of the year over year growth. For the fourth quarter, we anticipate integrated care revenue to be flat to up 3.8% versus the prior year.

Fourth quarter adjusted EBITDA margin is expected to be in the range of 14.5% to 16.8%, with adjusted EBITDA dollars essentially flat at the midpoint versus the prior year.

Given integrated care, strong adjusted EBITDA outperformance in the third quarter, we now plan to make measured incremental investments into strategic growth initiatives during the fourth quarter.

Moving to the Better Help segment, following the outperformance in the third quarter relative to the guidance midpoint, we now expect 2026 revenue to decline 16.1% to 12.9% versus 2026.

The year over year comparison reflects continued headwinds in U. S. cash pay and to a lesser extent in non U. S. markets, partly offset by growth in insurance revenue. We remain encouraged by the ongoing progress in insurance and expect to generate insurance revenue of $99 million to $105 million in 2026. With the midpoint of the range increasing by approximately $4 million.

The increase in insurance revenue expectations reflects continued progress across user acquisition, therapist capacity and session growth. We expect Better Help adjusted EBITDA margin of 2.7% to 4.3% for the full year. With the midpoint down approximately 30 basis points versus our prior guidance and down approximately 90 basis points versus the prior year, reflecting the impact of revenue mix, investments to support the scaling of insurance and a reduction into advertising and marketing expense in the mid 20% range versus 2025 levels. For the fourth quarter, we expect Better Help segment revenue to be down 31.5% to down 18.5%. With insurance revenue expected to be in the range of $32 million to $38 million.

We anticipated adjusted EBITDA margin of 9.2% to 15.1%. Recall that the fourth quarter is impacted by unique seasonal factors, including a moderation in session utilization as well as holiday ad pricing dynamics that lead us to pull back on our advertising and marketing spend as it is less efficient during this period.

And as Chuck mentioned, we expect a more meaningful sequential quarterly reduction this year compared to prior years. As would typically be the case, we intend to provide formal, consolidated and segment guidance for next year during our fourth quarter earnings call. However, since there are several important moving parts to the Better Help transition we are executing, we thought it would be helpful to provide some directional commentary on Better Help as we think about 2027 in the context of what we are seeing in the business today. With respect to insurance as we continue to execute on increasing provider capacity, improving therapist engagement and growing utilization of Better Help services, we expect continued growth in 2027.

We look to build on the insurance momentum we are currently seeing with a goal of sequential quarterly improvement over the course of 2027 and a goal of achieving an annualized revenue run rate of at least $200 million as we exit 2027.

Regarding cash pay, we expect a continued challenging environment in 2027 as Better Help continues to evolve its advertising and marketing approach, including lower overall spending levels as we spoke about earlier.

Note that in the third quarter of 2026, the first full quarter since we began implementing the additional actions to pivot the business. Better Help's advertising and marketing spend declined by 27% from the prior year's quarter. Looking at 2027, we would expect a similar level of spending to decline in the mid to high 20% range for the full year of 2027 with these actions more fully underway for the year.

Given the correlation we have seen between advertising spending and cash pay user acquisition, we would anticipate these changes to impact Better Help's revenues, excluding insurance, generally in a similar corresponding manner.

Turning to our balance sheet, we remain focused on maintaining financial flexibility while strengthening our capital structure. We currently intend to address the June 2027 maturity of the $1 billion in convertible notes through a two phase approach subject to market conditions. The first phase would potentially involve repurchasing a substantial portion of the outstanding notes using a combination of available cash and proceeds from more traditional debt financing potentially before year end. We would then expect to repay the remaining balance with cash at maturity in June 2027.

Following the June 2027 maturity, we expect to have a meaningfully lower gross debt position. As you've heard from us over the course of this call, while there is more work ahead, this was a solid quarter driven by execution and continued progress across our key strategic priorities. And with that, I'll turn it back over to Chuck.

Thanks, Mike. Our overarching objective is to be the most trusted leader in virtual care, creating value for our clients around the world and delivering outcomes that matter to patients, clients, and other stakeholders. We believe virtual care is a catalyst for Better Health, and we intend to build on our strengths as we move forward. Our organizational focus and strategic priorities are aimed at driving performance and advancing our position, impact, and differentiation within a broader health care industry that faces ongoing challenges and to play a constructive and increasing role in addressing them.

