All right. Good morning, everyone. Thank you for joining Teladoc Health's 2021 Investor Day. I'm Patrick Feeley, Head of Investor Relations. It's really great to be back with all of you again. It's been a little while. Before we begin, I wanna remind everyone that this presentation may contain forward-looking statements, so the safe harbor and risk factors apply. Please refer to the latest SEC filings, including our 10-Ks and 10-Qs for more information. We have a great program for you today. You're gonna hear from leaders across the business who will provide insight into our approach to whole person care, walk you through our multiple levers for growth. Today's presenters in the agenda in the back of the presentation deck, both of which you can find posted on the website.
The morning session will wrap up just before noon with the first Q&A session, at which point we'll take a short break so you can grab lunch. We will then come back for the final sessions of the day, followed by a Q&A with all of today's presenters. We expect to be wrapped up around 1:30 P.M. With that, I'm very pleased to turn it over to our CEO, Jason Gorevic.
Thank you, Patrick. Welcome, everyone. Thanks for being here. We appreciate those of you who are here in person. It's nice to see you again. For those of you who are tuning in on the web, we appreciate you taking the time. I feel like there's some bizarre, like, you know, Rumpelstiltskin event where we were here 20 months ago in this very room and somehow blacked out and had a crazy dream about the world turning upside down. Now here we are back in the very same room. Unfortunately, I don't think that's actually true, and we're gonna talk a little bit about the impact of the last 20 months. What I will say, though, is that I have never been so confident about the future of Teladoc Health.
What I hope to do over the course of the next three and a half hours is demonstrate the reason for that confidence and share with you a little bit about where we're going. Before I do that, I wanna start in a way that we start all of our town hall meetings. When we do global town halls with our 5,000+ employees, virtually now all around the world, we always start with why we do what we do. We always start with a member story that helps to bring it to life for us. I wanna do that myself for all of you. Rather than hearing from me at the outset, we're gonna hear from Jamie Sun.
I learned about Teladoc through my employer-sponsored healthcare. I've used it when my children were sick, and I didn't want to expose them at an urgent care, and I didn't want to wait for three hours. I was called within minutes. I have some services that are close to us in our tiny town in Kentucky, but a lot of the specialty practices are an hour away. I mean, any time that I've used Teladoc, it's just been wonderful. Through my employer health insurance, I learned about Livongo. I was actually driving to Alabama a couple weeks ago, and I had started to feel a little funny. So I pulled off, and I checked my blood sugar, and my blood sugar was 46 while I was alone with my three-year-old.
Within probably 2.2 s, a Livongo coach immediately texted and called me to make sure that I was okay, and he guided me to go to the vending machine to ask for help when at that moment I just couldn't focus to put one foot in front of the other. Now that Teladoc and Livongo are together, I feel like that with the data from my Livongo meter, I could just do my visits with my endocrinologist. Through Teladoc, they can see my A1C. They can see my trends. They could probably help me with my insulin pump and to adjust my basal and bolus rates. I am really interested in the mental health therapy through Teladoc. Also, I like some of the nutrition counseling.
I'm a fairly new diabetic, only about three or four years, so the counting the carbs and other nutritional guidance and coaching that would be really helpful to me.
Hopefully you can see why we start all of our town hall meetings with a member story. We always find them inspirational and galvanizing and remind us why we do what we do. What you hear from Jamie Sun there is about how the breadth of Teladoc Health solutions can impact a consumer in a way that more narrow solutions just can't. Hopefully you can get a view into how the breadth of our solutions and our ability to bring those solutions to life for the consumer can also fuel our growth. Because as we bring more solutions to bear for the consumer, they achieve more value from it. We are able to capture a larger share of the healthcare dollar. I wanna start with a little rundown as we usually do of the investment highlights. Hopefully these aren't new to you.
What I also hope is that you'll sort of walk away at the end having said we've proven these. We have true industry leadership. There is no question that we are the leading brand operating at unmatched scale. The breadth and depth of our digital and professional assets are truly unmatched. It's a complex ecosystem, and we deliver a seamless experience. Our data-driven approach to care delivery, and it really fuels our stepped care model. That stepped care model that takes advantage of digital assets and human capabilities and professional intervention in a way that you just saw brought to life with Jamie Sun's story. Our integrated strategy and suite of solutions really delivers on the promise of whole-person virtual care, and we'll spend a lot more time diving into what we mean by that over the course of the day. Our distribution channels are diverse.
We're a leader in every one of our distribution channels, ranging from direct to consumer to B2B and all of the parts of the healthcare system. We believe that's a true competitive advantage. Lastly, as we've proven over the last six years as a public company, we have a strong financial model with high visibility, high recurring revenue, and that has enabled us to meet or exceed our guidance on revenue 25 out of 26 quarters as a public company. The video we shared a minute ago really helps to ground us in our mission. We're a very mission-driven team. If you talk to any of the members of our leadership team, they will tell you that the reason they're here is because of our mission. The mission really hasn't changed over the course of our.
I've been here now twelve and a half years or something like that, which makes me just feel old. But our mission really hasn't changed. It's been pretty similar, and we've always said our goal, our mission for being is to empower all people everywhere to live their healthiest lives by transforming the healthcare experience. That's a powerful mission. It's big, right? There's no question it's a bold mission. As we've gone through our iterations as a company, and we've evolved through the evolving healthcare landscape and our set of capabilities, we've expanded the vision to be able to achieve that mission. Right. Today we are absolutely, without doubt, the global leader in whole-person virtual care.
We rely on technology to connect and human expertise as well as machine learning to be able to provide a brand and an experience that consumers trust and that improves the health of all of the people who have access to our services. How does that manifest itself? Well, there are data points that I can point to, and these start to articulate the scale at which we operate. The size and scale you'll hear a lot about, but that's only part of the story. I think the data points here, like, you know, we will deliver or enable 18 million virtual visits this year. That really lends itself to significant scale and almost a ubiquitous presence.
I was talking to one of the analysts, and I'll spare him the embarrassment, who said, "Oh, yeah, I was in the hospital with my seven-year-old son, and I saw one of your devices sitting there." Right. The ubiquitous presence of Teladoc Health now in the healthcare system and in every part of the healthcare ecosystem is really kinda humbling and mind-blowing for me, given where we started 12 and a half years ago. I think that's only part of the story. Right. The fact that we now sit on a treasure trove of 2 billion data points that we can mine to deliver better care and a better experience starts to bring it to life in terms of the impact that we have on consumers and their healthcare.
What I'm really proud about are things like our net promoter scores and the J.D. Power recognition, because that's consumers saying that we are the best at what we do. Yet we always say, and our 5,000 people always say, "It's still not good enough. There's more that we can do. We're just scratching the surface." I talked a little bit about the Rumpelstiltskin moment, and I unfortunately have to acknowledge that it was real, not a dream. But it would probably be not fair to go through too much of the presentation without acknowledging the impact of COVID-19 on our business and on the role of virtual care in the healthcare system.
You can see some of the changes in the data and the dynamics in the market laid out here. You've probably also heard me say that really even in just this first six months of the pandemic, the market for virtual care and the role of virtual care accelerated three to five years. I think we're probably on the upper end of that, 20 months into this. What I can say is not only are people accepting it more and using it more, but equally important, their expectations, both among consumers, among plan sponsors, among providers, the expectation for the role of virtual care and the possibility has also changed along with that.
People are now expecting the same seamless, integrated, holistic experience that they get with all other parts of their lives delivered in a digital fashion on their terms, bringing the best capabilities of data, digital assets, and human expertise all brought together. Right, as you look at this, I joke with my team, they keep asking me to retire this slide, and I won't do it. If you look back to the origin of 2015, and of course, we were here a long time before our IPO, you can see how we've been building out capabilities, market presence, breadth of service, breadth of clinical impact consistently with the goal of delivering whole person healthcare and delivering on what now is a market expectation. Now, I consider ourselves fortunate to have been on this path for many, many years, because you can't build this overnight.
It's really complicated. You're gonna hear about how complicated it is to deliver on this and all of the assets and capabilities it takes in order to achieve this goal. We've been at it for a long time, and we took some big steps, fairly bold steps, I will admit, over the course of 2020 when everybody was shuttered at home, we saw where we thought the market was shifting, and we took some big steps, and we're starting now to see the real benefits of that. All right, I have a complicated model here that I'm gonna try to bring to life in a story. I've become. You know, when I took this job 12 and a half years ago, I got a lot of condolence emails like, "I'm sorry. I thought things were going well.
If it doesn't work out, let me know. Now I get to talk to a lot of CEOs across the healthcare industry about virtual care and where it's going. I got a call from a CEO of a large health system, a large academic medical center that also owns primary care practices, has a health plan, and a very, very impressive tertiary care facility.
The CEO said to me. I figured that the CEO was calling me to say, "Hey, we're interested in your hospital solutions, the platform to virtualize care so that we can deliver care virtually to our patients." What ended up happening was a discussion that said, "We want you to bring your whole senior team in to talk to us about how we can stand up virtual primary care, and maybe we want you to be our virtual primary care front door to our health system. We wanna talk to you about how we can bring chronic care solutions to our health plan members so that we can better manage risk in our chronically ill patient population.
We're struggling with mental healthcare capacity, so we'd like you to bring in your digital assets so that we can stand up a stepped care model like you've talked about, such that we can bring digital mental health solutions along with our professional capacity. We're interested in trying to expand the scope and reach of our specialty network, and we'd like to help you by bringing our incredibly advanced specialists to bear on a virtual basis for your populations, Jason. Oh, by the way, we'd also like to talk about that health system platform that you talk about so that we can virtualize care across our system. First of all, that conversation would never have happened 21 months ago, right?
Nobody was thinking about the vast, expansive role of virtual care in the healthcare system, the way that conversation shook out. The second thing is nobody else in the market can actually have that conversation, right? If you look at the various dimensions of this model, we're delivering on the evolution of our products, our technology, our business model, and on the right side of this, really importantly, we've moved from being a vendor to being a strategic partner, whether you're talking about a hospital system, a health plan, a large employer, domestically, internationally, and that puts us alone in the market. Right?
What everyone else is stuck here in the lower left with relatively narrow point solutions trying to solve a single problem, while based on that previous slide, we've spent the last several years, let's call it six or so, moving up and to the right. Right? Doing it right, much less moving it up and to the right is really hard. Right? It takes an incredibly deep set of leading capabilities to be able to do that. It's not a foregone conclusion. If you're starting now to try to build that, no matter how much funding you get as an early start-up company, it's really, really hard to do that and move all the way up that curve. Because look, a small company has to be super focused and focused on one thing at a time.
Our approach has been setting us up for whole person virtual care for years. Let's dig deeper into what we mean by whole person virtual care. Our North Star is that someone comes to us regardless of what their healthcare need is, and we provide for them a front door that understands that there's a connection between all the dimensions of their healthcare. Right. You have a lot of different individual needs here on this slide, but they're actually all connected, right? Someone's blood pressure and their weight and their mental state are all deeply intertwined. Treating only one of those is insufficient at best and really could be detrimental at worst.
We believe deeply that treating the whole person from their mental health care to their physical health care, from their acute episodic needs to their chronic needs, and being there for their complex needs, and also integrating with the physical delivery system where necessary, is the full credit answer. Anything short of that actually doesn't enable you to get up and to the right of that sort of strategic box. Now, it means that we have to rely on data science, and we have to rely on a stepped care model to do that at scale, right? We talked about some of the scale that we've achieved, but we have much greater ambitions. In order to do that efficiently, you have to rely deeply on technology to do that.
Over the next couple of hours, you're gonna hear from a bunch of my colleagues. You're gonna hear about how we make whole person care a reality. For a consumer, there are multiple on-ramps into that system, right? That whole person virtual care system. These are meant to illustrate that there are different on-ramps that someone could take because they're presenting with a different first initial need. What we find is that people who visit us first for a mental healthcare need are much more likely to have a general medical visit because they've already established trust and a relationship and a digital interface, and we're helping them on one dimension, so they want to turn to us for a different dimension. We can connect the dots, right?
That the physician who's treating them for a physical illness knows that they may be suffering from anxiety or depression or they're going through grief counseling, and that could have something to do with exacerbating their physical illness. What you see here is a number of on-ramps into whole person virtual care. You're gonna hear from some of my colleagues. Donna, for example, is gonna talk about the digital front door or the homepage of how you get into whole person care and what the consumer experience is. Our job, and Donna's job in particular, but also our whole clinical team who delivers the care, is to make it seamless and easy and intuitive, right? That's what whole person virtual care has to be. It has to be easy to walk through that front door and then be navigated to the right solution.
Well, Claus gets the enviable task of explaining all the stuff that has to happen behind the scenes in order to bring that to life, 'cause it's hard to make healthcare seamless and easy and intuitive. Every point along this continuum has to be a leading capability, a core capability in order to deliver a seamless consumer experience and really deliver best-in-class whole person care. You'll hear about various parts of this. People ask me all the time, and they've asked me since I got to the company and was raising my first round of venture capital, "What's your secret sauce?" Right?
What's your moat?" I've said, "Look, there are low barriers to entry and high barriers to scale and success, and it is a complex system of leading capabilities that creates a true moat in what we do." Every one of these points has to be a leading capability in order to really take advantage of the opportunity in front of us. I believe very strongly that our capabilities on every one of these dimensions leads the market. That results in what I would argue is an unmatched competitive advantage and one that, and a moat that is virtually impossible for an upstart to cross, right? Sets us up for the future of virtual care, not the past of virtual care. For a broad set of whole person care solutions, not a point solution.
If our competitive advantage sets us up for a leading place in the marketplace, then how do we build the blocks to give a growth outlook, right? To give the building blocks for where the growth is gonna come from. I wanna transition from what has been, I would say, a strategic overview to more of a view into, okay, where's the growth gonna come from, and how are we gonna deliver on it? You're gonna hear from some of our colleagues, Kelly, Alon, Dan, about the products, the go-to-market strategies, and our approach to how we get there. You're gonna hear from Stephany talk about how we engage consumers to build long-lasting relationships. All right, let's start with the overall market. My favorite subject, the TAM.
Okay, I would start by saying, look, we are just scratching the surface, right? We can add new members through new clients, as well as by increasing the population within our existing clients who have access to our services. We would say the full entirety of the sort of people who have access to our products and services is about 92 million people. Well, there's another 63 million people products. What does that really mean? Well, for CCM, chronic care, we've looked at prevalence data. What's the real opportunity within the 92 million for us to penetrate that population with our chronic care? What can we capture in terms of total membership with our chronic care solutions based on prevalence data? That ends up being about 47 million people.
Primary360, for example, we've tried to exclude the population who has strong primary care relationships, saying, "Look, we may get some of those people, but let's not put that in the sort of primary market, who is likely to opt in for our services for Primary360." Then at the bottom here, we've tried to give you a range of, revenue per member about what that could contribute to our overall revenue. Then at the very bottom of the slide, we've laid out, well, what does that mean in the aggregate on a revenue per member basis and then on a total revenue basis?
What you see is a sort of upper range of $68-$123 of revenue per member spread across our entire 92 million people, which translates to somewhere between $75 billion and $137 billion without adding another new member. We've gotten a lot of questions because Mala and I have been speaking a lot over the course of the last year about the expansion of our revenue per member. Mala's gonna translate that to, well, what kind of a contribution do we get for every chunk of additional population we add on each one of these products? And the question we've frequently gotten is, well, how big could it be, right? What is the opportunity? Hopefully we've laid out at least a framework for how to think about this.
That translates to, like I said, multiple levers for long-term growth. While we think about whole person virtual care, we understand that you need to get a little bit more granular in order to be able to model that. What are the components of growth? We've broken it down into virtual medical care, which includes some of our enabling technologies that enable the delivery of care for hospitals and health systems, as well as Primary360, our General Medical, dermatology, nutrition, like all of those things bundled in. Our mental healthcare, both on the B2B and direct-to-consumer side put together, 'cause we think of mental healthcare sort of, horizontally, if you will, and then our chronic care solutions. We've given you a range of a growth outlook for the next three years.
Now, some of those we think will be kinda stable-ish growth over time. With the introduction of Primary360, for example, I think that's gonna be an accelerating growth in our virtual medical care over the next several years as that takes hold and has a bigger contribution. But all of that translates to our outlook for the next three years of a 25%-30% CAGR over the next three years. If you translate that from what we've said is an outlook of about $2.6 billion in revenue next year, that yields a 2024 revenue target of over $4 billion in revenue.
Over the course of the day, what I hope to convey, and I hope our team will convey, is that we have the opportunity to transform how consumers experience healthcare, and that brings along with it a significant financial opportunity. We have the vision to fully address this opportunity like no one else in the market. We have the whole person strategy to bring the vision to life, and we have the core capabilities to deliver on that strategy. Each of our leaders today will work to prove these elements, and what I'd like to say and challenge you is, if we fail to really prove the points on any of these dimensions, please challenge us, right? We have two Q&A sessions, and we wanna hear if we're falling short because we wanna be able to address any gaps that are left sort of unproven.
