Teladoc Health Q2 2025 Earnings Call Transcript

Quartr
Provided by Quartr
July 29, 2025

Key Takeaways

  • Positive Sentiment: Teladoc reported Q2 consolidated revenue of $631.9 million and adjusted EBITDA of $69.3 million, both at the high end of guidance, and narrowed its full-year 2025 outlook.
  • Positive Sentiment: The company highlighted operational transformation—streamlined organization, enhanced cost efficiency—and unveiled a robust product innovation pipeline with WellBound, upgraded cardiometabolic care and an AI-driven virtual sitter.
  • Positive Sentiment: BetterHelp’s insurance initiative began a soft launch in one state with encouraging early results, as Teladoc and Uplift teams integrate platforms and credential over 2,000 therapists to drive long-term growth.
  • Negative Sentiment: The Better Health segment saw U.S. cash-pay headwinds, with average paying users down 5% year-over-year, rising churn rates and higher customer acquisition costs.
  • Positive Sentiment: International integrated care grew mid-teens on a constant currency basis, and BetterHelp’s localized global launches achieved high single-digit user growth, expanding Teladoc’s reach.
AI Generated. May Contain Errors.
Earnings Conference Call
Teladoc Health Q2 2025
00:00 / 00:00

Transcript Sections

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Operator

Good afternoon. Thank you for attending today's Teladoc Health Second Quarter twenty twenty May. My name is Victoria, and I'll be your moderator today. I would now like to pass the conference over to Mike Minczak, Head of Investor Relations for Deladoc Health. Thank you. You may proceed.

Michael Minchak
Michael Minchak
VP - IR at Teladoc Health

Thank you, and good afternoon. Today, after the market closed, we issued a press release announcing our second quarter twenty twenty five financial results. This press release and the accompanying slide presentation are available in the Investor Relations section of the teladochealth.com website. On this call to discuss our results are Chuck Davita, Chief Executive Officer and Mala Murthy, 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.

Michael Minchak
Michael Minchak
VP - IR at Teladoc Health

Please note that we will be discussing certain non GAAP financial measures that we believe are important in evaluating our performance. Details on the relationship between these non GAAP measures to the most comparable GAAP measures and reconciliations thereof can be found in the press release that is posted on our website. Also, please note that certain statements made during this call will be forward looking statements as defined by the Private Securities Litigation Reform Act of 1995. Such forward looking statements are subject to risks, uncertainties and other factors that could cause our actual results to differ materially from those expressed or implied on this call. For additional information, please refer to our cautionary statement in our press release and our filings with the SEC, all of which are available on our website.

Michael Minchak
Michael Minchak
VP - IR at Teladoc Health

I would now like to turn the call over to Chuck.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Thanks, Mike. I'm pleased with our strong performance in the second quarter with consolidated revenue and adjusted EBITDA both at the higher end of our guidance ranges. This reflects continued disciplined execution and builds on our solid results from the first quarter. Based on our results and outlook for the second half of the year, we're narrowing our guidance range in 2025 consolidated revenue and adjusted EBITDA.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Mo will provide more details on our performance and outlook later in the call. It's now been a year since I joined Teladoc Health, and I would like to take the opportunity to comment on the progress we've made and the direction of the company. It's been a transformative year in many respects as we've worked with urgency and purpose to improve performance and reposition the business. As I shared when I first joined, I saw the need to strengthen our market focus and increase the efficiency of our business. And we've taken decisive actions that have resulted in a more streamlined organization with greater agility and market orientation and a more efficient and scalable cost structure.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

I also shared the importance of accelerating innovation across our products and capabilities. We've made considerable progress in that regard, including a product innovation pipeline that's gaining momentum. Let me share some examples. We recently launched WellBound, a new employee assistance program offering for The U. S.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Integrated care market. It provides mental health and well-being support, including access to online therapy services from BetterHelp and seamless access to other available Teladoc services. While early, we're pleased with the level of interest we're seeing and we look forward to building a position in the EAP market. We're enhancing our cardiometabolic health program this year, including new connected devices as well as registered dietitian access, sleep support and other new features. And to further engage and support enrollees with rising risk and higher acuity conditions, we're developing additional clinical interventions leveraging our primary care specialist and care support teams.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We believe that a comprehensive approach focused on both prevention and the progression of diabetes, hypertension and obesity, will have the greatest sustained impact on patient health and value for our clients. For our hospital and health system clients, we launched a new AI enabled virtual sitter solution fully integrated into our proprietary technology. This new offering extends and supports our clients' workforce capacity and their care delivery and patient safety objectives, including matters such as fall risk and patient elopement. In our international integrated care business, we also continue to add new solutions, including hybrid care models for public health systems to support a variety of needs, including access to primary care and emergency department care in rural and remote communities. Product innovation will be an ongoing focus of our organization.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Over the past year, we've also added important capabilities, including through strategic acquisitions. Catapult Health strengthens our approach to preventative care through its virtual checkup and other solutions as well as being an important and complementary engagement capability with other Teladoc services. And we recently acquired Uplift to support BetterHelp's entry into insurance, an important initiative I also shared when I joined the company. I'll provide an update on our progress in this area in a moment.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Additionally, we've strengthened operational execution, added new partnerships and collaborations and made advancements in our technological infrastructure, all aimed at supporting our strategic priorities and our ability to deliver more services and value to customers. We've also hit some noteworthy milestones, including exceeding 100,000,000 U. S. Integrated care members, providing additional opportunities to grow our services over time. While there is important work ahead, I'm pleased with the progress overall and I'm confident we're in a stronger position to execute in an evolving market.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