It's why we've leaned into product innovation, expanded our care models, and invested in our technology, and why we are also highly focused on scaling insurance access and better help and pivoting its business model. And this orientation will continue to guide our investments and business execution.

With that, we are now ready for questions. Operator?

Thanks, Alan. Appreciate the questions there. We've been very encouraged by the progress we're making in insurance. I think the team is doing a great job in terms of accelerating our ability to credential and onboard therapists, and we are getting some scale benefit there. There's a number of actions that we're doing now that we have this national footprint that we established in the second quarter that are also helping us. There's a number of things that the team is going after in terms of not just adding therapists to the network, which is important, but also making sure that we have an increase in active therapists on the platform, therapists that are accepting new patients, looking at capacity on both a market basis as well as a payer basis.

There's a number of things that go into that, but what we are making some really good progress as you noted. We're taking a look at a number of things. Certainly, compensation programs, thinking about how do we evolve those programs to reflect local market conditions and create some more predictability in terms of compensation for therapists, really ultimately gaining more of their roster and more consistency in that. But we're also making a lot of investments and changes to the platform itself, looking at ways that we can increase efficiency, both for the therapists as well as the patient, and just ways to reduce the administrative burden and make it really easy to do business with us in this area.

So we're going to continue to do that. We've been excited about the progress so far, and we're going to keep it up.

Thanks, Richard. I think, you know, we were, you know, gratified in the third quarter results in terms of the cash pay performing, you know, better than we had anticipated, notwithstanding the pressures that are there. I think the team has done a nice job of implementing the actions we talked about in the second quarter and really looking to balance our approach to balance the demand for insurance in terms of capacity, but also manage the cash pay side. We saw a bit favorable customer acquisition costs, some improvements in a few metrics. But again, I think we just do want to reinforce if there's continued downward pressure on the cash pay. But, you know, better than we anticipated in the third quarter.

We look at the fourth quarter. As you know, we have more uncertainty in the fourth quarter with respect to the holiday advertising and dynamics that are there. We do expect a more sequential decline in advertising in the fourth quarter for the reasons we mentioned. And we have this 50 state presence and insurance presence out there as well. So we're taking a look at all of those factors in terms of that guidance. I would say that the more meaningful part of your question and the answer here is that reduction in ad spending, given the correlation that we've historically seen with the level of ad spending relative to cash pay user acquisition, our reduction in advertising in the fourth quarter, you know, is a major driver there.

And then, of course, there's additional uncertainties. You know, this is sort of new territory for us in terms of the scale of what we have insurance now. We've been building, you know, last year's fourth quarter was about $7 million in revenues for insurance and a smaller portion of the book and it's growing. So we want to see how all that plays out in the fourth quarter. We've kind of taken all that into account in how we thought about guidance.

Yeah, thanks, Lisa. I think, you know, first of all, you know, as we've talked about before, I see the operating environment, you know, really in line with kind of the comments that I made, you know, earlier as well as, you know, last few quarters and really seeing the challenges in the health plan market, you know, as they navigate through a number of aspects of their business, employers, of course, you know, looking at those high and rising costs and kind of how they're evaluating their programs. So that environment continues to be out there. I think for us, what's been, I think, you know, exciting is being able to describe the innovation agenda we have and how our value proposition is evolving and how we can serve them more comprehensively to help them, you know, address things across broader populations.

And I think that's allowed us the opportunity to talk about things a bit more strategically in terms of the value and benefits of working with us. All of that is kind of played into, you know, the selling season. Those are showing up at our client conversations and, of course, the activity. I think more broadly, that sort of overall environment, we're seeing it show up in the selling season. Like I said, bookings are generally in line with where we expected to be, and they're really looking for things that drive outcomes that they can see demonstrated ROI that we can handle things more comprehensively, that we can reduce fragmentation, which is significantly out there in terms of all the different point solutions.

And really why, to your point, we've leaned into innovation, including Teladoc 1, which is a really, I think, a new and exciting model for us in terms of the ability to us to bring our comprehensive model to the market, not focused on a singular, fragmented product category or a singular condition, but looking more holistically at what the care needs are. And so we, as I mentioned in my prepared remarks, we've moved from announcement to execution.