We want you to walk away with the same level of confidence that we have about our growth outlook. To get us started on the rest of the day, since I know you wanna hear more from the rest of the team than you do from me, I'm happy to introduce Kelly Bliss, our President of U.S. Group Health, who's gonna walk you through some of our commercial opportunities and how we deliver on some of those growth opportunities. Kelly.
Thank you, Jason. Appreciate it. All right. Thank you so much. Good morning, everyone. As Jason had said, my name is Kelly Bliss. I'm the President of our U.S. Group Health business. I'm gonna be speaking today around about our commercial strategy. We'll talk about what's happening in the marketplace, and we're actually gonna hear from some of our clients. Let me just start by reorienting everyone around our commercial construct. As most of you know, today in the U.S., we primarily sell into health plans, the government, employers of all sizes, and into health systems. Globally, our clients and partners span U.S. employer, financial services firms, and governments of countries with nationalized healthcare systems. We have the leading D2C mental health solution in the country, which you'll hear from that capture share across the global health ecosystem, creating diversified revenue streams.
Now, let's talk a little bit about what's happening in virtual health today. As Jason spoke to, virtual care today, formerly known as telehealth, had origins in adjacent or supplementary or ancillary benefits programs. Largely, progressive employers and plans would augment and layer in additional conveniences and savings for their populations. Times have really changed. As consumer expectations on the experience increase, our clients are seeing the need to think really differently about virtual care, and they're demanding broader, more seamless, more coordinated virtual care solutions powered by data and our expertise, and they want scale on a national and a global scale, which of course we've been building for many, many years now.
Virtual care is not only here to stay, but unlike the days of maybe narrow use cases, virtual care is spanning an array of services from primary care to chronic to mental health and many others. Our 2021 client survey revealed that the majority of clients believe that virtual care will have a significant impact on care delivery in the future. What's most important is 99% of our clients are interested in maintaining or increasing their levels of investment in virtual care, and I'm still working on that 1%. We're also pleased to learn that 80% of our clients see us as a strategic partner. With only 20% of those saying that their virtual care strategy is well established, we see tremendous opportunity to help shape our clients' offerings.
Our health system clients revealed that their emergency need to stand up solutions like Zoom during the peak of COVID-19 is not scalable and is severely gapped as it relates to their integrated provider tools and workflows. They're increasingly coming to us looking for our enterprise-grade healthcare platform to enable the delivery of their virtual care strategies. The net net, virtual care is permanent and it's growing. As I mentioned previously, only 20% of our clients believe that they have a well-defined virtual care strategy. Yet almost all of them believe that their investments in these capabilities need to remain or increase over time. That matters, yes, because of course, our clients appreciate our years of experience, our thinking and building and executing, and they feel that that does differentiate us.
More than a tailwind, our clients appreciate the fact that during what we might call a telehealth final exam, a pandemic where the majority of care was most appropriately delivered virtually, we not only showed up, but we delivered and we shined. Our clients expect us and asked us to come to the table and co-author their strategies for the future. As we enter 2021, we focus many of our commercial resources on engaging our clients in their effort to inventory, benchmark, and plan for the future. Clients and non-clients alike have reached out to us, asked us as the industry expert, what's next in virtual care? These forward-looking conversations continue today and have inspired our clients to capture the consumer and market momentum and to think bigger about what virtual care is to them.
To do this at scale, we're rolling out a peer-reviewed virtual care maturity model to engage our C-suite relationships and thinking about how to take healthcare, one of their largest financial spends, and make it more accessible, more scalable, equitable, and efficient in the future. This process has been quite swift. We have had clients across all of our unique markets at various stages within this maturity model trying to advance to the next stage quickly. Most clients, 80%, have self-identified at stage two or below, not having a well-defined virtual care strategy, but a desire to build one. Some of our clients are moving towards stage three in early stages of developing a comprehensive virtual healthcare strategy that is aligned with quality and cost outcomes. A few, largely the health plans and integrated health systems, are at stage four.
They're starting to think virtual as the entry point of the delivery mechanism for many types of healthcare needs, while also serving as the seamless connector to hybrid care. Building the engine and the platform for stage five is where our R&D team is currently focused, which Claus will speak a lot more to later. This is really our North Star vision of the healthcare delivery model. In stage five, healthcare interactions are personalized, pricing models are value aligned to drive outcomes, experiences are tailored and optimized for virtual first in the same way that e-commerce is today or fintech. While many of our competitors can deliver against one, stage one and stage two, perhaps even stage three, nobody else has the infrastructure, the commercial scale, and the proven track record to get to four and five.
This omni-channel strategy and meeting clients where they are, understanding their level of maturity, and helping them move forward and realize their virtual care goals is working. With over 2,200 related transactions this year, from bringing new clients on to new product penetration, to new lines of business, or adding new populations, our clients really value the scale and expertise and depth of innovation that we lead in this market. Said differently, the breadth and depth of category leadership across the digital health ecosystem uniquely positions Teladoc Health to meet our clients where they are in that journey, while building and leading them to a new version of virtual care. What are our clients saying? Most of the conversations that I have with CEOs and industry leaders of Fortune 500 employers, large health plans, and health systems fall into one of three categories.
First, clients migrating from point solutions towards more strategic partnerships who can serve their entire basket of virtual care needs. HCSC is a great example of an account where we've been serving them for many, many years, and early results of that partnership opened up many new commercial opportunities for growth on several dimensions. In this is a model we see repeating itself within our health plan book of business. You may have just seen that we just announced a virtual first health plan with Ambetter, Centene's Marketplace business. These are clients that really wanna think more broadly about their own investments in virtual care and what outcomes that can yield. Second, when the merger with Livongo was announced last summer, we spoke about our cross-sell opportunity, which had limited overlap. Just one year later, our cross-sell thesis is proving itself on multiple dimensions.
Tyson Foods and Blue Shield of North Carolina are just two examples of clients who quickly adopted the new integrated virtual care vision. I'm excited about the market leadership we're displaying around developing new clinical use cases. As health systems start to take on risk for new populations, they're looking for proven digital products that they can use to enable their physicians to keep track of those patients when they're not co-located 99% of the time. Baptist Jacksonville, a leading health facility in the system in Florida, is using our CCM tools as a remote patient monitoring solution. We've also just launched chronic and mental health products internationally, and we continue to do that over the course of the next 2022. Finally, we're expanding the frontier of what virtual care delivery can look like via market-defining partnerships with technology and consumer brands globally.
Our partnership with Microsoft enables providers to integrate Solo plus Teams to deliver care to their members. In an association with Telefónica and Vivo, we're providing virtual care directly to the consumers in several markets such as Brazil and Spain. I wanna double-click and illustrate what I mentioned earlier about having multiple levers of growth within a single account. You heard Jason mention this as well. Shown here is a health plan that we've had a relationship with since 2017. There are three main dimensions of opportunities for us to achieve deeper penetration with this plan. First, we can add lines of business, and in this example, we started with their commercial ASO lines of business.
Once we demonstrated positive client and member NPS and proven outcomes, we've been able to expand to their commercial fully insured business and their Medicare Advantage business. Second, we can see additional products within each lines of business. For example, here we started with our General Medical and Expert Medical Opinion products, and then we grew into mental health. We began offering the chronic condition management services via our diabetes management product. Finally, we've just launched Primary360 with them. These offerings are available in their consumer commercial ASO business, and we intend on that same trajectory to penetrate the rest of the lines of business. Third, enrollment and engagement mechanisms leveraging our market leading data science assets.
This is enabling us to perform personalized and targeted outreach to enable the consumers to best in class utilization, which is contributing greater revenue per member. Let's flip this view on its head a bit and look at one of our new products, Primary360, affectionately known as P360. Dan's gonna talk a lot more about all of our products today, and actually Donna's gonna dive into an actual demo of P360. I thought it was important that I would illustrate exactly how Primary360 models have been deployed in their respective markets. Health plan carriers want P360 available to their self-funded employers to further their distribution and differentiation.
In fully insured populations, Primary360 is about furthering access and enabling seamless handoffs to health plans contracted provider networks when required, and of course, fully insured to manage costs. For benefits consultants, our partnership is to enable an innovation and differentiation within a very noisy employer purchasing market. For our employer clients, virtual first primary care is about access, convenience, and staying competitive and innovative with benefit offerings to retain their employees and lower their cost of their healthcare spend. What's interesting is different clients wanna sign up for Primary360 in different ways. On one hand, some clients want a contract based on a PMPM across their entire book of business, their entire population, regardless of how many people enroll in the program.
For example, in a population of 100,000, we would be paid on the full 100,000, but that pricing of course would be reflective of an expected utilization rate in P360. On the other hand, some clients want a contract on a per participant basis, so we get paid on a PPPM, a per member per month basis, based on the number of individuals who elect to participate in P360, for example, our virtual first plan design. The point is, regardless of the model, today the economics are very similar. You're gonna hear a lot over the course of the day about how we believe that rather than point solutions, caring for the totality of the needs of the consumer via integrated whole person products is the wave of the future.
Nothing demonstrates this better than in taking a look at an employer client, a top 20 national retailer whom we have sold all of our products over the course of three years. We launched the partnership with them in 2019 via Livongo's diabetes solution. They very quickly saw the employee adoption rates were exceptional and demonstrated ROI, which led them to add on hypertension and diabetes prevention products. Post-merger, they were one of the first buyers of the entire telehealth suite, and we're thrilled to be taking them live on Primary360 effective 1/1. We're covering over 46,000 consumers with this one client, and we look forward to continued growth with them. What's important about the adoption of our products is that as our clients start to realize the value of whole person care, we realize an efficiency in revenue growth.
For similar level of sales motion in a same size population, given the prevalence of comorbid conditions across physical, chronic, and mental health, and higher price points for product packaging, we're able to realize 4x as much revenue. Notably, 40% of our pipeline is multi-product, and we expect that to grow. In addition to consumer and product capabilities, many C-suite executives are increasingly interested in value-aligned pricing in virtual care. As Jason had mentioned, we have a track record of skating to where the puck is, and this is no different. We've built a critical set of foundational capabilities to deliver scale on pricing models that align fees to outcomes that we realize for our members and for our clients. First, we have the largest breadth of integrated whole person products and services in the virtual care industry, and that we can align value to outcome.
Second, our diversified portfolio across 12,000+ clients, combined with our strong financial foundation, uniquely positions us to enter into outcome-focused contracts responsibly. Third, our clients are turning to us because of our track record of demonstrated results. It's table stakes in the health plan that you have to prove you can drive outcomes and lower cost and improve NPS. Finally, having the greatest depth of clinical outcomes, plus financial claims data, plus our deep data science analytics capabilities equals knowledge where our programs can be more effective. This allows us to focus on where we can have the biggest impact on any given population. All our capabilities and results at scale have positioned us to expand both market share and share of wallet as this market continues to shift towards value-based care.
Historically, we go to market two ways, both traditional fee for service and pay for performance. Today, we're also beginning to enter into partial capitation models in key markets for diabetes management and virtual primary care. We're able to do this because of our strong results in diabetes management, and we're leading the market evolution towards virtual primary care. As we demonstrate success in partial capitation and expand our suite of solutions across the care continuum, we're building capabilities to contract for full capitated and virtual primary care, chronic services, and mental health. Moving along this value-based care continuum enables us to unlock new channels, specifically commercial fully insured, Medicaid and Medicare Advantage. We'll be additionally able to grow membership numbers and drive more whole person solution in these markets, which is allowing us to increase revenue per member. Enough from me.
I'd like you to hear from a few of our clients and understand how they perceive the shift in the market and they perceive Teladoc.
The Aetna virtual primary care powered by Teladoc solution. It starts with the member selecting a physician using the criteria that matter to them. Once they do that and they make an appointment, their first appointment is a 30-45-minute wellness visit. That's to initiate that relationship with the physician that will persist. The solution centers around building that long-term relationship with a dedicated primary care provider who can continuously care for patients and do it in a personalized way.
At SAP, we've had a long-standing relationship with Teladoc. We've had partnership with them on the telemedicine side for years. One of the programs that we had the longest is on the diabetes side. What's been great is when people have engaged and they set goals for them for their health and their wellbeing, we see very, very high levels of follow-through. We saw folks that weren't able to manage their diabetes, that it was kind of out of control. To see that we have 70% of the population now managing their diabetes in a very effective way, I mean, that for us is just it really makes us, you know, feel like the program is having the effectiveness that we want it to have when we stood it up.
About four years ago, the Geisinger leadership team decided that they wanted to enhance the telehealth program. Our first marching order was to understand the barriers to adoption. What we found was that the equipment that they were using, the software, the platform they were using was too complicated. They had a different software for the telestroke program, a different tool for the outpatient telemedicine program, for the inpatient telemedicine program, and even for in-home patients. That's when we decided to transition to a unified platform, one that would allow us to see patients in all these modalities of care. Once we transitioned, we actually started to see a really nice increase.
We started to expand to ambulances, so paramedics would start using telemedicine when going into the patient's home, or community health assistants would use it when seeing some of our sickest patients. We started seeing telemedicine in our urgent cares. In fact, we started using it as a recruitment strategy for providers.
You are the one for us, and we think it's because of several factors. First, your portfolio of innovative health products and services, which is the best customer experience in virtual healthcare systems. It is very exciting to partner with a company that fully embrace innovation. Second, your position, and you are very aligned with us in terms of footprint, most in adoption for virtual health services in our key European and Latin markets, starting in Spain and now Brazil. In terms of segments, we contribute with local knowledge and capabilities to deliver to the residential customer, while Teladoc is strong in B2B and B2B2C. Then you are the leader in e-health, and we recognize and admire that.
Let me just wrap by saying, I want to really drive home why we win. You just heard from our clients. The executives you saw on the screen are not just purchasers for their populations, but they're also members too. Our commercial success and the commercial success that we have seen is because of our organizational competencies working in concert to support the needs of both our clients. Before I hand the mic over to Dan to get specific about product, living in this historic maturation of the global virtual health market spurred on by the pandemic, and it's remarkable to be a part of it. It's even more remarkable to be shaping it. Our mission has always been to improve access to high quality care and help people live their healthiest lives.
We ensure that happens by executing against well-defined plan that includes the things that you see listed here. Our ability to perform in value-based contract arrangements, our scale, our diversification of solutions, our broad omni-channel levers are all important to our clients and of course to our growth, which is just one way that we're really trying to drive change in virtual care. With that, I'm gonna hand it off to Dan. There you go.
Thank you, Kelly. I'm Dan Trencher. I lead strategy for Teladoc. I'm gonna dig much more deeply into our whole person strategy. Before I do, let me make two observations. First, my next few sections are sort of divided up. Don't think of virtual medical care and mental health care and chronic care as three separate things or three separate strategies, or even product families. Think of them as complementary components of our whole person strategy that all fit together, and I'll illustrate that as I go along. Second observation is that within the virtual medical care bucket, there's a wide range of services and experiences that are represented there.
General Medical, dermatology, our virtual primary care offering, which I'll spend a lot more time on, Expert Medical Opinion, even the platforms and products and services we sell into our hospital and health systems. Just examples. Today, I'm gonna focus more on Primary360 because it's new and because we see a great deal of opportunity into the future in growth there. Just don't forget the other pieces are there, and you'll see how they come through in the story. To focus first on the primary care market, I could have many, many slides that go through all the different ways that the current primary care market isn't performing for consumers and providers. You might call it broken. Let's say diplomatically, it's underperforming. The end result of that is that consumers are not engaging with primary care as they once did.
One out of four adults do not have a PCP, and four out of five adults say they don't have a strong relationship with a PCP. That creates challenges. In the end, it translates into an inefficient system. The stat there on the bottom estimates 20%-25% of savings if everyone had a strong primary care relationship. This is the problem we're trying to solve. Numerically, as we talked about the TAM, with the total primary care spending in the U.S. at about $250 billion. We then discounted that by two factors. One is what percentage of that care could be virtualized, and the second factor is taking off those people who, as Jason said, already have strong primary care relationship, that we're not trying to replace that.
If you reduce that down, that gets you to the $160 billion, which is in the middle. We also want to recognize, to be conservative, that we have had a, as part of our TAM, our general medical services, and we'd estimated that at $20 billion. To be fair, we want to make sure we don't double count, so we net that out. That gets you to the $140 billion that Jason talked about on his slide. Let's get into the product a little bit more itself. As we got started in this area, Jason threw down the gauntlet that the goal here is not to, you know, add virtual visits to the existing primary care experience, but to fully reimagine it.
That's what the team has been focused on doing. The heart of it is the integrated data that we have and the data science we apply to it in order to create a different experience and different outcomes. Data points from the programs themselves, from the devices, from claims, from information from health plans, from information from community providers as we bring that back in. That's all powerful, and you'll see how it comes through as we walk through the entire experience here. It does start, I'll start on the bottom left of the slide, having a unified whole person experience.
