All right. To kick things off, thanks everybody for joining us today. We are hosting Teladoc and the CEO, Chuck Divita. For those of you that don't know me, my name's Peter Warendorf. I cover Teladoc at Barclays, as well as some other Healthcare Technology names. Maybe a good place to start, Chuck, we're coming up on two years in your tenure at Teladoc. Can you take us through your time there? Maybe in your experience so far, is there anything that's gone better than you thought, and maybe anything that's been a little bit more challenging than what you were expecting?
Yeah. I was a longtime customer of the company, actually was an executive at a large health plan, large blue plan for many years, and Teladoc was something that I'd watched through the years. I remember when I took over responsibility for a big part of the payer in the commercial space. I remember being at a broker's office and talking about this Teladoc thing, this was in 2018, and why it was important to his customer base. It was awkward. It was a buy-up at the time.
I went back and talked to our team, and I said, "Why aren't we doing this more broadly?" We talked about it, and I decided to roll it out to all of our commercial members, and we finished that in the fall of 2019. Of course, the pandemic hit, and all of our members had access to Virtual Care, and we had expanded Virtual Care to all of our population and additional Chronic Care Management programs. I had a lot of good understanding at Teladoc when I came in from the perspective of how do we take this scaled, you know, historically strong player to drive more value in the healthcare system. When I came in, I had some expectations.
I think what I found was probably maybe more acute on both ends of the spectrum, some strengths and assets and capabilities that I probably didn't appreciate fully, and then some challenges that I probably wanted to address more significantly, and we can go through those if you'd like. I think the course of my time as CEO has been trying to increase strategic focus, our operational rigor, our product innovation, which we needed to reinvigorate. Of course, I'm sure we'll talk about turning around BetterHelp, which was about 40% of the revenues of the company. That's been quite the journey. It's been a quick two years. I think we've got a much stronger footing heading into 2026 and happy to talk more about that with you.
Great. Yeah. Before we kick it off and start jumping on the business, can we maybe get an update on the CFO search, where that is and kind of the timeline for things there?
Yeah. It's been going well. I mean, we hired a large search firm to go after that opportunity, important position for us. I've interviewed many candidates, really looking for the right combination of course, financial expertise, as you would expect, but operational rigor, business background, really to be a strong partner as we execute these various initiatives. And we've been very fortunate that we have a strong finance team that had been built, so we've got a little bit of the luxury of making sure we get the right person in that seat. It's progressing well, but nothing to report right now.
Perfect. On the Integrated Care side, maybe we start there. The business has been a low- to mid-single-digit grower with low double-digit to mid-teens EBITDA margins over the last few years with some margin expansion. I mean, what's your overall assessment of how that business has performed and kinda what the opportunity is there?
Yeah. I think there's a few things I would highlight for those that are familiar with Teladoc, really was a pioneer in the space and had been around for about 20 years. For a large part of its history, was really predominantly a subscription-based model because, you know, the market wasn't quite sure how to think of this new space, and companies like Teladoc needed some predictability in revenues and cash flows and things like that. It was a subscription-based model. Well, then the pandemic hit and obviously broad adoption of Virtual Care, and post-pandemic, we've been seeing a migration from those subscription models to more like the rest of the U.S. healthcare system works as a fee-for-service basis. We call it business-based arrangements in Teladoc.
Inside of Integrated Care, we've had this mix shift that's going on, and can add more color on that. But I think we're in the middle to later stages of that transition and had good underlying growth in visit revenues to offset that. The Chronic Care space, which we've had some good enrollment growth there. I think inside of Integrated Care, there's two or three big levers that are going on there, changes. The last thing is we've got a significant international position in Integrated Care. I think as we look at the sort of growth algorithm going forward, you're gonna see this visit-based growth, subsiding subscription mix headwind, growth and penetration in Chronic Care and continued growth internationally, and that should drive the revenue growth as well as the EBITDA margin expansion.