As we've all seen, the health care challenges are substantial. Affordability and rising costs, the impact of disease and chronic conditions, unmet mental health needs, provider pressures and other issues continue to impact all stakeholders. And it's clear to us that virtual care can and must play a greater role going forward given the extent and magnitude of these challenges. Prior to 2020, virtual care was largely about convenience and access to quality cost effective care. Teladoc led the way through technology, services and scale and also delivered during the pandemic.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Now virtual care has become widely adopted and there's also been a proliferation of point solutions adding to fragmentation and complexity. Teladoc again led the way by taking an integrated approach across physical health, mental health and chronic conditions, placing the whole patient at the center. Looking ahead, we intend to build on our leadership position, our assets, clinical capabilities and range of services with an intensified focus across patients, providers, platforms and partners, all aimed at enhancing the patient experience, improving outcomes and delivering greater value. We're uniquely positioned to advance this important work, and we're prioritizing investments that are aligned with this vision. And we plan to deliver on it through our four strategic priorities.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

First, we're enhancing our integrated care offerings, particularly in The U. S, to drive a greater impact on both clinical outcomes and the cost equation. We'll support our growth objectives through continued product innovation and we intend to launch new and enhanced offerings across our portfolio on a sustained basis. Leveraging our millions of engagement points in new and unique ways, advancing clinical intervention opportunities and orchestrating care more holistically, we intend to deliver greater value for clients and the people we serve. Second, we're further leveraging our scaled mental health position.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

In addition to new products such as WellBound, we have several initiatives underway to expand mental health access and our ability to serve more needs. This includes momentum in integrated care where we saw a thirteen percent year over year increase in mental health visits in The U. S. During the second quarter. And in Better Health, where we'll be building on our unparalleled consumer position by adding insurance capabilities to grow and expand our market opportunity.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

On that front, I would like to take a moment to provide an update on BetterHelp's insurance coverage initiative. As we've shared, we believe insurance will leverage BetterHelp's strong consumer activation, experience and scale, while having a positive impact on conversion rates, the number of user sessions and return on advertising spend over time. With ongoing headwinds in the consumer cash pay business, we see insurance coverage as essential to the stability and growth outlook for BetterHelp. And we believe we can meaningfully scale insurance over time. We are being methodical in our approach to ensure the long term success of this business.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

This includes ensuring a robust and scalable operating infrastructure, growing our network of credentialed mental health professionals and supporting and expanding our payer relationships and corresponding membership coverage. From an operating infrastructure standpoint, the BetterHelp and Uplift teams are partnering in a seamless way. Execution is progressing well, including unifying the platforms and experience and ability to leverage and scale the combined capabilities. In late June, we began a soft launch of BetterHelp Insurance in a single state, laying the groundwork for a methodical ramp of the business over the next several quarters. We're encouraged by the early results, including the performance of our technology, the strength, reliability and durability of the insurance processes and growth of the insurance provider network.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We see significant opportunities to access and leverage BetterHelp's expansive network of 35,000 therapists to support growth in the insurance network. As a reminder, BetterHelp's therapists are all fully licensed and with a master's degree or higher. The network averages eight years of experience and consistently delivers results, including over seventy percent of patients reporting symptom reduction within twelve weeks as well as high satisfaction rates, including over eighty percent of patients that would recommend their therapist to others. In this regard, we've begun initial outreach to many of our Better Health therapists to join the insurance network, and we're seeing good interest. To date, over 2,000 have engaged and are now in various stages of the credentialing process.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

This outreach will continue as we look to complement and further build on Uplift's already robust base of over 1,500 mental health professionals. We're also seeing success in further expanding payer relationships. Uplift brought arrangements covering over 100,000,000 lives. And over the past few months, we have signed additional new contracts adding over 15,000,000 lives. We'll provide further updates on progress during the third quarter call.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Our third strategic priority is international growth. Our international business now accounts for over 15% of our consolidated revenue, and we see continued growth potential. We already operate a robust international business in Integrated Care that has delivered steady double digit growth and is well positioned to meet diverse needs across countries, markets and client segments, including leveraging our hospital and health system technologies to support public health systems in several countries. We continue to evaluate opportunities to increase our position across both existing and new geographies. Fourth, we're highly focused on operational excellence to consistently deliver for clients and to achieve our business and financial objectives.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We've made considerable progress in driving operational excellence, including a highly successful client implementation season for 2025 coming off of a very challenging one in 2024. This was also a key priority when I joined. With respect to cost efficiency, as noted last quarter, we're tracking modestly ahead of our cost savings and productivity targets. We've made meaningful progress across several areas, including technology and development, administrative costs and stock based compensation. And we'll continue to make progress while balancing the need to invest in our strategic priorities.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

In closing, I'm encouraged by our first half performance. We're making progress against each of our key strategic priorities and our teams continue to operate with focus, urgency and discipline. We're committed to maintaining a balanced approach by delivering solid financial performance and investing in the products and capabilities important to our future. While broader market dynamics continue to impact health care and the operating environment, I remain confident in our strategy and our ability to return the company to an overall growth trajectory over time, including through the initiatives I have outlined. With that, I'll turn it over to Mala.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Thank you, Chuck, and good afternoon, everyone. Second quarter consolidated revenue was $631,900,000 near the high end of the guidance range and down 1.6% year over year, driven by a decline at Better Health, offset to some extent by growth in integrated care revenue. Adjusted EBITDA of $69,300,000 was also at the upper end of the guidance range and represented a margin of 11%. Net loss per share was $0.19 compared to a net loss per share of $4.92 in the 2024, which included a $4.64 related to a pretax noncash goodwill impairment charge. Net loss per share in the 2025 included amortization of intangibles of $0.50 per share pretax and stock based compensation expense of $0.13 per share pretax.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