That, that's having not just one product behind the virtual front door, but our full range of products and experiences that cover the full clinical gamut, brings people in the first time and coming back for more as they go through. This is also a great example of how we're applying data. We bring into that front page, and Donna is gonna show it, what we call next best actions. Those are recommendations that are generated from all the different data and analysis that we're doing behind the scenes to prompt for a consumer what programs might be beneficial to them, reminders about their taking their meds or other sorts of things like that. Lots of very personalized in-the-moment recommendations that can help the consumer take full experience advantage of the experience. Second, a dedicated care team.
Certainly every consumer who joins and uses our virtual primary care offering, P360, will have a chosen, but you know, ongoing primary care physician that they'll work with. They'll also have a care team, so it's not just the physician, of nurses and other types of clinicians to support that relationship. Importantly, it's powered by technology, which makes all of those relationships more efficient, and it really amplifies what those humans can do in taking care of that patient. We've talked before about sort of a one-to-many model, and here's where we can increase the efficiency of primary care through the use of technology. One of the key, let's call it outputs of that team working with the patient, is a longitudinal care plan. This is not an episodic experience.
This is very much a longitudinal experience, and it's personalized for each individual, and it helps provide a guide as to how they can help themselves. They keep track of results, and certainly, the care team has access to that, so they can work on it together. That leads to the continuous guidance and support. This is a component that consumers are really latching on to. Having 24/7 access to their care team through messaging and other means really keeps them engaged. The next is around navigation and coordination. We know that there will be occasions certainly where a consumer could benefit from one of our other programs, so there might be a referral or coordination into that. Sometimes they're gonna need to have a service in the community, maybe for a specialty consult or you know, other sorts of therapies, for instance.
We're making personalized, high-quality referrals to those community physicians using, importantly, health plan data because we know we want those referrals to be in network. We want to take advantage of COEs or tiered networks or other sorts of components of health plans' design and network strategy, so we make the most efficient use for that consumer of that access. The last piece there is last mile. We got a slide on that specifically to click down. When we talk about last mile, we know we virtualized a very large part of the healthcare journey, but there are still parts at the end that, you know, you can't quite virtualize, right? When you get to needing a lab, when you talk about, you know, a prescription, unfortunately, I know people still.
You can have a great virtual experience, and then you still have to go to the pharmacy to pick up your drug, or you still need to go to a PSC center to get your lab draw taken. That's what we want to change and to make it as convenient as possible and cost-effective for that consumer. This just lists out some of the examples of the last mile services. We certainly see the home as the next frontier for where care is gonna take place as much as possible. It's about bringing as much of that as close to the consumer as possible. Sometimes that'll be a human, you know, like a phlebotomist who might come to the home.
Sometimes that'll be mail-based, so you can think of lab kits that could get sent in the mail to the consumer. They get the sample, it goes off to the lab, and the results come back in. There'll be multiple different modalities, but the real focus is on making it as convenient as possible. Certainly, this is an area we're going to build out through partnerships and through having a flexible platform, so that we'll be able to work with multiple different partners, different devices, you know, for vitals, and to both be flexible for the consumer and for our clients who want to have customized solutions. We've talked and used the term on-ramp, I think, a couple times today. This provides some data behind what we mean.
If you take a population of consumers who might engage with primary care, we looked, and you could see 80% of them, based on claims, could benefit from one of the services that we currently offer, right? Almost 60% for General Medical, 24% for nutrition, 30% for dermatology. As you go through that, you can see the power of this model, and you can also see it in a Primary360 environment where we do have a long-term relationship with that patient. It's perfectly set up for making these sorts of referrals, which of course translates into what we would call multi-product utilization financially, but really impactful for the consumer as well.
I was also here 20 months ago, and through that looking glass moment, looking back, and I was actually talking a little bit. We were just about starting our virtual primary care pilots. Here to talk a little bit about some of the results, and we're very pleased with how they've turned out. One of the value props is around access. We've seen that we've been able to connect a patient, let's call it new patient, with a PCP in under a week. If you look at the data, it's 30 days or more in most communities around the country. We've succeeded in pulling through and having consumers engage. More than half have engaged with another service. We're also finding and uncovering, let's call it, new diagnoses.
We're not just, you know, picking up things that the patient already knew about or already in the records. We're almost 25% or around 25% of diabetes and hypertension diagnoses were new. You can think of the power of catching those in the downstream care that we're gonna be able to provide. And of course, you know, it comes down to consumer satisfaction as well. That's what's gonna keep people coming back and utilizing the service, and we're over 95%. We're super excited about the results so far. Jason talked a little bit about the competition. I won't focus on it here too much other than to say, let's call it virtual primary care as an industry is a fairly immature, right?
It's new, and there are a lot of different types of companies calling what they do virtual primary care. There are lightweight text-based offerings. There are the traditional telemedicine pure play players who are really focused around virtual visits. There are hybrid players that are really anchored around physical clinics and adding some virtual to that. I won't go into all the details on how we line up, but where I'd focus you is none of these players and models, you know, have the clinical depth, the clinical breadth, and the ability to scale, all powered by data and data science that we do. We think that those are the capabilities that are really gonna drive success in the market.
We also think that this gives us the ability or the opportunity to define what virtual primary care is in the market, and I think we're well on our way to doing that with the commercial success that we've had. I'm gonna switch gears a little bit and now talk about mental health. I couldn't do that without recognizing this is an area that has probably been more impacted than anything else in healthcare and more impacted than with any other part of virtual care as well, by COVID, right? Clearly, adoption of virtual within this space has taken off dramatically from a consumer and a provider perspective. We've seen an increase in need, right?
More people need help because of stress and because of you know, shelter in place and all the other factors that we know about. None of this data reflects that, right? This is all pre-pandemic data, let's call it. We see the opportunity is only bigger than what's reflected here. Starting on the left, in our previous TAM calculations, let's call it, we had estimated about $15 billion TAM for mental health services. Think of that as really a replacement, right? Taking existing outpatient mental health visits and virtualizing a share of them. Unfortunately, the dynamic in the U.S. and around the world really is that more than half of people who have a mental health need aren't actually accessing care, 55%.
Yes, that sort of creates a bigger market, but it also creates a bigger challenge for engaging those consumers to get the help they need. This is actually an area Alon, when he talks about our BetterHelp model, will show us some statistics around how we're actually engaging a lot of people who almost half of his members or our members that haven't sought mental health care before. It really is a powerful combination, our mental health services. In the middle there, solving mental health problems obviously has a huge impact on consumers, and it's a good thing. It also has an impact beyond mental health because mental health is so often tied in, let's call it, comorbid with chronic conditions such as diabetes and hypertension and others.
There's a real amplifying effect when the mental health condition isn't managed well to the total cost of that consumer, to that patient in that episode. Really important to have all those things together and manage well together. Of course, it's not all just direct medical costs. This is a space where productivity and disability are really a huge factor, and employers get this, and why there's been such an interest in mental health solutions, accelerating in the last 18-20 months. Let's talk about our model. Our flagship offering in mental health is what we call myStrength Complete. It's built upon two basic pillars, right?
The first is having intelligent personalization that allows us to assess the patient, assess the consumer, and direct them up to the optimal way to access care or the type of care, and that includes purely digital, that can include coaching, that includes therapy and psychiatry, and we'll get more into that model, and really using data to help do that. The second part of it is having that full spectrum solution, right? It is having the purely digital, the coaching, and all the other elements I just described, and having breadth in terms of the clinical specialties, so for a wide range of different types of mental health needs. That translates into different types of content and different types of providers in the network. The combination of those makes a really powerful mental health service.
The topper, and what's really important, is that it's connected to the rest of our whole person system around chronic care and around virtual medical care. That's what really drives results, and that's actually what consumers want, right? The stat on the bottom there is 78% of consumers prefer a single unified experience for their mental and physical health. That's what consumers want, and that's what they're reacting positively to, is bringing it all together. This dives a little more deeply into that, myStrength model, and we've used the term step care a couple times, so I wanna clarify for folks. That doesn't mean you have to start at the bottom and, like, walk your way up as a patient.
Part of what I was trying to describe and sort of the beauty of the model is as a consumer comes in, and maybe they were referred in from another program, maybe they found it through because of our marketing or various different ways they could wind up at that front door, they then can take an assessment that helps understand what's going on, and then can guide them to the right component of this stack here that meets their needs. It can be fluid, right? They might start with you know engaging in digital content, sort of purely digital content and self-managing. Often that might be used actually in between therapy visits, as an example. It could be complementary.
A coach is always checking in on them and seeing how they're going throughout the course of their treatment or their engagement with us. If something goes wrong and there's a crisis of the moment, we can actually take care of that as well and connect them with resources that can help them in the moment. That all delivers a very wide range, as you can see on the right, of different types of client value, which is really important in mental health. Let me bridge then to the last topic that I'll talk about around chronic care. Similar to the story I was just telling around mental health, chronic care also, the different conditions don't happen in isolation, right?
Many people who have diabetes also has hypertension, and it translates into, again, this amplification of costs, and therefore potential impact if you can treat all of and handle all these different conditions at once. Unfortunately, as you can see the stats on the bottom, 60% of Americans have at least one chronic condition, but 40% have more than one, right? That's what we're really talking about here and really being able to impact those costs, 'cause that's where the big costs in the system are. How do we do that?
One of the things I think is really interesting is that, you know, we've sort of migrated ourselves in the market away from thinking about individual conditions, as I was talking about, like, helping somebody who has diabetes with just their diabetes, but also then moving towards helping them with their hypertension, their dyslipidemia, so think of that as around, cholesterol and other lipid challenges, weight management, mental health. We're selling these chronic condition solutions, like a diabetes solution or pre-diabetes solution, that contain all of these different services that each individual consumer will use which ones make sense for them and which ones will provide value. It's really tailored around, again, whole person, right? Treating the whole person, not just the condition.
Of course, financially, this does translate, similar to what Kelly showed in one of her examples, into higher revenue per member. You can think about a, you know, order of magnitude compared to just a diabetes-only product. Going to a diabetes solution might be 25%-50% higher sort of revenue that we can generate, obviously impact there as well.
I'd be remiss if I didn't sort of point out we think what powers all this, of course, why we win, is that we've got a differentiated offering that is driven by the very easy and sort of seamless way consumers can interact with the product in terms of gathering, you know, collecting the data through the device or enrolling right out of the box, how we utilize that data to generate personalized health signals that can ultimately drive behavior change, which is really the key in many chronic condition management situations. That it is human-centered, right? It's not just digital and it's not just coaching. It really is the combination of those, and as I'll talk about on the next page, bringing in sort of medical, you know, physician services as well.
Finally, it's all anchored on a long history of proven outcomes and ROI, right? We have years and years, studies and studies that show that it works, and it's the combination of all these things, but particularly that last part that allows us to talk about entering into value-based arrangements with our clients and having confidence that they'll turn out positively. We've talked about before the step care models that applied to mental health. Here what we're saying is we're now bringing that into that same sort of model into the chronic care space, what we're calling Chronic Care Complete. In lieu of walking through each individual piece, I'll just provide an example because that may be easier to sort of think through.
We would have a patient who, you know, maybe has diabetes, they're engaged with the blood sugar reader, and they've, you know, signed up and they're using that and the data's flowing through, and they're periodically engaging with their coach. They're getting nudges and they have developed action plans to help manage their blood sugar and help manage other conditions that they might have. Maybe one of those or two of those readings start going way out of whack. Actually, it was similar to the story in the video, if you heard that earlier, where you know within a few seconds, the patient got a call from their coach, "What's going on?" That's the acute outreach, right?
We can handle it in the moment, but then the coach and the patient may talk and realize, you know, we need a higher level of supporting care. Maybe there's something else going on. This is where we could bring in a physician, right? One of our Teladoc physicians who could have an A1C test ordered, right? And that test goes to the home. It gets, you know, it's mail-based, let's say. It goes off to the lab, comes back. The results come back, and then that physician working with that coach and the patient can make an adjustment to their medication perhaps, and that can make all the difference. It's really the combination of all these different components in bringing together, you know, what you may have thought of as old, you know, sort of Livongo components, Teladoc components.
That isn't really the point at this point. It's bringing all of these different capabilities together in a single experience to create greater impact. Lastly, we're not resting on our laurels. We're continuing to innovate in this space as well. The three themes I would use here, one is increasing the clinical impact, the depth of our clinical impact, the breadth of what we're doing clinically, and then bringing solutions into new markets and use cases. On the depth side, I talked a lot about the Chronic Care Complete model, so that's a great example of it. Further expanding our integration with continuous glucose monitoring, being able to order labs, new and different types of devices, being able to close and record gaps in care, continuous RPM.
Those are all examples of how we can get deeper on the conditions that we're serving and covering. On the second column, we touch people every day with heart failure and CKD and MSK and all these other conditions, but what we're here really focusing on is program-focused programs around these conditions. We're pretty excited about the early results of our partnerships and products on the CKD, the kidney disease side and pilots on the heart failure side, as well. Those really help us round out our cardiometabolic sort of syndrome series of services. Of course, we're looking at new spaces as well.
MSK, musculoskeletal, respiratory, and cancer are all areas that we're looking at for getting deeper in some of the other big key drivers of costs and outcomes for our clients. On the third column, taking some of the solutions, all of the solutions that I've just talked about, and bringing those into international markets. As Kelly talked about bringing CCM management into the hospital health system market so that providers can manage their own patients utilizing our tools and technologies. Even new use cases such as at least new use cases for us and focusing, for instance, on a post-acute, right? Like transitions in care model to help prevent readmissions.
We're just scratching the surface how we can use our assets and capabilities to tackle some of those important use cases. With that, I'm gonna transition in a second. To wrap up, I hope you've taken from this that while we do have, we believe, three market leading differentiated series of solutions and strategies around virtual medical care, including primary care, mental health, and chronic care. It's all those together that helps us address the large markets, but also make a bigger impact and drive greater ROI for our clients because medical conditions don't occur in isolation. We're taking a very people-focused approach. With that, we've talked a lot about our experience. You're gonna get to see it, which is gonna be really great. I'm looking around for Donna over there.
She's gonna come up and give you a quick demo. Thank you.
Good morning. I'm Donna Boyer. I'm our Chief Product Officer. As Dan said, in this next section, I'll be bringing to life the consumer experience, really showcasing the integration and the, as Jason said, the intertwining of primary care, mental health care, and chronic conditions through the eyes of a member. I'm going to be demoing this through a magical AV setup that brings together my phone and the screen and this screen and that screen with a sprinkle of Bluetooth and Wi-Fi. Just give me a moment to make that magic happen. All right. We can do this the old-fashioned way perhaps. Okay. We're gonna get started with our first example of Judy, who is a fictional member, but a very common persona for us.
Judy is. She does not have a primary care regular relationship. She's one of the 80% of people who fall into that category. She has a prior diabetes diagnosis, and she has not really been proactively managing her health. She's looking to turn over a new leaf and really start a new relationship getting her diabetes under control. She starts this by jumping into primary care from her digital front door, which allows her to see all of the care options that are available to her. Through her access to primary care, she has an option of 24/7 access for opportunities like allergy shots, sinus infections, flu. For today, she's really looking to establish that relationship. She goes ahead, and she selects starting with a primary care doctor.
Judy can choose from a collection and a selection, a curated list of primary care physicians. She has an opportunity to filter by specialty, by language, by gender. She can see an in-depth portfolio. She goes ahead and decides to select Dr. Myers. We know, particularly for primary care, that this ability to handpick from a curated list to understand who the providers are, gives her an opportunity to establish rapport and a relationship and comfort even before that first visit. Understanding what to expect really lowers, we know this from our user research, the anxiety and the trepidation of really jumping, particularly for people who have not had established healthcare, into a healthcare relationship. Before her first visit, she has an opportunity to schedule from a number of dates, times, and selections.
As Dan mentioned, on average, our visits are within a week, which is very different than the national average of over 30 days to schedule a first visit with a primary care physician. She goes ahead and schedules that for the next Monday. Prior to her visit, she answers a brief set of questions covering her mental and physical health, as well as her lifestyle factors and health goals. We've optimized this first visit assessment to really bring out the most important information for physicians to understand, while also acknowledging that members often are concerned about sharing their health information, and they also have a short attention span.
I bring this up because it's a great example of us not just replicating the clipboard waiting room experience, but rather bringing together our collective expertise in consumer technology experience, behavioral science, clinical operations to reimagine the whole experience, starting with that initial intake. In addition to her standard physical health, she also goes through a mental health care assessment. This is really important. Up to 70% of mental health needs are missed by primary care physicians in their first assessment. We do a combination of both physical care and mental care using adaptive personalization to understand the most relevant information, answering and adapting our questions in our surveys based on the answers that people have given in their prior answers. This allows us to get the maximum amount of information to the physicians in the shortest amount of time for the members.