We've got initial launch partners. We're starting to engage patients in the new model. And those are giving us additional data points and proof points as we talk to clients. Of course, we'll have Teladoc 1 more broadly available for 27. You know, there's a normal commercial motion in terms of the selling cycle to get those things to market.

We do expect to see some benefit in 2027 from Teladoc 1 and, of course, building further in 28 given the selling cycle.

Yeah, I'll make some comments and then see if Mike wants to add anything. You know, we did outperform in the third quarter, as you mentioned in integrated care. And as we thought about the fourth quarter and the full year, we maintained the full year, you know, generally where it was. There's a number of moving parts in the fourth quarter, you know, various puts and takes that overall sort of tend to offset each other. But we've got some FX pressures given where the currency markets have gone. We've thought about that, of course, infectious disease and flu season, like you referenced.

Generally, you know, we've assumed that that's similar to kind of what we saw in 2025. And we also, you know, baked in, you know, whatever additional benefit we get from that small acquisition. I mentioned in my comments really don't see that as a material driver in the fourth quarter. So, so all in, we've sort of felt good about the full year guidance and maintained it, given those various moving parts. I don't know, Mike, if you want to add anything to that.

No, I think that the third quarter results really, 3Q was dynamic and that there was there was that little upside the revenue. There was. Coming in lower. So it really all kind of came together for 3Q. And I think you're seeing part of that as well.

Yep. And then, you know, as I think we mentioned earlier, you know, taking the opportunity to invest in some additional growth opportunities we're looking for in 2027, given the outperformance in the third quarter.

Thank you.

I think, you know, we've continued to show that sort of run rate metric and the weekly sessions and all that to give a sense to you all about in terms of progress for making and the growth that's going on there. Obviously, the reimbursements are going to vary, you know, depending on the market, the payer, and the mix of sessions and types of sessions and things like that. But I think if you look over the last few quarters where we've given that statistics, it's been relatively consistent. So, you know, I think I think I would answer it that way.

You know, we are continuing to activate the full funnel in terms of better health to be able to generate, you know, awareness, activation, demand, you know, for services for those that want to use better health. I think since we moved to the national footprint, you know, during the second quarter, we really needed to modify kind of our approach to advertising and marketing given the prevalence, excuse me, given the preference that people have to use their insurance. So, that's kind of why we've been able to bring advertising down, continue to activate the funnel and generate, you know, growth and insurance. From an SGA perspective, you know, we're making investments there to, you know, scale credentialing, as we talked about earlier, scale the operations, make sure that we've got the right infrastructure to support the insurance.

We do believe that over time, the scaling of insurance will give us the opportunity to, you know, create some operating leverage in benefits of what we're doing. And then, of course, balancing the cash pay and the insurance business, you know, to create overall, you know, operating leverage for the company.

Thank you. That's helpful. And then my quick follow up is just, can you help us understand kind of what you're referring to when you talk about hybrid care? Is that the in touch health business? And then can you maybe help us understand or size that hybrid care business? We've been modeling in touch flat at about $100 million of revenue for the last several years. So just interested to know, like, is that the correct ballpark or is that is the business significantly larger than, then maybe we had appreciate it. Thank you.

Yeah, I think the, so I've answered this way. I want to get into the specifics around the revenue from a particular offering, but the historical part of that business was the acquisition of in touch for those that understand that term. And we've been able to continue to innovate those devices and software, you know, over time. What we've done outside the U. S. I think very effectively is take that technology and work with care delivery organizations in a number of countries. To bring virtual services with those with that technology, whereas in the U. S. , the current business and historic business was really a technology product that was being sold in the hospital and health systems, not the services piece.

Whereas in other countries, we're doing both in what we've termed hybrid care in that environment, bringing virtual services with our technology into a physical care setting in places like Canada and France and Australia and other places. In the U. S. , though, it's really been technology. What we're looking to do and what we're excited about with this bringing Teladim to the company is this is a company that we've worked with for a long time that's used our technology and really commercialized the services part of the equation using our technology. So it's someone that we're, you know, it's a company we're very familiar with, a lot of trust, a lot of, you know, tracks that have been laid in terms of using our technology and supporting use cases to those health systems.