These items were partially offset by a discrete tax benefit of $06 per share. Free cash flow was $61,000,000 in the second quarter, slightly ahead of the prior year period. On a year to date basis, free cash flow increased by $11,000,000 compared to the same period last year. We ended the quarter with $618,000,000 in cash and cash equivalents after retiring $551,000,000 in convertible senior notes that matured during the quarter. Turning to our segment results.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Integrated Care segment revenue of $391,500,000 increased 3.7% over the prior year period and exceeded the high end of our guidance range. We saw good growth in visit revenue and continued strong performance in our international business, which then delivered mid teens growth on a constant currency basis. Catapult contributed approximately two forty basis points to segment growth. Foreign exchange also contributed roughly 50 basis points to growth in the quarter. Underlying fundamentals continue to trend favorably.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

US Integrated Care segment membership at quarter end was 102,400,000 members towards the high end of our guidance range and up 11% year over year, while U. S. Integrated care virtual visit volume increased by 6% versus the prior year period. Chronic care program enrollment at quarter end was 1,120,000, down versus the first quarter due to the previously discussed contract loss. Excluding the impact of this loss, underlying program enrollment would have increased by a low single digit percentage on a sequential basis.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Second quarter Integrated Care adjusted EBITDA was $57,500,000 which represented a margin of 14.7% and was at the high end of our guidance range. This benefited from revenue flow through, which was partially offset by higher OpEx in the quarter, including marketing spend and legal fees. While this compares to an adjusted EBITDA margin of 17% in the prior year period, recall that we had cited a roughly three forty basis point tailwind to adjusted EBITDA margin in the 2024 from performance based revenue, variable compensation costs and the timing of certain marketing and other operating expenses. Moving to the Better Health segment. Second quarter revenue was $240,400,000 up slightly sequentially and just above the midpoint of our guidance range.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Foreign exchange contributed approximately 45 basis points to year over year growth, while Uplift contributed roughly 100 basis points. Second quarter average paying users declined by roughly 9,000 sequentially to 388,000 and were 5% lower versus the 2024. Despite encouraging early progress on our insurance and international initiatives, we continue to see headwinds in the underlying US cash pay business. While the year over year decline has moderated relative to 2024 levels, U. S.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Cash pay users saw a high single digit percentage decline versus the 2024. Last quarter, we pointed to a slight uptick in churn rates, which we believe was reflective of softening consumer sentiment and uncertainty around the macro environment. That trend continued through the second quarter, while we also saw an increase in customer acquisition costs and fewer gross user adds. We believe these factors and consumer interest in accessing therapy through insurance coverage is impacting the cash pay business. We believe that validates our insurance acceptance initiative with Uplift meaningfully accelerating our effort.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

We continue to believe the unification of customer acquisition funnel between cash pay and insurance coverage will allow us to more effectively leverage BetterHelp's advertising and marketing budget and leads to a lower acquisition cost per user over time. While not enough to offset the headwinds in The US cash pay business, international users were up by a high single digit percentage over the 2024. With more attractive customer acquisition costs, we plan to continue reallocating advertising spend to those markets. While still early, our localized launches continue to see good month over month growth in users, and we are evaluating opportunities for additional localized market launches over the balance of 2025. Insurance revenue totaled 2,400,000 for the quarter, which was in line with expectations and attributable to Uplift as we continue to build out the operating infrastructure to support the future scaling of our Better Health insurance business.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Better Health adjusted EBITDA was $11,900,000 in the second quarter. Adjusted EBITDA margin of 4.9% was in the upper half of our guidance range of 2.5% to 5.25%. The margin declines on a year over year basis was mainly due to lower revenue and incremental investments to advance the insurance initiative. Turning to guidance. We now expect 2025 consolidated revenue of $2,501,000,000 to $2,548,000,000 with the midpoint increasing slightly versus our prior range, with an increase in integrated care outpacing a lower better health outlook.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Adjusted EBITDA is expected to be in the range of $263,000,000 to $294,000,000. The midpoint of this range is slightly below the previous outlook, impacted by similar segment dynamics and now incorporating the anticipated impact of tariffs, which I will speak about momentarily. Full year free cash flow guidance of $170,000,000 to $200,000,000 remains unchanged. We now expect 2025 stock based compensation expense in the range of $95,000,000 to $105,000,000 approximately $10,000,000 below our prior outlook and a continued area of focus for us.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

For the third quarter, we expect consolidated revenue in the range of $614,000,000 to $636,000,000 and adjusted EBITDA in the range of $56,000,000 to $70,000,000 Drilling down into the segments, starting with integrated care, we are raising and narrowing our full year 2025 revenue guidance, which we now expect to be up 1.75% to 3.25% year over year versus our prior guidance of flat to up 3%. The increase of 100 basis points at the midpoint reflects our strong first half performance relative to guidance, coupled with updated assumptions on foreign exchange. We continue to expect Hanifold to contribute approximately 200 basis points to full year revenue growth. We are narrowing our full year 2025 adjusted EBITDA margin guidance to 14.5% to 15.25% versus our prior range of 14.3% to 15.3%, which is up slightly at the midpoint. As previously discussed, this includes a roughly 40 basis point headwind from the Catapult acquisition.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Excluding Catapult dilution, adjusted EBITDA margin would be up slightly year over year at the midpoint of the guidance range. Our guidance of 101,000,000 to 103,000,000 U. S. Integrated Care members remains unchanged. Last quarter, we provided a preliminary view on the potential impact of tariffs.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