After she completes that assessment, her doctor on the other side, Dr. Myers, has an opportunity to review it before they fast-forward those six days. Judy and Dr. Myers have an opportunity to meet together to discuss Judy's diabetes, her mental health needs that have surfaced, and their healthcare goals. Being able to address all of these concerns in that first visit really speaks to the heart of what Jason and Dan and Kelly talked to earlier, the intersection of these all in one place, and the importance of that in terms of being able to manage outcomes. 33% of people with a chronic condition have an undiagnosed mental health need.
Being able to address those all in one place not only helps the mental health aspects, but the intertwining of those addresses the 2-3x additional cost in chronic care management by not managing those mental underlying mental health needs. Following up from Judy's virtual visit, she receives an integrated personalized care plan in her app. That care plan covers everything from her diabetes management all the way through to her mental health in a comprehensive way, in one easy place for her to follow through in each of the recommendations. In her case, Dr. Myers has encouraged her to enroll in our diabetes management program, regularly checking her blood sugar, but also going forward with lifestyle coaching and nutritional coaching to help her take control of her diabetes management. Additionally, you'll see that she's ordered her a lab test, an A1C test sent to her home, right?
By being able to send this kit just directly to her home, it lowers the barrier for Judy to actually complete and return the test. Another really crucial factor is making sure that she schedules her annual eye exam. Through this, we are making sure that we're covering the gaps in care related to the programs in her deferred physical health that she has put off over not having a primary care relationship for years. Last, but certainly not least, a seamless integration into our mental health programs. This ability to incorporate this into an integrated care plan is really crucial. Less than 10% of referrals for primary care physicians to mental health actually get followed through because of that, the disparate nature of these.
By integrating these, we're just scratching the surface, just getting started, and we're already seeing a 2x improvement in those referral rates, in those completion rates. In Judy's app, when she goes through her care plan, she starts on her recommendation first to get an eye visit. For these eye visits, we're working with, as Jason mentioned earlier, integrating seamlessly with physical delivery. We take her health plan's network data and generate a curated list of options on the best-rated network preferred ophthalmologist within close to her home, within 30 minutes of her home. Once she selects that eye doctor, her care team provides her health records electronically. There's a seamless integration as she goes to see that eye doctor both, and the results seamlessly get back into her app experience and to her care team.
She goes ahead and schedules that, sees her doctor, and we'll fast-forward. When she returns to the app, what you'll see there on the top is an example of what Dan talked about earlier as a next best action. It's a tongue twister. These are personalized recommendations based on data science, clinical science, and behavioral science to recommend the single most important next thing that our members need to do. We know that it is really overwhelming for people to receive a large to-do list, so we send personalized, targeted next best recommendations to nudge people along that healthcare journey. In Judy's case, her single most important action is to get started with her diabetes program. When she does so, she sees the results of that A1C test that she took at home seamlessly integrated in her app.
She's happy to see it there, but less happy to see that the results are not what she anticipated them being over her lapse in managing her care. The ease and simplicity of this encourages her to get started. She's able to get started in the app directly, going through and learning how to do a check with her connected blood glucose meter. Beyond just measuring her blood glucose regularly, we know that there's lifestyle and nutrition and diet changes that go along with managing her blood sugar, and those changes can be really overwhelming. What you'll see down here is an example of a personalized action plan that helps with that behavioral change. She decides to get started. Action plans are another example of how we're using data science in conjunction with behavioral science and clinical recommendations to drive behavior change that drive outcomes.
What you'll see here is an opportunity for her to select from a variety of activities personalized and adaptively recommended to her based on where she is in her healthcare journey and recommended based on her likelihood to complete the activity. She chooses dinner pre-pairing and gets started on her action plan. This is really important. We know that members who are able to take part in choosing their care and have control over their activities have a higher completion rate, and those higher completion rates lead to better outcomes. Members who actively engage in their action plans see statistically significant benefits across lowering their blood sugar levels, as well as their blood pressure and their weight loss. All three of these lead to better outcomes and lower complications. Again, fast-forward.
Next time Judy comes back to her app, she sees a different next best action. We know that she is participating in doing her blood sugar checks regularly, right? Her blood sugar readings are under control. With that, we're able to make a next clinically appropriate recommendation for her to get started on our mental healthcare options. Again, integrating this into her digital front door, into her homepage, all in one place, meets members' expectations of simplicity and drives better outcomes by more likelihood of following up on referrals. She decides to get started with a mental health program. One thing that we know is that when people are starting mental health, they don't know where to start, and not knowing where to start is a significant barrier to getting started.
We start with a very easy, approachable intake assessment that helps us uncover what her needs are. We take the burden off of our members and use our decision science and our clinical recommendations to put her in the right place based on her needs. She goes through an in-depth assessment. That in-depth assessment covers a variety of clinical standard questionnaires as well as, again, adaptive personalization for us to get to the heart of what her underlying mental health needs are and at what acuity level. These are foundational for us in developing personalized health plans. What you'll see next is the personalized health plan that's recommended to Judy based on these assessments. What we've uncovered is the important things for her to work on is getting started with managing her depression and second to that, processing grief and handling stress.
This takes it from having her to have to self-diagnose to us giving her some easily approachable recommendations that she's able to action. Dan talked earlier about step care. This is a great example of step care. What we're recommending to her is teletherapy. This is based on our assessment of her acuity and what she needs next. She will also have access to self-guided content and a variety of tools, but her next best step in our step care model is getting started directly with a teletherapist. She can go ahead and schedule this very similarly to how she did her primary care, so it's a familiar interface, which again lowers the friction and increases the likelihood of her going ahead and following through with this referral. Similarly to primary care, our average times for scheduling a mental health visit are within a week.
Again, very different to the weeks and months that we're seeing increasingly as mental health needs continue to escalate. Even in advance of that week, we want her to be able to get started with our digital content to begin taking control of her mental health journey on her own. Based on her needs, there's an assortment of recommendations. She decides to get started with mindfulness and grief. Our digital mental health programs use adaptive learning algorithms to get people started in the right place and then personalize the content for them based on their needs and their level of engagement. We're gonna get her started with a very simple, easy exercise. This is just a simple seven-minute early success. We're not gonna go through seven minutes of breathing.
I wanted to point this one out because it's a really good example of giving people early wins to start feelings of success with something that might be overwhelming. This is a really important recommendation from a clinical perspective, but it also is very rooted in behavioral science. Kind of like in Super Mario, getting those first coins, really important, but this is way more significant. Right? We're getting her started early and often, and we're choosing the most important content from her from over a bank of 1,000 pieces of content that we're using our recommendation engines to put forth to her first step on this journey based on her history, her clinical significance, and what she wants to get going.
These easy steps really help overcome the barrier of her feeling like a win and feeling like she's getting started on her journey even before her first appointment. Less than a week later, she does have that first appointment with a licensed therapist for the first time. Very successful visit, and she and Dr. Adler decide to continue with therapy on an ongoing basis. They determine the date and time for their next appointment, and that again shows up seamlessly in her app. Following up from this visit, she receives a message, a push notification from her care team. Again, important because those push notifications are a reminder and a prompt to bring her back into the app on a regular basis so she can continue her exercises and continue to engage. This particular message is a message from Dr. Myers, her primary care physician, noting that she's received the results of her eye exam, her blood sugar levels are looking good, and that she's looking at her engagement in the mental health programs is further driving her blood sugar levels down.
This really matters to our members. This longitudinal relationship and this acknowledgment that what she's doing is taking steps creates just a cycle of continuing to engage and continuing to commit to changes over time. What we've seen in this example is bringing together primary care as a way of integrating in mental health and different aspects of chronic care engagement, all very intertwined in one place really seamlessly, creating a longitudinal relationship with a primary care doctor. I'm gonna switch gears and do another example. In this example, we're gonna meet our member, Umar.
Umar has been a long-standing member of our diabetes program. Recently, however, he's seen increases in his blood sugar levels. Umar receives, in this case, a mail notification that he has something to pay attention to in his app. Going into the app, you'll see a slightly different version, an alert version of our next best action, noting that he's had a few high blood sugar readings recently and asking if he wants to see a physician. This is an example of step care applied to chronic conditions. In Judy's case, we saw step care applied to mental health, seamless access from digital care to all the way up to seeing a physician. In this case, this is an example of Umar being able to access a physician directly. These next best actions are highly effective. These are targeted based on clinical predictive analytics.
In advance of something happening, being able to reach out to a member and pull them in to take more proactive control is a very, very both effective method of managing chronic conditions, but a very effective way of engaging people. We see upwards of 60% of our members engaging in these alerts. Umar is gonna be one of those 60% and chooses to schedule an appointment right there within the app with a provider who can help him manage his blood sugar. Again, similar interface, similar simplicity of going through and just being able to schedule directly in the app interface itself.
Before meeting with a provider, the doctor has full access to his blood sugar readings, notes from his coach, trends over time, so that when he is meeting Umar for the first time, he has a complete view of his clinical diabetes history and trajectory. Umar has an appointment with Dr. Hansen, and in that they make a decision to increase his medication dosage. Similar to Judy, these next steps are seamlessly incorporated automatically into his care plan, available both to him as a member but also to his full care team. In this case, he receives another email follow-up from his care team, and this one is from his coach who he works with regularly on his diabetes program, noting that he's had the increase in the medication and checking in with him to see how that's going.
This is an example, again, of step care going from remote care to licensed physicians to the care team, taking a holistic integrated view of the step care model applied to chronic conditions. Both of these examples are really from key takeaways. An example of us being able to bring together our virtual medical care, mental health care, and chronic care in one easy integrated consumer experience. Throughout this experience, Umar and Judy's examples show how we're interweaving data science, behavioral science, and clinical science integrated and interwoven throughout the experience to create a truly adaptive, personalized experience, which then in turn drives relevancy, trust, and ongoing engagement, creating an upward cycle of care management. Within this whole person experience, Step Care matches the members to the right intervention at the right time, whether that's digital coach, digital coaching, digital content, remote monitoring, or integrated seamlessly licensed care.
I'm gonna hand this over to Claus then to show how that happens behind the scenes, what is happening under that member experience to make this all possible.
Good morning. It's still morning. I'm Claus Jensen, Chief Innovation Officer, and I'm gonna try to give you a view of what I believe is a uniquely valuable way of putting the pieces together to our integrated product and platform strategy. You've seen we're solving a new problem. We're creating a whole new market. We're delivering this next normal whole person care model. I call it we're solving a paradox. It's the paradox that people want the sophistication of modern healthcare, but at the same time, they also want the closeness, the intimacy, the historical understanding. All the things you just saw Donna demonstrate is we know you, we recognize you, we are with you for the duration. That's hard to put together 'cause solving that paradox requires actually two paradigm shifts.
The first paradigm shift is removing the tight coupling between bricks and mortar and care, and acknowledging that some care components are done as well, or I would say in some cases better, especially with regular interaction, as it is in bricks and mortar setting. We've done that, but there's a second paradigm shift. The second paradigm shift is much harder. It's choosing to not just focus on one piece, but to amplify all of healthcare, and through a unique combination of clinical and technology assets, helping people make better holistic care decisions. Think about that. The actual outcome of care is based on decisions. We talk a lot about the decisions made by physicians, by the care team. Donna just demonstrated that the decisions you make as an individual have at least as much impact on that.
We're not just replacing parts of the system with new care components that remain disconnected. We're not just sticking the pieces together. What we have done is drive transformation through innovation and integration, being that strategic partner that Jason talked about earlier for all parts of healthcare. That second paradigm shift, as I said, is a much harder problem to address and it embodies the full multi-hundred billion-dollar opportunity we talked about. That problem requires the fusion of four sciences to actually solve. They're on the slide. If you think about it has to be based in clinical science combined with technology, otherwise you can't get to the reach and scale that's necessary to solve this for a country, let alone the world. But that's not enough.
You also need the logistics to be able to execute at scale, and I'll walk you through each of these four sciences. You need the behavioral science that Donna talked about because if you can't activate the self-care component of, let's say, a chronic condition management care plan, you're not gonna get the outcome they're looking for. Before I talk about each of these four in more detail, there is a fifth: data science. That underpins all of the other four. That delivers the intelligence that powers our integrated platform, and by the way, just for reference, we have more data scientists than most organizations have R&D people. Delivering care with integrity, with quality, and with compassion requires a situational and emotional understanding at every single point of interaction. You can't miss one, 'cause then the trust is gone.
You have to connect all the pieces all the time. The entire R&D team is totally passionate about that, about the mission, and we're pretty much relentless in making sure that everybody in healthcare, be that clinicians, be it health consumers, have the right experience. It's totally unacceptable that you have to wait a month or more for an appointment. It's equally unacceptable that when it's not necessary, you have to drive somewhere, wait for an hour or two or three in an office to get done with a component of an integrated care plan. That's just not acceptable. Having built the right whole person care platform, we've actually done something about both. It's by embracing our role to augment and amplify the rest of the healthcare ecosystem that we have a much greater positive impact on healthcare as a whole.
It's the very relationship with our clients that actually maximizes the value of the assets we can bring together and the integrated platform we've built. Our job is not to replace everybody else in healthcare. It's not to be a concierge that helps navigate. That's not enough. We have to break down the barriers, disaggregate the isolated solutions, and then put the pieces back together. That's a complex problem that requires a lot of sophistication in the five sciences you're seeing on the slide. How have we done that? How have we actually practically driven transformation through integration? That's the pivotal problem to solve in healthcare. We began with creating not just a data record, but what I would call a clinically curated, personal, trusted truth about your health. Not actually about the data, it's about what the data means.
This is, in a data-rich environment, an order of magnitude more difficult than managing an EMR, and I worked for a hospital for a couple of years. That's hard. It's not just about the EMRs, but all these other data points that live in this data-rich environment that we have created. It spans all kinds of data points, from visits to screening surveys, to device interactions, to the measurements that Donna talked about, to third-party interactions. If you look at that little circle, there's a lot of different data points that are coming together from lots of different sources. Some of these interaction points are through a telehealth clinician, some are through a licensed clinician, some are through a device. Some might be through your employer. There are lots of different ways to engage with the healthcare system, and every single interaction has to be connected.
I said earlier, you can't miss one. To construct that, because this is a hard problem, but we actually solved it. To construct that lifetime personal clinical truth, the very first thing we did was to build a notion of global identity. That sounds boring. It's not. 'Cause it's the difference between feeling connected and recognized every single time we meet you and not. Think about this. We get an eligibility file from a health insurance company, from a payer. All we get is the names, address, information, and maybe a few other demographic pieces. Now, we have to be able to recognize this is a person we've seen before, though not through that insurance company. That was the first problem we solved, because now we can recognize people at every single point of interaction.
The next thing we did was to step up as your health data partner for life. Not for a relationship that happens for some short period of time, not for a single interaction, but pretty much for as long as you want to work with us. Managing diabetes, let's just take that example, is a lifelong exercise. You can't stop. Something has to connect the parts. That's us. We built a unified data fabric for whole person health. That wasn't easy either. That has the ability to remember and combine the data points from all these different interaction points I talked about. It's a pretty sophisticated data and technology platform. Consumers in general, and look, you've all seen the newspaper articles. Everybody talks about how I will have an app on my phone that will manage my medical record. It's not going to work.
For most people, having an app on their phone that collects all this data doesn't actually make it meaningful to them, and it certainly doesn't make it meaningful to their physicians. We need a different model where somebody helps you remember, manage, combine the complexity, the integration, and the sharing of data, and that help has to be consistent and persistent over time. It has to be part of just managing your health, not something that happens on the side. We've done that. That was a choice. People can make different choices. We choose to help you manage your personal clinical truth for as long as you want to work with us. Finally, none of this matters if not based on robust clinical science. It's great.
Like, okay, I get it, Claus, you built the data fabric, you got all the data points, it's put together, the data is integrated. What does it mean? It's the very combination of data science, clinical science, and technology science that allows us to understand and interpret because we're doing sophisticated filtering and separating clinically meaningful data points from noise. Donna showed it to you. She didn't show you all the moving parts underneath. There are lots of them. That combination of clinical science and technology science is totally fundamental to delivering whole person health at scale. You can't do it without the combination I talked about. That is in our DNA as a hybrid healthcare and technology company. That was the first one, the whole notion about clinical science. Okay, let's talk about behavioral science. Now we have the unified data relevant for care.
Enter behavioral science, combined with data science. Think about it. Step care begins with self-care. Donna showed it. Kelly and Dan talked about it. Self-care begins with the right motivation. The right motivation is always deeply personalized. People have different motivations. If you don't understand the motivation of something, you can't actually get them to take action on their self-care. Matching the right provider includes self-factors, the ability for people to choose based on what's important to them. Culturally competent care, let's not forget, requires cultural understanding the context that's also deeply personal. This intelligent engagement platform only stays intelligent if it receives high-quality feedback on what works and what doesn't. Donna used the word adaptive personalization. Everybody talks about personalization. Personalization that isn't adaptive is not going to work in the long run.