Great. Maybe we'll start on the membership side within Integrated Care. I know you guys have right around 100 million lives which is a pretty impressive membership base. You're guiding to that being down kind of a low single-digit number this year. I know there's a little bit of nuance. Can you maybe unpack that for us and what's happening there? Because I know that in 1Q, maybe the membership guidance is a little bit higher than the expectation for the full year. If you can unpack that as well as the timing of those customers.
Yeah. You know, we've grown membership pretty materially over the last several years, up about 40% since 2020, including adding some big clients last year. We've got good stability in the membership base, good stability retention with the clients. What we tried to factor into the guidance was, you know, there's a lot of things going on in healthcare, as you all know, that are tracking this. You've got Medicaid redeterminations, you've got the enhanced subsidies going away, some challenges in Medicare. We just tried to look at that and say, "What do we think membership is gonna look like for us in the year?" Then we'll see how that unfolds.
You know, there's some indications that maybe the challenges in the Affordable Care Act in terms of retention may be better than some people think. We just need to see how it plays out. I think that's different from what converts to revenues for us, though, because we've seen this migration I mentioned towards visit-based arrangements. It's really about not just the raw membership number, but the utilization of the services, which is why our guidance in 2026 shows revenue growth even with some headwind in the raw membership count, and we'll just see how that plays out.
Got it. Maybe touching on Chronic Care within the Integrated Care segment, I mean, enrollment has grown a little bit sequentially each of the last couple of quarters. How would you characterize the opportunity there? I mean, how much of that comes from upselling versus engaging new members? Are there any products that you guys get particularly excited about? I know we get a lot of questions on weight loss more broadly. If there's anything you would highlight within Chronic Care.
Yeah. You know, we've had sequential growth in enrollment, like you said. We do have a tough comp year over year because of last year in the second quarter. I mentioned a customer loss that we had, and that will, you know, comp out, if you will. We do expect to continue to see Chronic Care enrollment growth. You know, the way that that business works is we sell the product. We can sell, cross-sell multiple products in Chronic Care. We get what we call recruitables. It's the addressable lives that we can go after, and then we activate them, enroll them, and retain them. We have many multiples of the one product Chronic Care as recruitables.
Clearly there's opportunity in penetration there, and we've continued to grow the recruitable base. There's penetration into that 100 million lives. We've made nice progress there, so there's upside there. I think within the portfolio, and I think maybe it distinguishes us a little bit in this area, is at the end of the day, Teladoc is a provider, and we approach these populations more with that provider clinically oriented lens. The more services we can do for the population, the more they engage, the stickier they are, those kinds of things. Within the product suite that's within Chronic Care to address more populations, we have seen more interest in weight management, to your point.
Obviously, there's been a lot of interest out there and a lot of outsized interest within our portfolio, but we're really trying to cross-sell multiple products so that we can have deeper penetration and sort of longer sustainability of population health. That's kinda the way we approach it. I think it's a little bit different from others.
Okay.
Yeah.
You mentioned earlier the shift to visit-based revenues within Integrated Care. Can you remind us, like, who is pushing for those visit-based fees or visit-based revenues? Is that the customers pushing for that? Is that something that you're dictating? And which kind of contracting is maybe more beneficial to you guys?
Yeah. It's more of a market environment. If you think about it, you know, I mentioned a little bit earlier, but pre-pandemic, it was a subscription model for the reasons I mentioned. The customers wanted it, Teladoc wanted it for predictability purposes. There's still a significant percentage of our customer base that sees the subscriptions as valuable, right? Because it's predictable and you can plan for it. As we've now had broad adoption in Virtual Care, you know, the customer base is more like, "Well, you know what? I'd like to pay you like the rest of the U.S. healthcare system," which is a fee-for-service environment.
The market's kind of evolving, I think naturally and predictably, towards these more visit-based arrangements. From our perspective, we're fine with either way. I think we have seen a headwind from the subscription-to-visit mix over the last few years that will subside. Ultimately, that visit is a opportunity for us to provide services, engage, and connect them with other services we have. We see those visits as beneficial beyond just what we saw in the subscription model.