The initial estimate we provided, which was not included in our prior guidance, given the fluidity of the situation, was based on proposed rates at the time, including a 145% China tariff and the impact of our mitigation efforts. Based on the latest information, we now estimate an unfavorable adjusted EBITDA impact in 2025 of approximately $3,000,000 which is now included in our guidance ranges. This reflects a partial year of impact based on the timing of new rates and inventory on hand. We continue to evaluate additional levers to mitigate the impact of tariffs now and into the future. This includes assessing alternative sourcing arrangements to diversify our supply chain, which we think is a prudent long term action.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

For the third quarter, we expect Integrated Care segment revenue growth to be down 0.5% to up 2.25% and adjusted EBITDA margin in the range of 1415.5%. Recall that the 2024 had included a favorable resolution of a prior period billing adjustment, which will drive a roughly 115 basis point headwind to revenue growth and roughly 95 basis point headwind to adjusted EBITDA margin in the 2025. Importantly, we assume a return to sequential growth in chronic care program enrollment in the third quarter, driven in part by continued growth in our weight management program, which was augmented by the addition of one of our largest customers at the start of 2025. Regarding the second half cadence, our updated guidance implies a sequential step up in revenue in the fourth quarter, driven largely by typical seasonality related to infectious disease business as well as contribution from new business implementation. It also implies a sequential increase in adjusted EBITDA dollars driven by the revenue increase coupled with disciplined cost control.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Moving to BetterHelp. We are narrowing our revenue guidance range with a revised midpoint reflecting ongoing headwinds in our U. S. Cafe business. Although still in the early stages, we are encouraged by the progress of our insurance initiative, which we view as a critical driver for restoring long term growth in the Better Health business.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

We now expect a year over year revenue decline of 6.8% to 9.2% in 2025 compared to our prior outlook of a 3.75% to 9.75% decrease. Our guidance continues to reflect approximately $10,000,000 in insurance revenue for 2025, net of any mix shift from the existing cash pay business. We expect a more meaningful revenue contribution in 2026 as we continue to methodically scale operations and expand our fair therapist network over the next six to twelve months while steadily enabling access across additional states. We now expect a Better Health adjusted EBITDA margin of 4% to 5.5% for the full year, with the midpoint down 75 basis points versus our prior guidance. This revision primarily reflects the flow through impact of a lower revenue outlook, partially offset by incremental G and A reduction as we continue to prioritize investments that support the growth of our insurance initiative.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

We remain focused on balancing top line growth with bottom line discipline. While we will not pursue inefficient customer acquisition, we are committed to maintaining strong traffic to better health in preparation for the broader insurance rollout. For the third quarter, we are guiding to better health segment revenue down 5% to 9.75% year over year and an adjusted EBITDA margin of 1% to 3.75%, reflecting the early investment phase of scaling our insurance initiatives. Lastly, our balance sheet remains strong. We retired $551,000,000 in convertible senior notes that came due in the second quarter with cash on hand.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

The $1,000,000,000 convertible note maturing in June 2027 is our only remaining debt outstanding. We remain comfortable with our leverage as net debt to trailing adjusted EBITDA stood at 1.1 times at quarter end. We continue to believe our strong cash balance, cash flow generation and business position provides us with optionality in the future. Separately, in mid July, we entered into a new $300,000,000 revolving credit facility, which enhances our financial and operational flexibility. At the current time, there is nothing drawn on the facility, and we have no immediate plans to use it.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Our capital allocation priorities remain unchanged. First, we look to maintain a strong balance sheet and an appropriate net leverage profile. Second, we will invest in the business to support our strategy through both organic and inorganic initiatives. And third, we will evaluate share repurchases as a potential use of cash. With that, let me turn the call back to Chuck.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Thanks, Mala. We continue to believe that virtual care could be a performance multiplier within the health care ecosystem, helping to address key challenges and that Teladoc Health is well positioned to play a key role in doing so. Just last week, we hosted our annual Teladoc Health Forum event in Nashville, which brought together healthcare thought leaders, virtual care advocates and innovators from across the globe to share their experiences, exchange perspectives, discuss strategies and offers insights into the further advancement of virtual care. And spending time with many of our clients and partners in attendance, I was encouraged with the level of interest in deepening our partnerships and further collaborating to help them achieve their goals now and into the future. With that, we'll open it up for your questions. Operator?

Operator

Of course. We will now begin the question and answer session. Our first question comes from the line of David Roman with Goldman Sachs. Your line is now open.

David Roman
David Roman
Managing Director at Goldman Sachs

Thank you. Good afternoon, everybody. Try a lot of moving parts here, so I'll try to make sure I'm limited here to one question. I guess, you've talked about over the past year, Chuck, the transition away from a subscription model to a pay per visit or pay per use model that does to some extent obfuscate the underlying performance of the business. And I know you went through a few metrics on the call, but maybe you could unpack a little bit, what's going on there and where we are in transition, either if you can give us a sense of is that a 2025 event, does that extend into 2026 and how you're thinking about measuring success in that initiative?