You need to have the intelligence, the behavioral science, the data science, the analytics underneath to adapt as somebody moves through a journey of, hopefully, a relatively healthy life. The derived actionable insight is not just for the health consumer, it's also for the clinicians. They very much want that as well. Finally, don't forget that more data and more holistic data requires and leads to faster learning and better decisions. As Jason has been saying for years, and as Teladoc Health has been doing for years, the notion of intelligent actions and referrals matter, whether it stays inside our ecosystem or it's referral to the outside. Think about the notion of an applied health signal. What's an applied health signal? Well, it's actually in the name. That's the heart of combining clinical science and data science.
It codifies an important next best health action to take. These applied health actions are the difference between a care model that looks good in theory and one that actually works in practice and at scale. I think the 22 million nudges and 1 million clinical signals speak for themselves, as do the outcomes they've helped generating, and we're only accelerating from here. We're just getting started. Technology science is the third science. I could probably talk about this slide for a couple of hours. I'm not going to. Having a sophisticated and adaptable technology platform is crucially important. We're not just digitizing brick-and-mortar models. That is not going to solve the paradox I started out talking about. We have integrated whole person care in a way others can't because we chose to take a different approach to technology. I'm not talking about the future. We've already done this.
The underpinning technology looks very, very different now than it did two years ago. That's a current state statement. Historically, healthcare solutions have been designed as solution towers aimed at solving a particular problem. This is not a bad thing because that's how you drive the frontier of science. What is a bad thing is that forces patients and clinicians to navigate this very, very complex system on their own. The answer to fixing this was not establishing a parallel system. It was to do things differently by the disaggregation and recombination of the parts in a totally orchestrated ecosystem of our creation. This next normal better healthcare model, in that next normal model, is not actually about the what, it's about the who. It's about the experience and the outcome for the people that exist in the healthcare ecosystem.
The right questions are not, "What's your diabetes solution?" Or, "What is your telemedicine solution?" Those are building blocks. The right questions are, "What is the right whole health experience for a patient member health consumer?" Or, "What is it a clinician needs in total to understand what's going on with an individual to give them the best possible care?" Those are the right questions, and it's totally aligned to the mission of the company. Getting people to engage in care across all those things. We've talked about primary care, we've talked about chronic condition management, we've talked about mental health. There are three foundational on-ramps to a whole person care model. We've integrated all of that.
Hundreds of moving parts underneath the cover coming together the right way, powered by a single unified technology platform that keeps patients and providers in touch the right way, not just at a visit, but in between. That's the hardest problem in healthcare. How do you stay in touch in between? Our front door to health is so much more than just a UI overlay. It's deeply connected to all your care needs and all the resources that you need to take care of yourself and for people to take care of you. This relentless focus on low-friction experiences is what drives the adoption. It's what improves health equity.
Because even when people sort of want to engage in their own care, it's hard, and you have to make it easy for them, especially in an environment where digital presence means much more frequent interactions. If that becomes hard, people are not going to do it. A small simple example. Donna talked about our chronic condition management programs and the devices. Okay, I'll give you one tiny technology tidbit of how those devices work. They are cellularly enabled. They're not actually tethered to your smartphone in terms of how to send data points. Why? Because that reduces friction. And in the example that you saw in one of the videos, as soon as somebody takes a measurement with one of our devices, we know what that data point is. We can reach out if that's what's appropriate and necessary. That's low friction.
It's quite simply why we're integrating and delivering in a way that I don't think other people can easily match, if at all. On the client side, this is not just about the clinicians, and it's not just about health consumers. On the client side, Kelly mentioned large comprehensive deal opportunities. I'm telling you, they're gonna be based on white labeling and deep integration because health plans are making strategies and plans for how to take better care of their populations as well. They don't want something that's not connected. They want something that fits into their plans and strategies. We deliver on that without sacrificing the cohesion and integration and niceness of the experience for the people that we serve. Anytime somebody interacts with our technology platform, it always happens in the context of everything that went before.
These successful care models actually have to sell three times. The first time is to the client. They want to buy what they want to buy, and it has to fit into their overall environment. The second time is to the clinicians, what the integrated care teams need. Care teams have opinions too, and if they don't think that it fits what they need, they're not going to use it. Finally, you have to sell what consumers want to use when they want it, all of which we're doing at a massive scale. Enter logistics. That's another hard problem. We've built a powerful ecosystem platform that deals with an incredibly complex logistical challenge. That's the center of gravity for a digital/hybrid whole-person health economy. You can think about other industries. By the way, they're simpler.
Uber, Airbnb, those are logistical powerhouses, but they're in a relatively straightforward direct-to-consumer model. Healthcare is not that simple. There is no successful platform play in healthcare today. That's about to change. I put nine examples of the complexity in logistics in healthcare on this slide, and I'm just gonna highlight one overarching thought, which is think about how hard it is to match thousands of clinical resources, clinicians and members/patients that want help every single day across the complexity of, you know, what queues do we have for who wants what? What's the credentialing and licensing? Which provider are able to practice in what state? I can go on about that for a long time. We have already solved that problem. Every single one of these nine things we already solved, and it was not easy. We do it not just once.
We do it differently for every single client because the different clients have different integration needs, again, every single day. That's a problem that I would pose to you nobody else is really positioned to solve. I'll give you some examples. Be that a health system that uses our technology to power up their virtual visits, but maybe also handle overflow when they don't have enough clinicians that's actually at duty at 2:00 A.M. in the morning. Or it could be a client taking on population risk, but they want to contract chronic condition management with us. Or it could be a health plan that uses our white-labeled clinical programs and products to engage members and lower medical costs. This is not future state. We are already uniquely delivering and amplifying healthcare. I want you to remember that word amplification.
It's a funny word, but it talks about adding value so that two plus two becomes more than four, and that's actually what we do with our clients. This is how we become strategic partners for our clients and not just somebody that delivers a point solution. We set a pretty high bar for what integrated products and experiences look like, much higher than what most organizations contemplate. We continue to invest in the heavy lifting, building the right foundation, solving the hard problems, and then accelerating the differentiated value. We've clearly delivered on that in the context of whole person care. It's all about changing consumer behavior, laying the foundation for better decisions, stronger self-care. It's all about managing clinical resources at scale, avoiding putting that burden on the clinicians of the world. They're the scarce resources.
It's all about integrating the last mile, which Dan and Kelly and Donna all talked about, which is getting the interface right between clicks and bricks and integrating devices, sensors, referrals, labs, medication, which by the way has to be technology-based to work at scale. If it sounds like I'm passionate about this, you would be right. We're not standing still, I'll just talk for one minute about some of our current R&D focus areas. We're actively adapting our programs and products to new channels. Give you two examples. By the way, this requires significant time and effort for localization. I talked about that. Context is everything. One example is we recently went live in Canada with our mental health product, myStrength. Canada is like, okay, English-speaking, but it's still a different culture. It's a different context. It's different integration. It required work.
We have a couple of recent examples where we took the chronic condition management programs and took to hospitals, not employees, but patient population. Again, required adaptation. Our ability to continue to adapt our products to new settings is what will unlock this massively expanded addressable market that we've talked about. To increase penetration, the integrated platforms is what we continue to invest in. For example, I talked about unified data fabric. That's already giving us new insight. Donna mentioned a couple of examples. The integrated experience you saw is the essence of what it means to put the pieces back together better, especially for high charge areas like chronic condition management. Kelly talked about the Primary360 product. That breaks new ground for virtual first care. We'll continue to expand those capabilities, and we're continuing to do new last mile integrations.
There's a lot of things you can integrate out there. Lastly, we're accelerating our investment in value-based whole person care, not only by expanding the clinical product differentiation that's important, but also, as importantly, by expanding our provider network capabilities so that our clients can put their providers on our ecosystem platform seamlessly integrated with our provider resources when appropriate. You could say that we lead growth and share of wallet for whole person health. That's what the headline says. I think more importantly, this is certainly true, but we have a proven track record of continuous innovation, but innovation from the top of the market rather than innovating one part sitting over here in a corner. You can say that we're a multidisciplinary example of what it means to operate at the top of your license.
That's, by the way, what you will hear healthcare professionals say. Their ambition is to operate at the top of their license, a manager nurse. Is ours, and we've shown it. We led the market as virtual visits became normal. We've clearly demonstrated our ability to scale that model. As the virtual and hybrid care transition accelerates, as it moves from visits to meaningfully connected journeys, we create the foundation of this personal and compassionate health journey that we've talked about all morning. myStrength Complete. The step care model, that's a first of a kind example of a fully integrated step care model. That didn't exist before. A step care approach to everything, Dan talked about it, is our strategic foundation. Mental health was simply the first place we did it.
As always, we invest in the foundation, we learn what works, and we accelerate the deployment at scale. If you go all the way to the right, we continue to create and lead the market, innovating on top of everything that came before, including our existing stuff. The next frontier is our new category for whole person care. With full last mile integration, a complete and holistic step care model to chronic conditions and mental health, and that new category is absolutely based on the fusion of all the five sciences I've talked about, all of them. You cannot do it without integrating all five. All in all, clear line of sight to full platform integration. Clear line of sight to fully integrate whole person capabilities, a first in healthcare.
Delivering a new category, solving for that inherent complexity, solving a really hard, complex problem through sophisticated technology and the integrated application of five different kinds of science on top of that. Pretty sure we're uniquely positioned to deliver. We have all the right ingredients, we have the right team, we have the right vision, and we're gonna be the ones that define and power the next normal in healthcare. Which is why when Jason asked me to join Teladoc Health, that was an easy decision. I think it's time to move on to Q&A. That is correct. If I could have the morning speakers come up, I'll do a little bit of curating of the Q&A. I'm sure we have a bunch of questions. We have a couple of microphones that will go around the room. We'll take hands.
I see Sean is eager at the front.
Okay. Sean Dodge, RBC. Maybe on Primary360, Jason, when you've piloted those programs in the past, what's the uptake been of the members that have had it made available to them? How, I guess, how eager are consumers to self-select into a virtual primary care program?
Early pilots are really promising. I'm not gonna give expected enrollment rates because that might set expectations before we have an adequate sample size. I wanna be cautious about doing that. In many of the populations that we've served in early pilots, uptake and enrollment has been higher than our expectations. As you saw from the slides on Dan's introduction to Primary360, the engagement of those consumers in terms of interactions with the care team, identification of chronic conditions, mental health conditions, has been even stronger than we expected. We're excited about the impact it will make and, you know, just sort of generally looking at what our health plan clients are modeling.
They're modeling savings of anywhere from 10%-20% from a virtual primary care, primary first product, rather than the sort of traditional delivery system. Next question. Anyone. It's okay.
You need to speak into the mic, otherwise nobody on the webcast can hear you.
Sorry. Jess Tassan from Piper. Can you just talk a little bit about how you employ and compensate providers across all of the businesses, BetterHelp, Advance Medical, the virtual primary care? And then just does the virtual primary care solution change at all sort of the way that you're thinking about employing primary care docs? Thank you.
Yeah. Historically, we've always compensated providers essentially for the value that they provide. As they perform visits for us, they have generally been 1099s. We reimburse them as for us, a variable cost for them based on their productivity. We will begin to move into more employed providers who are paid on sort of a hybrid model with a base plus a productivity and value basis. You know, that is certainly to create a more longitudinal relationship and aligns relative to value-based reimbursement that you heard Kelly talk about. I think that aligns us with those providers. We will always be a hybrid that includes a substantial portion of independent contractor providers.
Thank you. Jailendra Singh, Credit Suisse. Following up on your discussion around the incremental revenue potential discussion, specifically related to partial capitation and capitated whole person care models, what are your views on the timeline around transition to or adoption of these models? What could be the key hurdles there? And are you assuming any significant adoption within your 25%-30% revenue CAGR there?
Yeah, the question is about new payment models. I'll start, and then maybe, Kelly, you can give us some insight into what the clients are asking for. We've taken very modest expectations into our modeling relative to our outlook for additional contribution from new payment structures. I will tell you that today we're having discussions with clients that range from sort of guarantee of savings all the way through Primary360 discussions that have a set capitation with downside risk and upside benefit as we get to share in the savings that we generate. We are already having some of those discussions. You could call that a partial cap or sort of a cap with corridors. Those are evolving now.
I think over time, as we integrate all of the chronic care and Primary360 and whole person care capabilities, you'll see us more move to a larger, more traditional capitation, because we can make a bigger impact on the overall healthcare dollar. Kelly, you wanna give some insight into the client conversations?
Yeah. I think what I would add to that, Jason, is that what we're seeing is, as I talked about the maturity model, across our entire you know portfolio of clients, I think each one of those clients sort of arrives to a decision around whether or not they're ready for a value-based care arrangement. As Jason said, they all sit along that spectrum somewhere. A lot of our conversations are, well, let us understand what you're after. What is the solutions you're looking to incorporate into your populations? What are you trying to achieve? That leads us to the next level of conversation, which is, are you able to actually you know adopt a program of partial or even consider a full capitation?
Many times, again, their sophistication levels, along their maturity of virtual care aren't there yet. Some are. I think it is a little bit of a n equals one conversation—you know, with each one of our clients.
Let's go to this side, maybe Lisa.
Lisa Gill with JPMorgan. Good morning, and thank you. It's so nice to see everyone in person again and kind of set the stage for JPMorgan 2022. Anyway, just really wanted to go back, you know, all the excitement around virtual Primary360, and you made a lot of comments today. When I look at the targeted growth rate of 10%-20%, what am I missing in that expectation? Is it just gonna be a longer ramp for people to implement this? Is it that, you know, some of the things we saw today around, for example, chronic care having a much higher PMPM dollar amount that impacts that revenue? How do I think about that opportunity?
Well, remember that the virtual medical care encompasses a lot more than Primary360. It's working off of a very small base, admittedly, right? It's brand-new in the market. We're modeling a very modest contribution, really not material contribution in 2022. When we talk about a three-year CAGR in terms of our growth rate, and I mentioned that one specifically accelerating over the course of those three years, it's really because we expect that to be a meaningful contributor to 2023 and 2024. And really not much of a material financial contributor to 2022. What we expect to do is set the stage with a lot of phenomenal clients and proofs of concept for that in 2022 that will play out in terms of growth in 2023 and 2024.
Does that mean, like, the program is growing much slower than it has historically? Like, I mean, I just look at the different buckets of growth rates that if you're talking about kind of being the slowest of the growth rate, I just wanna understand how to think about that.
Well, I think it's been clear, and as we've talked about it. Sort of the General Medical business, which is the bulk of that, is not the explosive growth rate that we had seen in the past, and it's shifting to more whole-person care. Lisa, one of the challenges honestly that we've had internally is decomposing the parts because we see it as really whole-person care being the pulling together of all of those parts, and that's more and more how we're selling it.
Exactly. George?
Jason, mental-
I think it's on.
Mental health and behavioral has been a huge home run for you guys, and it's expected to be the fastest-growing part of the business over the next couple years. It will be about half the business according to your 2024 targets. I would imagine there's been a huge pull forward as it relates to COVID-19. I'd love for you to talk about what you see and what gives you the visibility in that sustained very strong growth for the next handful of years, assuming that COVID-19 ramps down at some point, and we don't all stay crazy.
Yep. Maybe Dan can take the B2B side of that, but I would ask you to hold that question for the afternoon. We're gonna hear from Alon, who's gonna talk about our direct-to-consumer BetterHelp offering and a lot of why we feel very confident in the sustained growth of that. Do you wanna talk about the B2B side?
Yeah. From a B2B side, you know, it is dramatically under-penetrated even today after you might say 18 months of crazy, you know, growth, because of all the dynamics we talked about. You know, that's both from a percentage of the book that has the service, and we'll get into more of that later. The usage of the service within that population continues to grow, and we continue to see that those patients are having more visits and more patients are getting involved. Of course, as I was talking about, the story's a lot bigger than telemedicine, right? Sort of what Teladoc would've been talking about, you know, 20 months ago.
Because of the Step Care multimodal model, that is, myStrength Complete, that is almost a new sort of category, right, that we see tremendous opportunity to bring into our client base. We're seeing that interest in sort of, I might call it, upgrading, right, to that more full solution, that can very efficiently take care of a broader part of that population, and drive outcome. I think there's sort of a additional phases that we're entering into that are more than what you might have sort of thought of as traditional telemedicine.
We have a question from the web. From Daniel Grosslight at Citi asks, "Can you talk about how data is shared between different providers within the Teladoc network? For example, if a consumer's utilizing primary care and mental health care, how is data shared between those two providers? And when referrals are made out to in-person care, how is the data shared with the in-person providers and then back to Teladoc?