So we think bringing that expertise we have in non-U. S. markets, which is considerable and been a nice source of growth for us, bringing that expertise combined with our technology and Teladim services together to really go after that market opportunity in 2027.

Thank you.

Yeah, I would say we provided that because we've got a number of moving parts that better help and we just want to try to give some directional commentary in terms of how we're thinking about 27, you know, and how we're seeing the business today. You know, we're already seeing 27,000 visits a week as I referenced earlier. You know, a significant run rate of $140 million.

We're going to exit this year at that level as well. And we're going to see, you know, our goal is to have sequential growth each quarter and of course, you know, exit with at least $200 million and more like we referenced. So we've got a good line of sight in terms of the plan to execute against that. We've got really good momentum that we've seen an insurance to expand capacity, really, you know, evaluate the demand equation.

And of course, the payer contracts, you know, we have over 150 million lives in our current payer contract. So we've got plenty of room to activate the strategy. Again, there's execution in front of us, so it's directional, but that's how we're feeling about it. Thank you.

Yeah, I think the first thing I would say is, you know, as you would expect, we're going to provide full 2027, you know, guidance in the fourth quarter. The reason for us making some comments here is because we know there's so many movie parks coming out of second quarter. And the actions were undertaken. And really, there's, you know, a couple of key pieces there, obviously, cash pay and insurance, which is why we've made sure we talked about those directionally. So with cash pay, you know, we're going to continue to focus on insurance, growing insurance, and evolving that advertising approach.

And we're going to see where cash pay goes with that. Given what we're seeing in the third quarter, you know, really our first full quarter of these additional actions, we wanted to give that data point and reference it in terms of what cash pay might look like as we go into 2027 because we will see lower advertising expenditures for the reasons I've already covered. So I think that's all where I'll leave it at that in terms of where we think cash pay might go.

Again, we'll cover full guidance in 2027. With insurance, we're very focused on scaling it, increasing capacity, making sure that we are leveraging this national footprint that we created in second quarter. And so that's why we wanted to make sure we provided some commentary around that. I don't want to get beyond that at this point. From a margin perspective, as we talked about earlier, the insurance business, we do expect lower gross margin than what we've seen in cash pay. Of course, cash pay margin, you know, is high because of a level of advertising that you have to do to activate that cash pay market, given that the churn dynamics there. So we're going to do what we've been doing.

Which is focused on balancing the top line and the bottom line as we execute this important. Thank you.

Yeah. Thank you for that. Yeah. I think with better help, think about the insurance business, you know, really as an in-network model, meaning we're a provider in those payer networks. And so getting those lives under contract is 150 million plus that I referenced is sort of the first point. The second is how you make aware people that have mental health needs and want to use those kinds of services, virtual services, aware that better help is in network with those payers. And third is really creating that awareness through the strong brand recognition and the customer acquisition channels that we built a better help over time to the consumer lens. So all of that is coming into play in terms of responding to your question.

And then as we create that awareness and people have a need and they want to use less better help services, they want to use their insurance. Then they come through the funnel and they will be matched with the therapist. And then of course until they're seen that session becomes our revenue when that session occurs and then obviously recurring sessions.

So all of those things have to come into play. From a therapist capacity standpoint, you know, as I've touched on really looking at our platform, which is historically been built to optimize for cash pay. And now we're making a number of advancements to really optimize as much as we can for insurance in terms of creating more efficient model for them, more predictable model for them. So all of those things are coming to play. And then the last point I would make to your question is as we look at what we need capacity wise, it's important to look at it on a local level too on a market basis as well as payers. And that's why we're very focused on not just the number of membership that we have under contract, but this credentialing process, as I've mentioned before, we have delegated credentialing in place with a number of plans.

And we are continuing to explore in CQA accreditation for delegated credentialing so that we can go to the other payers and see if we can get delegated credentials with them where we do a lot of the heavy lifting and then ultimately get them enrolled in the plan. So hopefully then it was responsive to your question. Yes, thank you so much.