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yes. I appreciate the question. This transition has been going on for a few years now in earnest because post pandemic, obviously, with the broad adoption and maturity of the market, and that's continued. In 2025, we now are at a point where more than 50% of majority of our revenues in virtual care are coming from visit based arrangements versus subscription based. So there's more room to go there, probably, but we've we've sort of reached a place where it's majority.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

And it varies a little bit by product line. In mental health, we're now at about 70% that are visit based. So you'll start to see over time more of that underlying growth in visits, which is a good thing, and translate into revenue growth. But we still got a little bit of headwind from that subscription move.

David Roman
David Roman
Managing Director at Goldman Sachs

Great. Thank you very much.

Operator

Thank you for your question. Our next question comes from the line of Richard Close with Canaccord Genuity. Your line is now open.

Richard Close
Richard Close
Managing Director Digital & Tech-Enabled Health Equity Research at Canaccord Genuity Group

Yes. Thanks for the questions. Congratulations on the progress. Maybe on BetterHelp and Insurance. First, can you discuss how you see the margin difference between cash pay and insurance, I guess, longer term?

Richard Close
Richard Close
Managing Director Digital & Tech-Enabled Health Equity Research at Canaccord Genuity Group

And then second, your launch I think you said launching insurance in one state, a soft launch. How are you thinking about the rollout going forward? Is that just a state by state basis?

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So thank you, Richard, for the question. Look, on the margins for insurance, if you think about the legacy cash pay business in BetterHelp, we have always said that the gross margins for that business are, you know, in the range of overall Teladoc health margins. Right? It's always been around the high sixties, early seventies type of gross margin. Relative to that, you know, as we have thought about insurance, we recognize that it is going to be lower than that, those levels.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

You know, it's a little bit early for us to comment on exactly where it is going to reach equilibrium in the longer term. But, you know, there are enough public proxies out there that will tell you that it is a lot lower than those levels. Having said that, what we are, you know, what we are focused on is the fact that we have 4,000,000 plus consumers coming at the top of the funnel, if you will. So, you know, the advertising spend that we have, the scale of it attracts that scale of consumers seeking therapy. And we believe that offering the choice of insurance acceptance side by side with cash pay, which is what is live on our platform now in one state as we talked about, is going to allow for greater conversion than we have with just cash pay.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So that is the investment thesis we have that we will continue to make progress on as we scale this initiative. Chuck?

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yeah. And I'll talk a bit about the the rollout. So I guess, think of it this way, supply and demand. We know the demand out there. One, the unmet mental health need, adoption of the virtual modality, in terms of therapy and just the size and scale of BetterHelp.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So what we wanna do is make sure we are, you know, preserving that user experience, which BetterHelp is known for, as we turn this on. Obviously, the scale is is pretty massive. So the demand side will be there as we turn that on. The supply side, we also wanna make sure that we have the right level of therapists, credential in the network to meet the demand in the way that we that we want. Behind the scenes, we are continuing to build that network out beyond the single state so that as we ramp further, we'll be able to turn on multiple markets, over time.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So I wouldn't necessarily think about it state by state per se because we're gonna reach a point where we're gonna be able to activate multiple markets. But we do wanted to take it, methodical here at the start to make sure all the capabilities that we built in place are working. The good news is they worked quite well, and we're at a position now where we're behind the scenes building the supply side.

Operator

Thank you for your question, Richard. Our next question comes from the line of Lisa Gill with JPMorgan. Your line is now open.

Lisa Gill
Lisa Gill
Managing Director at JP Morgan

Thanks very much. Good afternoon. Chuck, I wanted to go back to where you ended the call today. You talked about virtual healthcare can be a performance multiplier to help address key challenges and the evolving healthcare landscape. Clearly, following managed care, we see that right now from a cost perspective.

Lisa Gill
Lisa Gill
Managing Director at JP Morgan

As a former managed care executive. What do you think are some of the biggest opportunities for Teladoc to help to really drive cost or bend the cost curve going forward? And maybe if you could just spend a minute sharing some of the takeaways from last week. And is it talking more to providers? Is it talking to employers?

Lisa Gill
Lisa Gill
Managing Director at JP Morgan

Is it talking to the managed care organizations? What do you see are some of the biggest opportunities?

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yeah. Thanks for the question. I think, you know, first of all, if you go back to where sort of virtual care took off, you know, was just like I said in my prepared remarks around access and convenience. And that's still an issue. You know, access to care, whether it's primary care, specialist care, it varies pretty significantly.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So I think access will continue to be a place where virtual care can can support the the ecosystem. I think we're the next sort of generation of that is is and the reality of this, you know, each individual, all of us are unique. We have our own health care, situation and needs and expectations, and health care is also local. And so I think over time, the reason why we've been investing in the technology we are and the approach we have is because we think we have an ability to partner with the local delivery systems more and more over time to advance our customers' strategy. So we have a number of things underway to do that.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

And I think then extending that longitudinal care capability to help complement the system sometimes will be on point for those services, and other times we'll be playing a complementary role. And I do think that's where it's gonna evolve over time. I think with the with respect to the forum, it was a great event. I mean, there was a lot of excitement. We shared a lot about the progress we're making.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

I would say uniformly, a lot of the things that you you study in health care are are live and well. They're very concerned about the affordability issues, cost increases, provider capacity shortages, and sort of the dynamics that are at play. Certainly, the health plan world, a lot of uncertainty with respect to some of the changes that are thunder underway. And I think there was a, I would say, a good level of interest in the strategic direction we're taking and how we're approaching this issue. So I think the level of partnership is going to be even deeper going forward, and I think we're going to build on it in the coming months.

Operator

Thank you for your question, Lisa. Our next question comes from the line of Jessica Tasson with Piper Sandler. Your line is now open.