Yeah, I think just to maybe frame the question, we've gotten a lot of questions about, well, can a Teladoc physician see the chronic care results, right? Can they see the blood sugars? Can they see the blood pressure readings? I think there are some misconceptions out there. The answer to that question is yes, we've executed on that part of the integration. Then, Claus, maybe you wanna talk about how we make sure that the data is ubiquitous across all providers, whether they're part of our network or part of the d elivery system.
It really comes down to the unified data fabric that I talked about. I mean, it's labeled unified data fabric because that's what it is and what it does. Using our global identity capability, every time we have a data point that comes in, we will immediately connect the dots and say that belongs to this particular individual that we're tracking over time. Donna showed an example of how the primary care physician has access to the report, the readout from the management of your diabetes. That's one example of how it comes together.
I think we have time for maybe just one more question before lunch. We'll have another Q&A session at the end of the day with the full management team.
Stephanie?
Thank you for sneaking me in. I have one for, probably best for Kelly. You talked a lot about how you were seeing a lot of traction in the cross-sell thesis paying out for Livongo and Teladoc.
You mentioned Tyson Foods and Blue Cross Blue Shield North Carolina. Could you give us a little bit more color from the ground of what you're seeing in these conversations, why it is happening, and maybe the level of penetration of these conversations you've had with your client base given the breadth of it?
Sure. Couple things on that. I'd say first, it's the ground game. I had mentioned what we had launched into 2021 with the close, and the thesis around our cross-sell was in Q4 of last year. We sort of hit the ground running early in 2021 with really sort of aggressive notions to get in front of our clients and really start to tell the story and as I mentioned, sort of inventory where they're at. Those conversations have been really fruitful because not only do they give us an insight, they give us an opportunity to sort of benchmark where that client is and further the conversations about expansion. We moved quickly in Q1 of 2021 to make sure that we were, you know, in the field having the conversations.
Those conversations have continued to grow over the course of the year. I would say that it then tees up an opportunity to talk about Primary360, for example, sort of what is their more holistic strategy, and what are they after in that? What I'm seeing in the U.S. group health markets is that what we typically have seen is sort of nascent products would evolve in the D2C, in the employer space first, and they would sort of gain some traction and adoption and really start to prove themselves out. Slowly, they'd migrate over to the health plans, which would take notice for differentiation reasons, cost reasons, etc.
One phenomenon that we're seeing on P360 is that that product is being adopted concurrently in all markets. It's really been sort of fascinating to watch because I think what we've seen is that early, the health plans and, you know, integrated health systems and, employers are all seeing the value sort of day one. We're really excited about that momentum, and we're really sort of trying to harness it and move into 2022 with even more sort of ground game and focus.
A quick follow-up on that one. If I can sneak that in, this is probably more for Mala. Let me know if this is something I should not be asking. Just given that color, is there any way to track it against the original Livongo revenue synergies?
Mala's gonna talk about our financial outlook toward the end of the day, and we'll talk about sort of where we are relative to synergies. The short answer on that is that we're on track this year relative to our expectations for the cross-sell synergies, and feel very good about where we are.
All right. Thanks, everyone. We're gonna take a quick 15 minutes for lunch. I know that's quick, but we wanna get back and we'll be back. Thanks.
Thank you.
Thank you.
Okay, we're gonna get started again. It's my pleasure to introduce Alon Matas, President of BetterHelp.
Thank you. Good afternoon, everyone. My name is Alon Matas. I founded BetterHelp nine years ago, and I joined Teladoc six years ago with BetterHelp's acquisition. Now that Dan and Jason mentioned, we see mental health as a key growth area, and that is true for both B2B and B2C. With BetterHelp, Teladoc extends its mission to provide care to any person who's looking for mental support. Now, BetterHelp has been the clear leader in direct-to-consumer mental health for several years now, but this year was pivotal, with tremendous growth that exceeded all our expectations. To put that growth in perspective, we had this year more live sessions than in all previous eight years combined. As a result of this massive growth, BetterHelp will generate this year revenue of about $700 million.
A key learning from this year is that COVID-19 was much more than a circumstantial temporary spike. It had permanent and lasting impact on the consumer's desire to get therapy online. In fact, from March to September of 2021, we had more new members joining BetterHelp than between March to September of 2020, when much of the nation was under shelter in place. Despite traditional brick-and-mortar therapy being available pretty much everywhere available again, consumers continue to prefer and appreciate the advantages of getting therapy online. On the other side of the equation, BetterHelp established itself as the number one opportunity for any therapist who wants to work remotely. This year, over 20,000 therapists provided services on our platform, with more than 10,000 of them joining just in the last 10 months.
Another thing we really got excited about this year is the increase in the caseload size of therapists in our network. That happens because many therapists join us with the intention of doing it just as a side gig for a handful of clients. But then when they discover how compelling and rewarding this can be, they increase their share of work at BetterHelp, for some of them making it their de facto full-time. We're not just increasing the number of therapists in our platform, but we're also increasing the volume we get from each therapist. Our scale is helping us to provide quality of service that is superior to any competitor. There's really no better way to demonstrate that than with the critical challenge of therapist matching, which studies have found to be a determining factor in the therapy success.
Because in therapy, you're not just looking for a therapist, you're looking for your therapist. Now, let's say that you live in Wisconsin, which means you'll need a Wisconsin-licensed therapist, but you also prefer a female therapist who is Black and older and has specialty in grief counseling and expertise in parenting. With the very large size of our network, we not only have what you're looking for, but we probably have many, many therapists to choose from. By leveraging the massive data that we have and analyzing over 150 million interactions we facilitated, we're able to pick and choose and match the therapist for you that is most likely to succeed in helping you. We continue to innovate and add functionality and value to the platform beyond the member-therapist communication. Previous years, we added webinars and journal and guides and worksheets.
This year, we started rolling out support groups where members can connect with each other and a dedicated therapist over a shared experience. We got extraordinary feedback and tons of enthusiasm around support groups from members. Now, all these additions make the service more sticky, more valuable to members, and also let us adjust our membership rates to higher price points. The merits of our product and service yield high engagement, high satisfaction, and high retention. These three data points here show how quality translate into long-term value. First, 86% of our members continue after the first session to have more sessions. This is remarkably higher than the standard retention rate in traditional brick-and-mortar therapy.
Second, while some people may use BetterHelp in a kind of a transactional way, maybe to get help with a temporary specific issue, the vast majority of our revenue is generated from people who use BetterHelp for at least three months. Third, our goal is definitely not to keep people in therapy forever, and we're actually happy when they reach their goals and move on. What we constantly see is that when past members have new life challenges, and they need help again, they come back and use us again as a trusted resource. This chart puts some of that in financial lens. What it shows is the trend in the average revenue we generate from a member in the first 12 months of their membership. As you can see here, it keeps going up.
For example, the revenue we generate from a member who signs up today is almost double compared to the revenue we generate from a member who signed up four years ago. What you can see here basically is how the engagement and satisfaction and retention and long-term value that I talked about in the previous metrics translate also to increased revenue and also increased profitability. It's no secret that part of our growth comes from increased investment in marketing and advertising, and this is where we leverage economies of scale. Our marketing becomes more efficient, more sophisticated, and more effective as we keep accelerating. As you can see here, although we spend much more than we used to, our return on investment of every additional dollar is actually not diminishing.
If you take out the impact of shelter in place from last year, our marketing ROI keeps increasing over time. I'd also like to point out that the marketing has become very diversified with multiple channels, multiple sources, and multiple strategies. In 2021 was the first year where we didn't have a single source that brings more than 25% of our new members. This is very important because unlike some of our competitors, which may rely just on a handful of sources, this diversity give us scalability, but it also protects us from the volatility that sometimes happen in the media landscape. In fact, being able to shift budgets between different channels and different sources let us capitalize on opportunities that come out of this volatility.
I know there's a specific concern around the rising cost of social media advertising and even more specifically Facebook. It's important to know that over the last two quarters, less than 10% of our new members came from Facebook ads. Thanks to our scale, BetterHelp is also becoming a household name for online therapy. In a recent survey by Qualtrics where consumers were asked to mention the first brand that comes in mind as it relates to online therapy, BetterHelp was mentioned more times than all other major competing brands combined. This brand awareness means two things. First, even people who don't use us know about our solution, and that means that when they come to a moment of need or they need help, they sign up to BetterHelp organically.
Second, it's a massive accelerator to our direct response marketing because people are much more likely to respond to a message or an ad from a brand that they already know. Last, but definitely not least, we're able to establish our sites and apps as a leading source of knowledge and expertise around mental health. This year, over 20 million people visited them. That does not include any ad-based traffic. We saw how our member lifetime value gets better with scale, thanks to data insights, ongoing innovation, and the size of our provider network. We then saw how our advertising ROI gets better with scale, because of economies of scale, increased efficiency and brand recognition. If you combine the two, you get not only the rapid growth that I showed in the first slide, but also high profitability.
BetterHelp has a consistently strong and improving margin profile, which is accretive to Teladoc's consolidated adjusted EBITDA margin. Where do we go from here? If there's something that 2021 taught us is, that we're barely scratching the surface in a market that is almost untapped. Dan has already covered the enormous TAM of mental health, so I don't want to repeat it, but I want to explain why direct to consumer specifically is such an exceptional opportunity in mental health. Well, mental health is an area where people, many people, are relying on themselves to make decisions and take action. These three data points here demonstrate why direct to consumer, well, mental health basically is such a consumerized market and why it's so ripe for DTC growth. First, 32% of people who have private health insurance go out of network for therapy.
That's compared to just 8% in other medical specialties and just 3% in primary care. Second, this is also reflected on the provider side. A survey by the California Board of Behavioral Sciences showed that 42% of therapists are not part of any managed care panel. Third, mental health is unique because it's not just a replacement for a traditional brick-and-mortar care, but it can actually expand the market dramatically. For nearly half of our members, BetterHelp is their first experience with therapy, although many of them have been struggling for years. For many of them, if it wasn't for BetterHelp, they would continue to avoid getting any care at all. We're not just operating in a market with a very large TAM, we're basically doubling the TAM.
Not only that, all this additional TAM is exclusive to our type of offering. On top of that, we make intentional efforts to increase the market, and I want to give just two examples for that. The first example is the male population. It's known that the ratio between women to men in therapy is around 2-to-1, and that is true both online and offline. But we thought that by investing in marketing and messaging, we can help change that. We can break stigmas. We can raise awareness so more men would be inclined to get help and get therapy. In a 2-year timeframe, we're able to more than quadruple the number of men getting therapy through BetterHelp. I want to show you now a male-targeted video that we produced.
That video got overwhelming response with close to 30 million views in just one month.
What do you want?
Well, I want a job that I can be proud of. I want my parents to stop calling me for tech help. I wanna fall in love. Yeah, I do. Sometimes I feel like I just want someone to tell me exactly what to do. I wanna be more confident and less scared. Sometimes I feel like I'm on an island, and everyone else is in these rowboats with their full lives rowing somewhere, and I don't have a boat. I'm just stuck, forgotten.
I mean, what do you wanna eat?
Oh. Just the pad thai.
The chicken satay, the mango salad, and two orders of the pad thai. Yep, that's everything.
Yeah. Like I said, these kind of efforts help us to penetrate in the populations that would not typically use therapy. I said I'm going to give two examples. The second example for market expansion is international. BetterHelp is the only global therapy DTC provider. Although most of our investments are focused in the U.S., we're already the market leader in many, many countries. This year we served members from over 100 countries and provided therapy in 26 different languages. From a financial standpoint, out of the $700 million, we'll generate over $100 million from non-U.S. consumers. After we've seen all these, indications for massive growth potential, we will double down on the international opportunity. Before I finish, I want to take a minute to talk about something that we're extremely proud of beyond the great business performance.
One of our seven core values in Teladoc is that we're passionate about taking care of people, and by that we mean all people. By being open to any person, regardless of insurance, in employment status, BetterHelp is already a great equalizer for affordable access to mental health care. But as a market leader, we felt we have the responsibility to do more, and we took this responsibility very, very seriously. We leaned in and harnessed our resources to tackle the mental health crisis. This year we provided $45 million worth of discounted sliding scale therapy to consumers who couldn't afford a regular rate due to financial hardship.
We partnered with many impact organizations to provide free therapy where mental health resources are needed, such as victims of sexual assault, young athletes from the LGBTQ community, and most recently, refugees and people impacted by the humanitarian crisis in Afghanistan. We're helping the helpers, providing free therapy again to volunteers and frontliners in situations where mental health is a problem, like with healthcare workers during the pandemic. Lastly, we support underrepresented communities that are particularly affected by mental health challenges. This is not happening just on the consumer side. This is also happening on the provider side. A great example is our college scholarship program where we support Black and Latino students, psychology students in their journey to become mental health clinicians.
To wrap up, we've seen this year very rapid growth with strong margins while reinforcing a leadership position. For next year and beyond, we see how our scale help us scale even faster in a massive market that keeps expanding. We do all that while fostering equitable access to mental health care and creating real social impact. Thank you. With that, I will hand it off to Stephany.
All right. Thank you, Alon. For those who I've not met, I'm Stephany Verstraete, Chief Marketing & Engagement Officer here at Teladoc Health. I've been studying the adoption curve for consumers within virtual care now for about six years, which I think isn't quite as long as Jason's, but it does give me a unique perspective on the trends we've seen emerge this year, right? First, there's no doubt that we've reached an inflection point in the adoption of episodic virtual urgent care, driven in large part by the massive awareness and openness that was brought on by the pandemic. Millennials are driving this, and we see during the pandemic, we've seen multi-service and repeat usage really drive the growth with this demographic.
We're also seeing the emergence of future power users through the adoption of mental health, right? On one end of the spectrum it's Gen Z, which is probably fairly intuitive, but the other end of the spectrum is actually older populations. In fact, last quarter, with one of our largest Medicare populations, we saw mental health visits actually exceeding that of General Medical. I say power users because those users that start with mental health, mental health services, somewhat like nutrition services, they're gateway services. When you start with mental health, you're statistically more likely to use two-plus services and become a multi-service user over time. Now, as we think about the shifting and expanding the category into whole person care adoption, we are expanding the category, but once again, it's still early innings. Why?
I think actually that the travel category presents an interesting analogy for the point that we've reached now. I joined Expedia actually just after the company went public. I held a variety of marketing leadership roles while I was there. I think when I look today at the point that we've reached with that mainstream adoption of virtual urgent care, it's very similar to at Expedia when we reached the mainstream adoption of booking a hotel online, right? In both cases, that first phase was all about meeting an acute need. In the case of Expedia, it was meeting, right, the desire for a better discovery experience or better access to a hotel stay. It was an entirely different paradigm shift to go beyond hotel stays and make staying in someone else's home mainstream.
For many consumers, it was absolutely not something that they could imagine. It was Airbnb's focus on making the stay an integral part of the overall destination experience that truly resonated with consumers' expectations for today. Empowerment, seamless end-to-end experience of the journey, and in their case, better holiday outcomes. Similarly, for many people, the experience that we're building in Primary360 is actually not something that they can fully imagine, right? We're seeing those early adopters of Primary360 really invested in being well, and that spans both their mental health all the way through to their physical health. What makes us confident in our ability to unlock the growth here is the proven track record that we have when it comes to driving sustained consumer behavior change, moving cohorts up that adoption curve.
We're already seeing very strong momentum in that multi-service usage. In fact, why don't we let Ray tell us. Ray is a member who has access to our full suite of chronic condition management programs.
I got this email from my medical provider about Livongo explaining this service, particularly dealing with diabetes. Since I unfortunately had acquired type 2 diabetes, I was very interested in seeing what the service was all about. They provide materials, they provide support, and they also provide a way to record your readings every day. That's something I found valuable. Valuable that when I got another email from them talking about high blood pressure, I said, "Well, I got that too. Let me try that." My doctor has always said that he wanted me to record my glucose reading every day and record my high blood pressure so he could analyze how I'm doing. I never did that. I might do it once or twice a week. With Livongo, I know there's a record being made.
After the high blood pressure, I got another email about weight control, and that's something that I wanted to do as well. I weigh myself every day. They gave me a nice scale. It automatically gets recorded. That's important for me to know that it's being recorded, and it's available for my doctors to see. I've lost 12 pounds. I reached my initial goal of 220, get below 220. Now my next goal is 210. My heart doctor did reduce my high blood pressure medicine. One of the side effects of that medicine was sluggishness, and so I felt very tired all the time. Now because of that, I feel much better. It's certainly better for my tennis game and my golf game. It's becoming a way of life for me, and I believe in it.
I believe what it's done for me. Healthcare typically treats symptoms, treat it with drugs and so on. With this Livongo program, they're getting right at those symptoms and trying to eliminate them, so I don't have to take the medicine, and I don't have to be treated. I think that's the great approach. I will continue it for as long as I can.