Got it. Is there any difference to the operating expense line, with that change in model? Like, is there any difference in the cadence of maybe advertising costs throughout the year or anything like that?
There's a few differences in, you know, fee-for-service environment versus the subscriptions. It's a different gross margin profile. I would say in the visit-based arrangements, the gross margin moves, you know, with the visit, if you will, as opposed to if you think about a subscription model, visits may be a bad thing to gross margin, or lack of visits may be a good thing to gross margin. At the end of the day, you want people utilizing your services. I think we see a little bit of a difference there. The advertising and marketing, we've actually been able to bring that spend down as a percentage of revenue in Integrated Care over the last few years. We've always been a B 2 B, B2 C kind of business.
I think we're gonna be able to manage that as a percentage of revenues. The OpEx is just, you know, the same level of complexity that we've had in subscriptions versus visits, installing the clients, the eligibility, the systems we use, and all that. I think when we're towards the tail end of that migration, you know, we're gonna see that settle out. We've been able to deliver a strong bottom line result through operational expense savings and other things. You know, I think we've been able to manage it.
All right. That all makes sense. Maybe we'll move over to BetterHelp now, where I would say maybe that business has been a little bit more volatile. You've seen some of the membership numbers have moved lower. It feels like we're maybe getting to a place now where that's starting to stabilize. I guess, what's your assessment of that business, and where are you at kind of in the turnaround of the overall business?
Yeah. I mean, that's one of the business when I joined the company, obviously, and when I was interviewing for the role, I learned more about BetterHelp. I was not as familiar with BetterHelp before that. I was more focused on the payer side and Integrated Care. What I found was, you know, one, I had been a big proponent of us in my payer life, adding more access to Mental Health. I'm glad to see post-pandemic, there's much more appreciation for the Mental Health challenges out there.
BetterHelp had really built a leading position in the consumer-oriented space, the largest by far in what it did, but had run into some challenges because it was a direct-to-consumer cash pay model, and you're basically asking somebody to pay the equivalent of a car payment every month for therapy out of pocket. I looked at that when I came in and said, "You know, we really need to pivot this asset more towards where the rest of the U.S. system is, which is insurance coverage."
We did an acquisition, and we've been executing that, and we're gonna see nice growth this year. To me, BetterHelp is, I think it's a story. Chapters are still being written. Amazing consumer experience. By far the strongest brand awareness, 30,000+ therapist network, huge scale business, and its customer base needs to be able to access their insurance and we should be able to see significant growth in insurance in 2026, and then ultimately the stabilization and growth outlook for that business.
Great. Yeah, that makes complete sense. I mean, if we're trying to think about maybe membership being a mid-single-digit headwind in 2025, is there a point in 2026 where we can kinda see that trajectory start to move upward, and maybe bottom out? Like, is there a sequential step up at some point in 2026, do you think?
Look, I think we're gonna see. There's two main parts of BetterHelp. Obviously, we have the U.S. business, which I'll touch on, which is really at the heart of your question, and we have a non-U.S. business. BetterHelp is actually in several countries and represents about 24% of revenues of the segment at this point, and that continues to grow. We expect to see continued growth internationally because of the access concerns in other countries. Mental Health is not just a U.S. phenomenon.
There's challenges globally. In the U.S. business, because of the size of BetterHelp's consumer business, again, the largest by far in that direct-to-consumer channel, we have seen that user growth be negative for a little bit. As we grow insurance, we expect to cross that at some point where we see the overall users, whether they're consumer or insurance, to stabilize and grow. You know, we would need to see more results from what we're doing, but we like what we're seeing so far.
Is that an area as customers come on the insurance product, is there some natural cannibalization of the consumer or the DTC product, where those customers see, "Hey, look, I can get this for cheaper using my insurance," the cash outlay for them is lower so that they naturally move to that insured product?