Jessica Tassan
Jessica Tassan
VP & Senior Research Analyst at Piper Sandler Companies

Hi, guys. Thank you so much for the detail. I was hoping maybe you could talk about 2026 for your Chronic Care Solutions in particular. Where are we in the selling season for the Chronic Care Solutions? And then just could you describe any kind of competitive efforts that you've noticed so far, retreats maybe that are expected to impact retention, competitive takeaways and pricing next year? Thank you.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yes. I'll just make some general comments here. I think, first of all, a lot of the things that we've said in prior quarters are continue to be the case. We've got employer channel continues to, I would say, largely be in line with our expectations at this point in the year. We do have continued pressure on the health plan channel for all the reasons that that we've given.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

And I think we've had, you know, a good level of interest across all of our solutions, chronic care included. We've added some accounts including in, you know, health plans with respect to Medicare Advantage. We've Mala mentioned that the we added last year coming into this year in weight management. So there's there's there's good activity. There's good interest.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

I will say there's some pause and some hesitation in terms of big moves by some of the players as they sort through their strategies. Where we're focused really back to the product innovation point is how do we expand the level of services. And I think with this new cardiometabolic health program that we're we're rolling out, to meet a variety of needs. If you think about a patient, you know, we we sort of carve people up into these conditions. Well, it's a whole person.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

And so they're gonna move through the journey of maybe it's a weight issue, some other kinds of acuity that happens during the cycle of that person's life. And so this program really is trying to be there in a more holistic way for those people. And I think the the features and enhancements that we put in place will be attractive to to our customers. I think where we're headed, though, is really leveraging what is, I think, one of our greatest strengths, which is our clinical capabilities. You know, as a provider, we have primary care.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We have specialist care. We have care teams. And I think when you're dealing with people with, you know, hypertension and diabetes and obesity and those kinds of things, the ability to support them clinically, and if they're not on the right path, I think is where we can add value to the patient as well as to our client.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

You know, Jessica, what I would also add is, you know, it's not a surprise. The chronic care market is a highly competitive market. It is a fast moving, fast changing market. We know that. You know, we are absolutely already, you know, with a cardiometabolic product that we have that Chuck mentioned, adding to the clinical capabilities that Chuck mentioned.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

That certainly gives us confidence in growing momentum in the chronic care business over time. The other thing I would also say is if you think about our 802 plus million member base and what that represents in terms of cross selling opportunity. If you think about the scale of recruitables with chronic disease and need for chronic managed care management that we already have, That I would say is sort of the, in some ways, the demand side that we already have for us to be able to continue to grow and penetrate. We've talked about the fact that our penetration levels are still relatively low in the membership base we have. So if you combine the innovation that we are bringing in from the product side together with the scale of opportunity in terms of the the recruitables and the member base we have, Those are the assets that we are going to use combined with our engagement and enrollment capability, and we are investing in that as well.

Operator

Thank you for your question. Our next question comes from the line of Daniel Grosslight with Citi. Your line is now open.

Daniel Grosslight
Daniel Grosslight
Senior Research Analyst, Healthcare Technology at Citi

Thanks for taking the question. Mala, you mentioned that you expect a meaningful revenue contribution from Better Health Insurance coverage in 2026. I was hoping you could provide a bit more color on that and the cadence we should expect throughout next year. And similarly, if there's any significant investments you need to make to kind of scale that in '26 and the cadence of those investments? Yes.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So what I would say, Daniel, let me sort of start with your second question first because we need to invest to be able to scale the insurance revenues. So we already are making investments. Right? Remember, when we announced the Uplift acquisition back in April, we actually had taken down our adjusted EBITDA. And the reason we did that was because of the investments we needed to make.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Those investments are essentially in think of it in two ways. One is just scaling up the number of people we need, the talent we need to be able to run this this business within the Better Health segment. It's not an initiative any longer. It's a business. And the second is absolutely scaling up the operational capabilities, the back end capabilities, billing, coding, all of that.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So those are the kinds of investments we are making. We've already started on making those investments, and we are going to make investments in the back half of this year between q three and q four. And I expect people continue to do more of it at probably a more modest level into the first half of next year. In terms of your second question on how this will pace, I would say, well, look, we have said from the outset back in April, we expect the revenue for insurance to scale and fully ramp up over the six to twelve month period. Right?

Mala Murthy
Mala Murthy
CFO at Teladoc Health

We have told you this year, we expect insurance to be about 10,000,000 in revenue. I think we need to see how this paces through this year, Daniel, and get more proof points. As we said, we are soft. We have launched in one state. Early signs of progress are good.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

You know, we are hitting and checking off on all the metrics that we expect to see at about this point, but we need to see more proof points. And what I would say is expect us to give a progress update in October and in February. You know, every time we talk to you on earnings calls, we will give you all progress updates on how things are going and how the scaling is going to take in through 2026.

Operator

Thank you for your question, Daniel. Our next question comes from the line of Jalinder Singh with Pearles. Your line is now open.

Jailendra Singh
Jailendra Singh
Managing Director at Truist Securities

Thank you and thanks for taking my questions. Chuck, I appreciate you spending some time on recapping the progress the company has made and all the initiatives you have put in place and actions you've taken over the past one year. But where we stand now, do you believe that you have all the pieces in place to get the company back on revenue and EBITDA growth and potentially accelerate in the coming years? And I completely understand all the integration and business financial still ahead of us. But just curious about your view, if you still think there's some work needed for organic and inorganic product expansion or any any restructuring?