While potentially hearing someone wax poetic about our emails might be an anomaly, Ray's story, Jamie Sun's story at the beginning, these are not needle in a haystack testimonials, right? With the millions of people who have access to more than one service through Teladoc, it creates an unmatched foundation for that, driving that growth of whole person care. The challenge, however, is that unlocking that full potential requires taking one consumer, making them aware, fully aware of that full breadth of services that individually they have, and then driving the relevant adoption around that, right? The relevant engagement around that. This cannot be done at scale without sophisticated, robust assets and capabilities, which Teladoc's powerful surround sound engagement engine has been built and refined over a decade specifically to do.
Now, if we were to look under the proverbial hood of the engagement engine, over the course of this year, we've significantly deepened our capabilities as we brought together and integrated the legacy Livongo and Teladoc marketing data and tech stacks. Right? In doing so, we've equipped ourselves to be able to deliver highly relevant, scalable, but one-to-one engagement lifecycle management, which drives those stickier relationships and which sort of allows us to reach any given member with any given service configuration. Okay, so what does this look like in practice? All right. So Ray, the emails that Ray talked about is one of the components within there. Here, what we can see is Ray had a good week, right? His stats are up, and the data shows us that that is the right time to introduce a secondary service.
In this case, it's hypertension. Now, unfortunately for Jamie Sun, she didn't have such a good week. What we know is when people get bad news, that they have their personalized stats, they can become discouraged and drop out of programs. This is the moment where we need to seamlessly be able to dynamically present her with help through the mental health service. Now, Chris happens to be a member of Primary360, right? You can see how this engagement engine and that ability to put them through this lifecycle management enables us to use an interaction that they're having with a chronic condition program of ours and really use that as a lead-in for driving engagement with his care team. If marketing is our tech stack that effectively
If the marketing tech stack really is effectively driving the delivery of those personalized experiences, its data science is the supercharged brain that powers that world-class engagement engine. Right? Compared to pre-merger, we've massively expanded the role that data science plays in creating unprecedented insights for consumer motivators and truly shaping new capabilities. Some examples on the right. First, our audience intelligence models enable us to reach very specific populations with or without claims data, which is a competitive advantage as we think about value-based care arrangements. Additionally, data science actually helps us deliver a better experience. By combining two distinct data science models, we were able to drive a 24% increase among an at-risk population. All of this is repeatable, it's extensible, and it's having an impact on our business now, right?
Not only are our campaigns better, but we're able to deliver cost efficiencies, and we're doing so in one of our most important marketing channels, which is direct mail. Historically, we focused on visits being the primary measure of our engagement with consumers. Today, as our business increasingly moves into whole person care, the breadth of interactions that take place between members and Teladoc assets, whether that's digital or human, has expanded well beyond that of our traditional visit. In fact, the 590 million total interactions that have taken place over the past year is a much more relevant reflection of the breadth and scale of the engagement that we're having with consumers today. Now, in the blue circle, you can see that a subset of these total interactions are actually health interactions.
Health interactions occur specifically during the process of a member requesting and receiving care with a Teladoc asset or through a Teladoc asset. Health interactions include things like someone completing a wellness survey within myStrength. It could be someone responding to a nudge who's enrolled in one of our chronic care programs. It could be a care referral by a provider, an internal referral, or it could be a session with a BetterHelp therapist. Of course, it includes our visits. In contrast, members registering, logging in, or engaging with marketing materials is really what comprises the majority of the interactions in the gray bar, the gray area up top. It's really these total interactions that are the reflection of us deepening our relationships with consumers, right?
Building on a very strong 2020, we're continuing to see our ability to drive growth. We've increased the Teladoc activated base by 44%, growing Livongo consumer app sessions by 78%. Lastly, as more and more of our members have access to multiple services through one experience, we're seeing the volume of referrals, internal referrals that are made by providers grow by 86%. To make that paradigm shift that we talked about earlier and really unlock the potential of whole person care, our consumer research shows that there is still work to be done when it comes to driving awareness and resolution confidence in virtual care beyond sort of those routine needs, right? A key barrier to overcoming this is trust in the effectiveness of the experience that they're going to receive from a care perspective.
Secondly, access to Teladoc's full suite of care services is a key differentiator when it comes to driving adoption. In fact, we're already seeing this with early Primary360 users who, with one of our early clients, almost 20% of the users had at least one mental health visit. Then lastly, no brand currently owns this space in consumers' minds, and Teladoc is well-positioned when it comes to driving. Teladoc brand is the leader across awareness, usage, and satisfaction. Teladoc is well-positioned to be the brand that people turn to first.
Research across a broad audience shows that we're well associated with a broad set of care needs, and that Teladoc users, as you can see from the stats in the middle, Teladoc users overwhelmingly see us as the provider that not only can treat a broad set of needs, but actually can help resolve them. What this positions us to do is actually be the brand that extends into that white space. As we continue to drive towards mainstream adoption of whole person care, we will continue to extend the Teladoc brand across our full portfolio of B to B to C solutions. In summary, we're well on our way to driving the adoption of whole person care.
We're deepening the relationships that we have with consumers, and we're uniquely positioned to win going forward with consumers given the unmatched experience we provide, our differentiated capabilities, the trusted brand, and obviously our proven track record. Thank you. With that, I will turn it over to Mala.
Thank you, Stephany. Good afternoon, everyone. I'm Mala Murthy, I'm the CFO of Teladoc Health. I hope what you take away from this morning is not Rumpelstiltskin, that Jason talked about. Apparently, Through The Looking Glass that Dan talked about. I hope what you have taken away is the depth and breadth of what we do, our strategic differentiated assets and capabilities, and how we are thinking about the business and the growth of our business going forward. What I'll do in the next several minutes is essentially bring it all together from a financial perspective. Okay. Before I look forward, just indulge me one moment. Let me look back very briefly. If you look at our revenue growth, that's on the top left. Our revenue growth of the past three years has been 69% on a CAGR basis.
That's over 40% on an organic basis. Our business has quintupled in size over the last three years. From a profit perspective, we turned positive adjusted EBITDA back in 2018, as you can see. We are expecting to deliver over $260 million in adjusted EBITDA this year. That's over 700 basis points of adjusted EBITDA margin expansion over the past two years. That's well ahead of what we said and expected to do when we stood before you all March of 2020. Importantly, the profit is generating operating cash flow. Over $100 million of operating cash flow delivered through Q3 year to date. That's important as we think about the investments that we are making, and we will continue to make.
Claus talked about it, Donna talked about it, and I'll go into a little bit more detail on it, so that we can continue to fuel our top line growth and momentum. Speaking about sustainable top line growth and momentum, I talked about the 69% CAGR, three-year CAGR over the past few years. We talked a couple of weeks ago that we expect to deliver between $2.015 billion-$2.025 billion in 2021. That is a 45% pro forma revenue growth, pro forma for the Livongo merger. We also talked about the $2.6 billion preliminary outlook in revenue for 2022. That is approximately 30% revenue growth for 2022.
If you put that all together, importantly, we are expecting to deliver between 30% and 40% revenue growth through 2023, as we said last summer. If we look over the next three years, we are expected to deliver 25%-30% revenue growth through 2024, putting us on track to be over $4 billion in revenue by 2024. How do we think about the building blocks and the drivers for this revenue growth? Jason talked about it up front. I'll double-click on it a little bit more. You can see it's three strategic areas of focus, virtual medical care, mental health care, and chronic care. Let's start with virtual medical care, which is about a third of our business today. That includes our Gen Med business. It includes international. It also includes, importantly, Primary360. Okay?
Dan talked very eloquently about Primary360, the product, how we are thinking about it. What I would say is, while we expect the revenue contribution from Primary360 for this piece of the business to be small in 2022, we are just rolling it out with some of our important relationships that Kelly talked about, like Aetna, Centene, et cetera. We do expect the contribution from that to steadily ramp up and be an important contributor to our revenue growth by 2024, right? Now, why is that? Because if you think about it, Jason talked about the fact that we have access to 92 million lives right across our clients.
If you think about the fact that most of them today have a General Medical solution, which they do, think about the opportunity for us to move them up to a higher value offering such as Primary360. That's gonna take time, and we will ramp very steadily through 2024. We expect this piece of the business to be between 10%-20%, accelerating, as I said, over the next three years. Now let's talk about mental health care. Both Alon and Dan have talked about mental health care, right? The vast opportunity for growth. It's about 40% of our business today. We expect it to grow between 30% and 40% over the next three years.
What's important is, you know, people ask us all the time, "Is it a COVID phenomenon?" I hope what you took away from what Alon and Booth said is, no, it's not. While COVID has merely heightened the need, the unmet need for mental health care, we've been seeing this for a while, and these are sustained tailwinds that will fuel this growth. Chronic care, we talked about it a couple of weeks ago on our analyst call. It's about 25% of our business. We expect it to grow 25%-35%, both from more enrollees and enrollees accessing multiple programs. Right? That's how it all adds up to how we are thinking about our 25%-30% revenue growth over the next three years. Why do we have confidence in this 25%-30% growth?
In our view, it boils down to a few important factors. Number one, what we affectionately call the membership donut on the left. You can see 92 million lives with access to a Teladoc product. That is an unmatched, unique, rich asset base that we have. Number two, think about the opportunity for us to penetrate that base deeper with higher value products and services such as Primary360, such as chronic care, such as MyStrength Complete. Right? That is how we think about expanding our share of the health wallet. Okay, I talked about product penetration. What is the opportunity for product penetration? Let's look on the right. It's true that if you think about the urgent care telehealth solution, it's very heavily penetrated, over 80%. But look down on the right.
Unsurprisingly, things such as Primary360 and myStrength Complete are very nascent. Obviously, we've just launched them. Just look at even something like diabetes, only a 20% penetration, right? Look at our mental health telehealth solution. It's about 35%. The legacy myStrength digital product, 22%. The point being, if you take the fact that we have access to these 92 million lives, combined with the opportunity for us to penetrate further into that base, a base we already have, with products that we already have, and these are our higher value products and services, that is what is fueling our confidence in expanding our revenue per member, as Jason talked about earlier. Now, it doesn't mean that we won't go after additional members. We will.
You can see again on the left side, there is scope for us to go after additional members, whether it be the 63 million members in our own client within our own clients or 92 million outside of that. This is where the land and expand strategy that Kelly talked about is important, right? We are increasingly having C-suite conversations and getting a toehold into additional populations with our clients with higher value offerings, conversations around 360, conversations around chronic care. Once we land, we will expand with this full suite of our products and services, including, by the way, in those products and services, the basic telehealth solutions, which will unseat our competitors. That is how we think about expanding our membership over what I will remind you is already a very, very rich base.
Let me now answer the question that we've been asked many times over the past year. What does this all mean in terms of the growth algorithm? We've talked about the 25%-30%. What it comes down to is we expect our revenue per member over the next three years to grow about 25%. Most of our growth, a lot of our growth, will come from expanding revenue per member for all of the reasons that I just talked about. Now, if you wanna think about how can you translate that into, say, a PMPM metric that we report, that you're all very familiar with. Think about it this way. Every 100,000 new participating, actively participating members in, say, something like Primary360 will add $0.07 to PMPM.
Every 100,000 in myStrength Complete add $0.4 , and every 100,000 in Chronic Care Complete will add $0.15 . Think about the value accretion to our PMPM. Last but not least, an additional five percentage points of BetterHelp revenue growth adds $0.6 to our PMPM. Membership growth will add between 1-5 percentage points in revenue growth over the next three years. I've talked about product penetration into the member base, the base of lives we have. The point is we know how to do it. We have done it. Why do I say that? We've talked in the last several quarters about multi-product sales, right? Over 70% of our bookings is multiple products. What is that translating in? You can see what it's translating into on the left.
Back in 2017, less than 10% of our members had access and used one or more solutions. Today, that number is over 40%, and in fact, over 25% of our members now use three or more solutions. Same phenomenon on the right. If you look at chronic care, back in 2019, less than 3% participated in multiple programs. Today, that's over 20%. Again, to wrap it all together, we have access to a large base of lives, the 92 million. There is an opportunity for us with our products to penetrate deeper into that, and we know how to do it. That is, again, fueling how we think and our confidence in expanding our revenue per member. I've talked a lot about revenue growth. Let's talk about profit.
I talked a few minutes ago about the fact that we are expecting to deliver greater than $260 million this year in adjusted EBITDA, the over 700 basis points of adjusted EBITDA margin expansion over the last two years. We are driving adjusted EBITDA margin expansion and growth through both revenue scaling and disciplined operating expense leverage, and I do expect that to continue, especially on the SG&A side. Now, in the next three years, we do expect adjusted EBITDA margins to expand by between 100 and 150 basis points. Importantly, that will include the R&D investments that we will make, and I'll go into more detail on that in a minute.
Just as a quick reminder, we will not get the benefit that we got this year of approximately 75 basis points of margin expansion because of the purchase price accounting adjustments from Livongo. What are we going to invest in from a P&L capacity standpoint? Three areas. First, product enhancements and integration. Donna talked about how an integrated user experience is critical to serve as a digital front door to our consumer healthcare needs. Klaus talked at length about our data, our data platform, and our integrated data platform. Dan talked about how myStrength Complete is serving as a blueprint for Chronic Care Complete, right? Which we will launch. Those are the kinds of things that we will invest as it relates to product enhancements and integration.
Second, market expansion, whether that is marketing dollars for Alon as he grows his business, engagement and enrollment investments to support launches of new products, whether that be chronic care expansion into international markets, something that we have talked about as we talked about synergies in relation to the Livongo transaction or new chronic care programs. Dan talked about heart failure and chronic kidney disease. That is what we'll invest in. Last but not least, Kelly talked about making the journey into value-based arrangements. We need to invest in analytical capabilities. We need to invest in data for that. We need to invest in predictive modeling, and we will invest in that. I hope that gives you a sense for how we will use our P&L capacity to make the right investments.
We will never compromise on our return measures and our need for attractive ROI, but we do believe that these are important investments that we need to make to sustain our revenue growth. Last but not least, I talked about how we are using our P&L capacity. We also have a strong balance sheet. We have over $800 million of cash through the end of Q3, and as I said, we are generating over $100 million of operating cash flow. As we have in the past, we will use it to make inorganic growth investments. Now our filters, our criteria for assessing inorganic investments remain the same as before, right? We've talked about how it needs to enhance our vision, our strategy. It needs to be a strong culture fit. It needs to have attractive financials.
I would be remiss in saying if I didn't say, we will incorporate the learnings of the integrations that we have gone through over the last 18 months and are still going through, right, as we assess these investments. I hope what you have taken away from the last few minutes is the following. First, we have a demonstrated track record of meeting or beating our financial targets. Second, what I hope you've heard all morning is the fact that we have a comprehensive virtual care product portfolio and scale that creates a compelling financial model. Third, our growth over the next three years, as we see it, is going to be driven by expanding our revenue per member for all of the reasons that I talked about.
Last, our profit expansion, our margin expansion and cash flow generation will fund continued investment in our business so that we continue to grow sustainably. Before I turn it over to Jason for concluding remarks, I wanted to thank you for coming, for participating, either in person or virtually. I hope what you have taken away is, again, the breadth and depth of what we do, our vision, our mission, our strategy, and our building blocks for success. With that, let me turn it over to Jason.
Before I wrap it up, I have an important correction to make. While you all were having lunch, I was getting brutally made fun of by my team for mixing up Rumpelstiltskin and Rip Van Winkle. I just wanna set the record clear. It was Rip Van Winkle who fell asleep, not Rumpelstiltskin. My kids always made fun of me, saying I was terrible at fairy tales. The good news is that I don't have to be good at fairy tales to make this a reality, right? I swear that wasn't on purpose. What I started with was the opportunity in front of us is massive to make a huge impact on the healthcare that people get in their lives and on the healthcare system at large, and there's a big financial opportunity that goes with it.
We have the vision to go take advantage of that opportunity. We have the strategy to execute on that vision, and we have the underlying capabilities that nobody else has. So we are uniquely positioned to take advantage of this massive opportunity in front of us. Now it really comes down to execution. I can say with confidence that we have a track record of executing, right?
We came out six years ago and said, "Here's what we're gonna do, and here's where we're gonna go, and here's how the market's gonna evolve." We have taken meaningful steps along the way and tried to give the investor community, and quite frankly, more importantly, our clients and members, a roadmap for where we think things are going and how we can help make their care better and take costs out of the system and improve the healthcare of our communities, so that we can achieve our mission of helping our members to live their healthiest lives. I wanna reiterate the things that Mala just said, and challenge you one more time, that if we have failed to demonstrate any of these, we're gonna bring the whole team up for a final Q&A section.
We really welcome your questions, and please challenge us if you think that we've omitted any part of this progression. Thanks again. We'll have the team come up. We have to bring our own chairs. Thank you. Linda, I think we have a question at the front corner. Let's right here. Are we good? Okay. Mala, come sit next to me. Come on.