Look, we expect to see some cannibalization, but I think, you know, stepping back on BetterHelp, just as a few data points. You know, we have millions of people every year that start the registration process at BetterHelp, give us their email. They have a need, and they express interest. Over 80% drop off in the cash pay model because, again, we're asking for a credit card, we're asking them to pay out of pocket. The insurance scaling is about taking that funnel, and by having the affordability be less of an issue for them, less of a barrier if they have an interest and a need to convert to users.
There'll be some cannibalization, but I would argue that a lot of the cannibalization we're seeing in BetterHelp was already occurring because those people were choosing not to use BetterHelp and perhaps use their insurance because we've seen growth in insurance coverage in our Integrated Care as well as with competitors. There'll be some of that. I do think that more of the funnel being converted to users of BetterHelp is the play. Again, with millions of people starting the process and less than 20% converting, we've got a lot of upside as we roll out insurance, and I think that will overcome cannibalization at some point.
Yeah. With those insurance customers, have you seen anything with the initial ones, like in terms of duration that they stay on the platform or any different ways that they use it, that you think are worth mentioning?
I'll tell you what we're expecting to see, and I would say that the information is early, so I wanna caveat that. We wanna see more progress before we say something too definitive. However, as we've seen our Integrated Care side and we've seen with competitors with insurance coverage, there is an opportunity for greater lifetime value of a member, of a user, as well as a more efficient use of the acquisition cost, the advertising customer acquisition cost.
We do expect and believe that we will see more sessions per user because we're taking the cost issue, the cost barrier down with insurance coverage, and a more efficient use of advertising spend because we won't have to necessarily reacquire that member over and over again or that patient over and over again. Early on, we like what we're seeing in the data as we continue to scale it, but I don't wanna get too far ahead of that other than we are expecting to see that, but I wanna see more results first.
Great. Obviously, there was some news in the space on the behavioral health space that I'd be remiss if I didn't ask. Do you have any initial reactions to the M&A news that came out yesterday, with one of your competitors?
Look, I think it's a validation of what we're looking to do with BetterHelp. You know, the unmet Mental Health need is very real. There's strong demand out there, and taking BetterHelp, which has the predominant, you know, known brand in that space, into insurance coverage, we can see the potential of what that could look like. I think that transaction is something to look at and say, you know, there's a validation of the value of Virtual Mental Health, which post-pandemic has been one of the modalities that's been most widely adopted and sustained, is Virtual Care and Mental Health because, you know, you don't necessarily need to be seen in person for that, and that's continued on. Again, I think it's a validation of what we're trying to do.
Great. Moving over to maybe the financial and kind of guidance section of things. Obviously with 1Q, you guided fiscal 2026. That implies a reasonable ramp throughout the year in terms of revenue growth and margins, I would say. Can you maybe help us think about some of the underlying assumptions there, and what gets you to that revenue and EBITDA ramp, and how that's split between maybe operational execution or any macro improvement that you guys are assuming?
I think for Integrated Care, you know, what we've really got and I would say overall, when you look at it, the first half, second half outlook for Integrated Care is gonna be pretty consistent with what we've seen in prior years. As I mentioned, the more we've migrated to visit-based arrangements, you see visits and therefore volumes of visits be more of a factor in that equation. We saw that in the fourth quarter where we had, you know, we exceeded our midpoint and were upper end of the guidance, and one of the drivers was visits from the flu season. In the first quarter, we brought that down a bit because of the timing of that flu season.
You've got volume going on through the year, including in the fourth quarter and how we see the first quarter. That's in there. Chronic Care enrollment builds through the year, so we expect to see that. I think in Integrated Care, that coupled with our international growth explains our continued cost management efforts underway. We've done pretty well on that, I believe, and we continue to focus on costs that will drive some of the EBITDA results. In BetterHelp, it's really all about insurance scaling and our international growth, and we did guide. You know, we had a modest amount of insurance in 2025. We guided to $75 million-$90 million of insurance revenues in 2026, and that's gonna ramp, you know, pretty notably each quarter.