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yeah. I appreciate the question. I'm not sure I would say we're ever gonna be done, in a in a, you know, highly competitive dynamic complex market, particularly in The US, in terms of advancing the vision of strategy. So I wouldn't wanna set that expectation. I think we've made considerable progress, you know, from the technology we put in place.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We now have the ability to surface information across each one of our care, engagement, whether it's Catapult, our Genmed visits, our coaches, our mental health, providers. We can action and surface information there that for the next best action. So there's a lot of things that I think we put in place. Clinically, we come from a strong position with all the the history the company has. However, there's additional capabilities we're gonna put in place to be able to, you know, continue to develop new intervention models for these individuals with chronic conditions.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So I think you're gonna see us continue to invest organically as well as if we think there are places that could accelerate our progress. We're gonna look for those opportunities just like we did with Catapult. That was a really nice strategic complementary acquisition. It's resonating with with our clients. They understand why we did it.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

One, because of their, own capabilities, which is, you know, quite effective. But the opportunity to use that as another point of engagement for people that aren't engaged in their health care and to get them, aware of their health care conditions, and and get them plugged into whether it's a Teladoc services or or get them a care plan. So I think there are going to be continued investments that we're gonna make to be able to have a sustainable growth path in The US, and attack some of those bigger challenges that the health care system has. We're well positioned to do it, but we aren't, finished yet. I think the other thing I would say, and I'll I'll enter this, with BetterHelp, you know, as as we've seen from the last many number of quarters, that's been a business that's been very challenging on the consumer front with notwithstanding all of its strengths.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So making a move like Uplift and being able to demonstrate progress on insurance, we do believe that that transition over time is going to position BetterHelp to return to its growth trajectory. So I think both integrated care and BetterHelp, we've made some really good progress, and I think we're gonna build on it.

Operator

Thank you for your question. Our next question comes from the line of Elizabeth Anderson with Evercore. Your line is now open.

Elizabeth Anderson
Elizabeth Anderson
Senior MD at Evercore

Hi, guys. Good afternoon. Thanks so much for the question. What are the highlights of the quarter, it looks like, which is for me, at least, is like the strong international growth as part of the broader strategy. Can you talk about given that you have a variety of opportunities across your portfolio as you've highlighted the BetterHelp, etcetera, how do you think about that?

Elizabeth Anderson
Elizabeth Anderson
Senior MD at Evercore

Is there any sort of change in terms of the emphasis you're putting on that business given the lower acquisition costs that, Molly, you mentioned? Or do you see that as sort of continuing along the path that you sort of previously described for us?

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Thanks. Yeah. So when we think about our international business, we need to think about it both on the integrated care side as well as on the better health side.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So on the integrated care side, Elizabeth, what I see this business performing at is very reliably, you know, in the mid teens, including this quarter. It was in the mid teens on a constant currency basis, actually higher high teens on a reported basis because of foreign exchange tailwinds. And, you know, this is a business that is looking at and working with clients around the world, you know, Canada, UK, Europe, Australia. You know, those are the countries that we have a strong b to b international business presence in. We have clients who have been with us for a long time, for many years, and we have a robust relationship with them.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

And then the last thing I'd point out is what Chuck said in his prepared remarks. We are making real progress in working with the public health systems in Canada. We are expanding province by province, for example, in Canada. They were part of our client event last week. And, you know, we talked they talked about how pleased they are with the partnership with us and let's say Newfoundland as an example.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

New Labrador is another province where we have expanded. So that's sort of the work we are doing on the integrated care side. On the Better Health side, the way I would think about international is so there are two sub parts to it. The first is we have now been in what I would call English speaking countries internationally for a few years in Better Health. So think about those as The UK, Canada.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

What we are now doing starting really this year is expanding into other countries with a localized platform and product experience. You know, this is this is still, I would say, relatively new, and we are seeing good signs of progress. One of which is you we've said in our prepared remarks, the growth in users in the quarter was high single digit. So I say this because this is we will continue to build on this localization initiative we have in international for better health. I expect us to roll out into additional countries.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

We are also learning candidly from launching these localized experiences. You know, it does require us to think about the experience with consumers, the therapists, etcetera. So it's we are taking learnings as we have launched in these countries and building it into the next wave, if you will, of countries that we are planning to launch into.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

One more point on the integrated care part of international, and I appreciate you raising that. It's, I think, an often underappreciated part of Teladoc. We have an amazing team. They are structured to really understand the unique local market needs and opportunities, and they are very creative at coming up with solutions that make sense for that market. An example is that that I think is really, really a great proof point.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

We they're using our hospital and health system technology, our devices. If you go to our website, you can see the pictures of those devices. They're using those in creative ways with those public health systems. And I was very gratified when they, take those devices, and they are helping keep keep emergency departments open in rural communities. We're talking about life and death stuff, keeping access available to to populations in remote areas.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So we're very proud of the work that's happening internationally, and there's a lot of learnings that we're, you know, looking to import, to to The US and vice versa over time, and I think it's an important part of the company.

Operator

Thank you for your question. Our next question comes from the line of Sarah James with Cantor. Your line is now open.

Sarah James
Sarah James
MD and Equity Analyst - Healthcare Services & HCIT at Cantor Fitzgerald

Thank you. You said earlier that you expected BetterHelp to exit the year flat with the prior year. Can you talk a little bit more about what changed relative to your prior expectations and will BetterHelp return to growth mode in 2026?