Stan Berenshteyn from Wells Fargo. Hey. Hi. Thanks. Wanted to come back to virtual first health plan side of things. I was hoping you could talk a little bit about more for the employers that have adopted these services. How are they educating their employees and pushing their employees to consider using these types of plans? When you talk about the 10%-20% lower cost that these plans could generate over time, is there a general way that you could help us think about whether the employees themselves that adopt these plans are seeing those savings, or is that something that's being used to sort of subsidize broader healthcare costs for the company? I'm just trying to think about what the factors are that are gonna push people to adopt or not adopt these types of plans.
Yeah. I'll take the second part of your question first and then hand it to Kelly for employer and client experience and really commercialization of Primary360. What we're seeing is a lower employee contribution when it's in a fully self-insured plan for a virtual first plan design because they know that the actuarial value, expectation for cost is lower, and they wanna pass that on to their employee population. Certainly, we're gonna see that reflected in the exchange plans and, you know, what the ultimate actuarial cost is, therefore minus the subsidy, what it costs the consumer.
You know, we're starting to see the plans talk about commercial fully insured plans in small group markets and even individual non-exchange plans that are based on that that again reflect the lower cost.
Yep. I think what I would also add is that there's actually two deployments when you think about an employer. They could actually opt to offer a Primary360 program as an additive layer on top of whatever plan offerings that they're putting forth with their populations, or and/or they can add to a virtual first primary offering where they're actually affirmatively electing their population would affirmatively elect that plan over any other plan in the lineup. There's actually two offerings, and what's fascinating about it is, as we've been talking to employers about the offerings, many of them are sort of stage gating, "Where's my population going, you know, to actually see the most value?
Where am I gonna see the most value?" Many of them are actually talking about deploying both of them simultaneously, one being sort of a stepping stone to another. We're opening up the access point with Primary360 as an overlay, meaning there's versions of how you might control costs on top of your health plan. Then the opt-in model is, "I'm gonna deliberately choose this offering." Actually, the way that they're modeling it is basically, you know, like you would model a health plan design. So every employer can offer sort of contribution factors to that. We're seeing a lot of momentum in how they're coming at it, looking at it actually in concert with one another.
Kelly, we also, right. As we, as your team and our teams come together in the contracting phase, are talking about the difference between how they are going to approach driving engagement.
Yep. Yep.
Is that Charles?
Yeah. Thanks. Question for Mala. You know, you gave the revenue accretion on the PMPM for the different buckets for every 100,000 members. Maybe can you extrapolate that to margins as well? Think about EBITDA contribution for each 100,000, whether it's, you know, chronic care, myStrength or-
Yeah.
Primary360.
Yeah. I'm not gonna give you product specific margins, but I'll answer the question, directly and more generally. On Primary360, it's candidly too soon, but as we are having the conversations and as we have talked about the rolling out of Primary360, you know, we will learn what the gross margins and what the variable contribution margins, candidly speaking, will settle out as. You know, we have a strong history of managing our margins, and frankly, managing both the gross margin and the operating expense such that we get to the adjusted EBITDA margins that we want. The fact that we are putting out there a longer term outlook on adjusted EBITDA margins hopefully gives you enough information that we have sort of thought through all of the puts and takes.
You know, if I think about myStrength Complete and the margins on that, attractive margins. I don't want to dissect it product by product, but I think we have given you enough information on how we are thinking about the corridors of each of those three areas. You know, in addition to the overall adjusted EBITDA margin expansion.
I might just add, just sort of echoing what Alon said, that the BetterHelp business is accretive to our overall consolidated.
Yeah.
Margins. I think you'll see an expansion of gross profit dollars per member as we go into higher value products, higher priced products like Primary360, where we play a bigger role. Of course, dropping through higher gross profit dollars per member, you know, a controlled expansion in our OpEx gives us expansion and the confidence that Mala talked about.
Mm-hmm.
Jailendra gets a second bite at the apple.
Thank you. Jailendra Singh, Credit Suisse. Just to make sure you're saying that mental health care growth, faster growth is actually accretive to your margin overall, right?
It is.
Okay. That's an important clarification. If I'm doing my math right, there's $100 million of non-BetterHelp DTC business in 2021. Is that traditional B2B telebehavioral business you're moving from core to mental health? Because that's important because I think people are getting confused with that 10%-20% growth with historical core growth. Actually, you moved a very important piece of growth from core.
Yes.
-to-
Yes.
That's.
Yeah.
Just confirm that.
To be crystal clear, what we have categorized in the mental health bucket includes the following components. It has BetterHelp, it has our historical Teladoc behavioral health solutions. It has the myStrength legacy digital solutions, and it has myStrength Complete, which has just launched. All of those four. If you think about it, Jailendra, we've taken myStrength out of chronic care and put it into mental health. To your point, we've taken legacy behavioral health out of virtual medical and put it into behavioral-
So one-
into mental health.
That's helpful clarification. Just one more quick one.
On the 10%-20% growth you're targeting for your virtual medical care business, should we think about it as slower growth in 2022 and then acceleration because of the Primary360? Is that the way to think about it?
Yes. Yes. You know, if you think about it from a CAGR standpoint, given what we have talked about Primary360 really being a small contributor to growth in revenue for 2022, and we have talked about the accelerating growth within the 10%-20% through 2024, I think you will be able to get a good sense for how much ramping we are expecting through 2024.
Okay. Thank you.
Steve, did you have a question?
Yeah. Hi. Steve Valiquette from Barclays. I know you're not giving the 2022 EBITDA guidance today, but with that target of 150 basis points of EBITDA margin expansion over the next three years, I mean, is it possible you could still have that type of EBITDA margin expansion in 2022 specifically, you know, despite the 75 basis points? Or is the message, you know, that with that headwind, you will not achieve that in 2022? Just wanna clarify that. Thanks.
I thought you started out by saying we will not give adjusted EBITDA guidance. I will not give adjusted EBITDA guidance. We will give it in February, pretty soon.
Is there a question at the back of the room?
Hi. Elizabeth Anderson from Evercore. I was wondering, you talked a lot about some of the investments that you're planning to make over the next few years in terms of patient acquisition and things like that. I was wondering if you could help put some guardrails around sort of how you think about the spend there versus in other parts of the OpEx. Thank you.
Yeah. Here's how I would sort of generally think about it, and again, I won't go into specific year guidance. Generally what we have said is think of A&M roughly in line with revenue growth. Now, I will say, Alon talked about the revenue to CAC efficiencies that he is getting. You know, one of the important factors fueling the strong margins that he's seeing in his business, he's also seeing higher LTV, quite candidly, right? All of those things are expanding his margins. Just coming back to our overall OpEx, the way I would think about it is think about marketing roughly in line with revenue growth. We have been getting good leverage on selling expense and G&A, right?
I would expect R&D investments, as we have talked about, to increase a bit, as we, you know, invest in the things that we need to, that Klaus talked about, that Donna talked about. Put all of that together within the context of the $100-$150.
At the front of the room, Linda. Sorry, make you walk all the way around.
That's okay. Thank you.
We have two questions side by side, so we can take them one after the other.
Jack Wallace, Guggenheim Securities. When you're talking with employers and talking about taking risk, how much of the PMPM is at risk? Is that bidirectional, and what type of metrics are being used?
Yeah. As Jason talked about, you know, as we are going in, making the journey into value-based, we haven't candidly at this point in time over the next three years factored a ton of that already into our growth outlook. I would also say, you know, we need to make the investments. We are going to do this thoughtfully, judiciously. We'll sort of do it. We've always talked about this being a multi-year ramp. I would say, you know, I view it as a strong enabler to the things that we have talked about, such as Primary360, the chronic care programs, et cetera. It's not as if that is very explicitly factored into our math today.
I would also just add, we're seeing more true, sort of risk arrangements with the health plans than with the employers. It's also not new for us to be paid for performance, right?
Yeah.
We've had for years situations where we're paid based on the value that we drive. Now, historically, if you go back four or five years, that was just how much utilization are you driving? Because we know for every-
additional incremental visit you drive, you're saving this much money. We've had an escalating PMPM that reflected the additional utilization and therefore the additional value. It was sort of an early crude form, quite frankly, of value-based reimbursement. We're now moving into more sophisticated models where we're starting to look, especially with the health plans that, okay, let's look at a population of people with diabetes and agree upfront on a methodology for what's the cost PMPM or the total cost for the year of those who engage with us versus those who don't. and therefore, we're willing to put a portion of our fees at risk to guarantee the savings that we're gonna drive because we know exactly what that looks like. It's just an evolutionary thing.
Yeah.
I don't want you to think, like, all of a sudden for the first time we're gonna be paid for performance, 'cause that's been at least five years old.
Hi. David Larsen with BTIG. Can you talk a little bit more about membership expectations for 2022? Then also on your slide 107, you highlight there's 298 million total U.S. insured lives. Why aren't you talking more about the 7.8 billion lives that are on planet Earth? Like, can you maybe talk about, you know, the growth potential in other countries? Is there a reason why there's not more emphasis there? Is it because they're socialized systems, they're harder to sell into? I would think that they would actually be easier to sell into because if they're cost-constrained, that's the whole strategy and purpose and value that your enterprise brings to those nations, and those could be sizable sales as well.
Yeah.
You want me to take the international part first, and then you jump into the membership outlook?
Either or both.
Okay, we'll do that. Internationally, look, I think the answer is, we expect to continue to get growth outside the U.S. Forecasting based on sales to big nationalized healthcare systems is a recipe for missing a quarter or even longer because they're big and they're binary, right? We don't build in any assumptions about giant, you know, sales to nationalized healthcare systems. That does not mean that we're not going after them, right, and that we don't expect to be able to land some of them, especially with our chronic care solutions, which we're finding a tremendous amount of interest from those nationalized healthcare systems. We just have to be like we always forecast based on what we know, not what we hope.
We try not to build that into at least a short to medium term forecast, and we view those as being upsides to our overall outlook.
Yeah. I would also say, you know, on international, Jason and I have had active conversations with the head of our international business, David, over the last two weeks, three weeks as we are building out our plan to next year. Suffice it to say, those are exactly the conversations we are having because, you know, as we think about our international growth, and I've always said this, you can go very quickly sideways if you splinter your investments across, you know, a vast swath of countries. I think international, it's really important that we stay focused on a few big bet countries, and that's exactly what we are doing.
If you take the chronic care programs combined with, exactly like you said, the national health systems, we are focusing it on a few big bet countries, and we are methodically going to grow into those, whether it be through the national health systems or whether it be, say, something like Telefónica, where we are very pleased with the growth.
Membership for 22?
Just like I said, I will not guide on adjusted EBITDA. We will absolutely guide on membership when it comes time in February. We will give you all the transparency that we typically do.
I'm sorry, just one more quick one. 21% penetration for CCM diabetes into 92 million Teladoc lives. I think about 20% of the population actually has diabetes. Is that 20% of the opportunity market within the 92 million lives?
Yes.
Okay.
Yes.
Thank you.
I think right here in front.
Thank you. Thanks. Cynthia Motz from Goldman Sachs. Stephany, maybe for you, maybe Kelly, can you talk a little bit more about how you market to providers, how you raise the awareness there? Also just in the consumer channel, like if a consumer has, you know, a plan with Aetna, how they get awareness so that they can go in and see, you know, what's being offered. Thanks.
Sure. I'll start probably with the easier one, which is the consumer, or the near and dear to my heart, is the consumer engine. When we talk about that surround sound engagement engine, it is really comprised of our ability to work with our clients, and that may be work with Aetna, it may be work with the employer through really the scalable infrastructure that we have. We know that is a very effective way to introduce the service.
What we also know is that all of our direct touch points that we have with them, and that may be through digital media, it could be through the direct mail that we do, it could be through, frankly, the TV advertising that we do, really is what is bringing together that whole paying off the introduction that we find either the health plan or the employer does. Kelly, did you wanna add anything on that?
Yeah. I think Jason was gonna talk a little bit more about the providers, but just to sort of jump on to from an employer perspective, we've always sort of taken the position that making sure that the member is aware of the services that are available to them, we take a lot of pride in that. You know, Stephany and her team do a fantastic job sort of owning that so that our clients don't. That's the value proposition that we bring to our clients.
We feel like it's our responsibility. There's many tentacles about it as to how do we get at that end consumer, whether that is via the health plan and the partnerships that we've built there to ensure that the services are, that they're made aware and that they're engaging in them, or as a direct channel, we can work directly with those employers to ensure that we have complete surround sound around, engaging them in whatever services are available. It, of course, is different, based on whatever that client has purchased along the way.
With respect to marketing to providers, we actually, we're in the middle of an evolution, I would say, from what was historically the InTouch business, of large devices in the hospital for high acuity situations like telestroke and telepsych in the ED, moving to more of a software platform that's a ubiquitous platform, and you heard from the Geisinger team about how we bring a ubiquitous software platform so that everyone can communicate with all of their patients regardless of where they are. Now we're seeing the benefit of the chronic care solutions being brought to the provider market, quite frankly, with faster adoption than we had expected, especially for those provider organizations who are taking risk.
We're finding that they're very interested in adopting those chronic care solutions to better manage down the cost of care, leveraging our technology and their physicians, when there needs to be a physician intervention.
Second bite for me, too. I hope I don't embarrass myself doing math in public here, but if you disaggregate the three product categories of virtual care, mental and chronic and model out your projected growth rates through 2024, you could wind up meaningfully above the $4 billion target that you guys have outlined for 2024 from a revenue perspective. I guess maybe could you just talk about the big puts and takes as you think about what could lead you to be substantively above or below that $4 billion number in 2024?
Yeah. Let me start, and then Jason, please chime in. If I think about the puts and takes, George, I'd say the following. We've talked at length about both Primary360 for virtual medical care, as well as myStrength Complete, the product that we just launched for mental health, right? What is embedded in our thinking about the ranges we gave you is the fact that these are very nascent, right? We have talked about all the reasons why we believe we are positioned to win. I think we are being, as Jason talked about, responsible in terms of how we think about the growth trajectory over the next three years. You're absolutely right. Mathematically, we could be at the high end of the range and absolutely beat it.
We wanted to at least give you the range in terms of, you know, how we think about it. That's one. The second is the point that David brought up that, you know, if you think about growth internationally, there is really attractive and sizable opportunities for us to partner with nationalized healthcare systems, but they're very lumpy. What we didn't want to do is to put out ranges there, and then have to come back and say, "Well, you know, we had factored those lumpy things into our forecast, and that's the reason for the miss." I would also say, if I think about mental health, you know, we have talked about the fact that there are sustained growth opportunities there.
That is also something that I would say when we, you know, we've talked about the 30%-40%, that is, you know, we've thought about the vast unmet need there is in terms of growth in that piece of the business.
The only other one I would add, I think you covered almost everything, is enrollment in the chronic care solutions. You know, when we sell into a population.
Yeah
We sell into a health plan or a large employer, we make assumptions about the enrollment that we're gonna get into the chronic care solutions from those populations. We're continuing to refine how we do that, as Stephany talked about, putting the marketing tech stacks together and leveraging the best expertise and technology from both organizations. You know, to the degree that we outperform our expectations with respect to chronic care enrollment, that could provide meaningful upside. I think, Patrick, are we running short on time, or are we still good? Two more.
Well, I have two questions then.
All right, the rest of you can pack up. Just kidding.
First on behavioral, curious, what's the split of B2C versus B2B in the revenue mix, and what are the growth expectations for each?
I think we have given you enough and more transparency in how we are thinking about it. I will not break it out further between B2B and B2C.
Okay. I guess maybe then my second question. For chronic care, how much of the growth expectations are coming from cross-selling the existing client base?
Yeah, you know, it goes back to the question, I think. I'll answer that question and answer the question that came up in the morning on synergies because they're sort of related, Stephany, to your question. Listen, we've talked about the robustness of the cross-sell pipeline. We've highlighted in our various earnings calls the cross-sell wins we are having. We feel really pleased with the progress that we are making on our cross-sell, and that's absolutely embedded into the growth ranges that we have provided for chronic care.
The thing I will also say realistically is, you know, if you think about how our business is evolving and the whole person approach that we are taking and the various on-ramps that we have talked about at length, I do think over time, it is going to be increasingly difficult to parse out. I totally understand you need it from a modeling perspective. By the way, that is exactly why we have laid it out in the way we did across the three tracks. I will be equally honest in saying as we think about the business, as we think about managing it, the client conversations we are having, it's all becoming increasingly intertwined. Like, if I give you know.
One example would be if you think about what Dan talked about for Primary360, the reason that will be successful is because of the chronic care and the Livongo capabilities we have. Is that a synergy? Is that not a synergy? It's completely unclear. I do think over time, this will all become sort of very, very intertwined and related.
All right. I think we're out of time. Thanks very much, everyone.
Thank you all for being here and for your longstanding attention.