Okay.
The last thing I would say about BetterHelp, and this is a little bit on the Integrated Care side too, is you've got more days, you know, after the first quarter. There's another day in the second quarter and two more days in the other ones. On a volume-based business, that could be a needle mover also.
Great. Quick one, we'll touch on the balance sheet. I know we're coming up on time here. You guys have $1 billion of debt coming due the middle of next year. Current interest rates are pretty low on that one. I mean, can you give us an update on the timeline there? Similarly, I know M&A has been part of the business in the past. Like, what's your appetite for additional M&A, and what might that look like over the next couple of years?
Yeah. Well, I'll hit the debt first. We, you know, we had $550 million of converts due at the middle of 2025. We paid those off with existing cash. We ended the year with $780 million in cash on the balance sheet, and we have these, you know, $1 billion or so converts due middle of next year. You know, absent some other needs or demands or changes in market conditions, what I said on the earnings call was, we're assuming we're gonna pay down a material portion of that outstanding debt, maybe potentially before the end of the year, we'll see how that goes, through a combination of more traditional term debt as well as the cash that we have available. Then the remainder we'll pay down at maturity.
Ultimately have a lower gross leverage position than we have today, and I think that's just a prudent place for us to be as a company. We've got a lot of cash, a lot of good cash flow and options with respect to the debt. In terms of M&A, we have done some M&A since I joined, as you know. I think it's been really more strategic. You know, we bought a company called Catapult Health to deepen our penetration in our Integrated Care side in the U.S. really exciting capability we bought there. We bought UpLift right to get us into the insurance market in BetterHelp. That was our accelerant. We bought a company in Australia to deepen our position there. We're gonna look at our strategic priorities. We're gonna focus where we can accelerate our progress.
I would say predominantly where you're gonna see our focus is in the U.S. market. We think we have tremendous opportunity with this scaled position we have. You know, 12,000+ clients, 100 million lives. Our customers have more challenges, not less challenges in healthcare, so we think we can lean into that more, and I think M&A will play a part of that.
Great. I know we're coming up on time now, so, maybe to wrap it up. A lot of HCIT has been hit by some of these AI concerns, so I'm just curious, like, how defensible do you see your business? Like, what kind of moats do you think Teladoc has? And then any other thoughts you have on the business or what you think investors might be missing before we wrap it up?
Yeah, I mean, it's an exciting time with the advances in AI, and I think healthcare is gonna benefit from AI materially in terms of engagement, awareness, access, support, those kinds of things. Teladoc's been an active user of AI in its history, mostly in the machine learning area in some of the things we do. Last year, we saw this coming, and we made some significant investments in what we call our Pulse Health data in AI platform . We have a lot of data, 20 years of history across conditions, across a number of things. We're unifying that data, putting intelligence on that data, and then most importantly, you gotta activate that data into where there's a clinical intervention. Otherwise, it's just an insight. Well, we are a virtually native company. All of our processes, our workflows, everything is built virtually.
We believe strongly that we're gonna have the ability to deploy AI, and already are across the things we do. We're gonna do it in a responsible way because we wanna make sure that clinician-patient relationship remains at the forefront and is strong and it's complementary. In terms of our moats, you know, as I mentioned, we're deeply embedded in the U.S. healthcare system. 12,000 plus clients across health plans and employers, you know, used to operating in those types of environments.
Two, we have tremendous data, and data fuels AI, and that's important. Third is the breadth of our clinical position. You know, we provide services in a variety of ways across Mental Health, Chronic Care, Primary Care, 24/7 Care, and we're gonna continue to expand that. The last part, which I think is very important, we've got deep expertise in healthcare, and healthcare is a highly regulated industry, and I think the ability to deploy these tools in a way, all of those things I think create moats for us.
Great. If there's anything else you think investors are missing before we wrap up?
I think we've covered it. I just think that.
Great.
Keep an eye on us. We've been executing. We've laid out our priorities. We're giving the proof points.