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Yeah. I think it's a it's a really good question, Sarah.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

And let me sort of give you a little bit of a longer answer on that to set the overall context. So as we have always said, when we talk about BetterHelp, especially, our guidance our revenue guidance range incorporates a range of expectations. Right? It's based on many factors, our ability to drive user growth, looking at what the macro backdrop looks like, the consumer sentiment. We had talked in the April earnings call about softening potentially softening consumer sentiment, customer acquisition cost, churn rates, etcetera.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

In the second quarter, we did see incremental pressure in our US cash business from, lower retention, so higher churn and fewer gross user ads additions. Okay? And that is what led to the lower user count that we reported, about 9,000 lower sequentially. And, you know, if you if we as we've analyzed what's contributed to that, we believe that these this is actually being driven by more consumers using insurance for their mental health needs, for mental health therapy, and an increase in advertising by other virtual mental health companies that offer insurance coverage. So we now assume that these trends are going to remain consistent for the balance of the year, and, you know, that is what is incorporated in the guidance range that we have now provided.

Mala Murthy
Mala Murthy
CFO at Teladoc Health

So as such, you know, we've revised our outlook, which we've obviously now talked about. We have narrowed it and brought, the sort of midpoint down, if you will. And it now assumes year over year revenue growth towards the lower end of our previous guidance revenue guidance. And if you think about what that also means based on the third quarter guidance and the updated 2025 guidance, what it means that is that the implied high end of the fourth quarter guidance range does not contemplate a return to flat year over year growth in the fourth quarter. Okay?

Mala Murthy
Mala Murthy
CFO at Teladoc Health

Just to be sort of spelling it out very clearly. Now adding to that is the fact that we have insurance where we are seeing encouraging early signs, but we have talked about the fact that it needs time to scale. We continue to expect 10,000,000 of insurance revenue this year as we have talked about, and we are pleased with, you know, the scaling of that overall initiative. So all of this put together, what I would say is as I think about next year, you know, we need to see how these different things pan out, how insurance scales in 2026, and provides the necessary offset for, the cash pay business, especially in The US. That's a little bit of a longer, view of how we are seeing the puts and takes in the Better Health business.

Operator

Thank you for your question. Our next question comes from the line of Charles Rhyee, Cowen. Your line is now open.

Charles Rhyee
Charles Rhyee
Managing Director at TD Cowen

Thanks for taking the question. Chuck, maybe I want to ask Lisa's question, maybe a little bit in the reverse. Obviously, during COVID, the use of virtual care skyrocketed in part because that was the only options. We also recognized the great demand for behavioral health services as well and better help fill an important need during that period of time. Since then, we've seen the use of virtual care drop fairly dramatically.

Charles Rhyee
Charles Rhyee
Managing Director at TD Cowen

You mentioned obviously, you talked about sort of the opportunities of where virtual care can be used. I know it's another question. Think you talked about sort of penetration rates remain relatively low. I think Chuck you also talked about healthcare being very local and it's very individual for people as well. What are the big challenges that you see in I guess the question really is what has been really the limiting factor then in getting sort of that penetration up?

Charles Rhyee
Charles Rhyee
Managing Director at TD Cowen

Is it really at the provider level and changing how they deliver care? And is that maybe more of a systemic thing and just how the workflows are designed? Or is it at the payer level where how benefits are designed and sort of set up? Or is it really just a consumer level of just people wanting to be in person with someone? Just trying to understand that you can tell us innovation and I guess the question really is more what's in your control versus what is it more that you have to wait for the market to come around to some extent? Thanks.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Yes. Appreciate the question. So a couple of things. I think you're gonna see over time continued recognition that there's not enough primary care in United States. And I think virtual there's there's at least a a more openness to virtual primary care, and I think that you'll see you'll see that continue on.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Think I the bigger part of your question though is, and this is kinda how how we're thinking about it. If you recall back when I joined, I I started highlighting this. You know, we have millions and millions of engagement points each year, with the various visits that we do. Those those were previously seen as visits. I see them as engagement points.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

So that's why we put this technology in place that allows us to start activating different strategies to create value for clients in that way. So maybe it's that same visit, but I can also address care gap closure. Maybe I can also help that individual, get get, navigate them to the next, best action. Maybe I can resolve things more holistically than I do today with respect to bringing, specialists, to the table and and provider provider consult. So there are ways that we can make this engagement points more impactful, more valuable to clients.

Charles Divita
Charles Divita
CEO & Director at Teladoc Health

Quickly. And I think the virtual care system, up until now has been set up to do. It's been very transactional in many ways. And I think trying to create a little bit more of a longitudinal opportunity is really where we're gonna, be able to drive more, volume and more impact.

Operator

Thank you for your question. That will close our question and answer session for today. That concludes today's call. Thank you for your participation and enjoy the rest of your day.

Executives
    • Michael Minchak
      Michael Minchak
      VP - IR
    • Charles Divita
      Charles Divita
      CEO & Director
    • Mala Murthy
      Mala Murthy
      CFO
Analysts
    • David Roman
      Managing Director at Goldman Sachs
    • Richard Close
      Managing Director Digital & Tech-Enabled Health Equity Research at Canaccord Genuity Group
    • Lisa Gill
      Managing Director at JP Morgan
    • Jessica Tassan
      VP & Senior Research Analyst at Piper Sandler Companies
    • Daniel Grosslight
      Senior Research Analyst, Healthcare Technology at Citi
    • Jailendra Singh
      Managing Director at Truist Securities
    • Elizabeth Anderson
      Senior MD at Evercore
    • Sarah James
      MD and Equity Analyst - Healthcare Services & HCIT at Cantor Fitzgerald
    • Charles Rhyee
      Managing Director at TD Cowen
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