Great questions. First, with respect to the marketing difference, you know, up until the second quarter. Well, first of all, prior to insurance better help was all a consumer marketing engine. So it was, you know, national strategies, national campaigns, you know, value proposition and so forth. And then as we entered insurance each state because we needed to make sure that we could only talk about insurance relative to what was available in that market. We had to tailor our marketing based on the state that we were operational. And as that continued to scale, you know, we saw ourselves having the ability to create some efficiencies by going to a national footprint. So now we can advertise and we can talk about, hey, we better help, you know, accept insurance.

So we get some synergies there as well as the marketing message where, you know, others that have already gone down this path previously were able to say that, you know, that they accept insurance and so forth. So that's been key as well as just lowering the overall advertising expenditures so that we can more connect the demand generation to the capacity we have. So it's the marketing strategies as well as the overall, you know, advertising levels that come into play there. You know, in terms of cash pay, you know, I think better help was a small acquisition. It grew significantly. And a lot of that was because it had a great consumer orientation and a value prop.

But also, you know, historically, there was a very difficult place for payers in terms of mental health capacity and access in the network. And so this consumer oriented model was able to meet a need at that time when there was less network access coverage. Of course, that's evolved a bit since post-pandemic and others have sort of moved into that space. So the market has evolved a bit in terms of creating capacity from an insurance perspective for mental health services.

I would also say that, you know, if you look at better health, we're essentially asking someone to pay out a pocket in the cash pay environment, the equivalent of a car payment. You know, if you think about it. So the consumer pressures, the cost and the fact that we can start to create insurance availability from an affordability standpoint is key.

And then I think the last part is, you know, as we've talked about, we think it's important for better health in the U. S. to be able to offer both insurance at scale and a cash pay option because they're going to be people that either aren't in network and want to use better health. That because of stigma or other reasons don't want to access their insurance. And I do believe there is going to be, there's going to continue to be a cash pay market for these services.

It's just given the level of preference we're seeing, affordability challenges and so forth. We just feel like moving this business much more into an in-network model, you know, as a more durable position, not withstanding the fact that I see us offering both cash pay and insurance depending on where the market heads.

That's helpful. Appreciate it. Thank you.

It's a great question. You know, I think if you look at integrated care, we have a pretty skilled mental health capability inside integrated care therapy and psychiatry. And really the approach there is, to your point, looking at things more holistically for the patient in terms of physical and mental health in chronic care programs and other kinds of access. And so that's been an important part of integrated care and will continue to be because of the overall physical health mental health aspect. To your point, the Better Help segment has got a strong capability in terms of focusing on mental health and making this pivot to insurance to create a more durable model. And we've got them head-down focused on that.

Now, I think over the longer term, as we think about where we want to take mental health more broadly, it opens up other kinds of possibilities. But I don't want to get ahead of us. I think focusing on execution, the priorities we've talked about, I think it's really important for Better Help to continue to scale that, continue on the integrated care side to care for people more holistically, and then, you know, explore those types of synergies down the line to your point.

Okay. Thanks, guys. Okay.

Yeah, thanks. I think, first of all, at a sort of overall level, what Teladoc one represents is really a culmination of a lot of work to get us in a position, you know, having this extensive virtual care capability from clinical breath standpoint. The technology, all the things behind it, and the ability to care for patients more holistically.

I think historically and currently, you know, companies like us have gone to market, you know, focused on conditions and certain products. And depending on whether a client has acquired multiple products from Teladoc, you know, determines what level of support and engagement and that we can do with a member, of course, right? In terms of what we're contracted to do. Whereas Teladoc one really brings the full breadth of what we can do to the individual. And that's a real difference in terms of both our differentiation in the market as well as how we're coming to market. And that also gives us the ability over time to serve broader populations than a particular condition or those kinds of things because the needs change in people and people are more than just a condition.

They have more care needs. So I think from an overall perspective, that's how we're looking at Teladoc one. We've got the initial launch partners underway, like I mentioned, starting to engage with patients, getting really good early feedback on that. And we're starting to have those conversations with clients and then for more broader availability in 27. But given the selling cycle process and dynamics, you know, we'd see, we would expect to see some impact on 2027 and 2027 selling for 2028. So we're excited to bring it to market. We believe we're going to have some impact on 2027 with Teladoc one, both in terms of current clients from a retention standpoint as value proposition standpoint.

And we believe over time, continue to grow the client base in this new offering. Thank you.