US Telehealth Customer Intelligence: Who Buys, Why They
Act, and Where the Market Fails Them

Healthcare providers — hospitals, health systems, ambulatory clinics, and federally qualified health centres — hold the largest share of telehealth platform spend in 2025.[Polaris] Their purchasing logic is operational: they need remote consultation tools that slot into existing clinical workflows, reduce specialist wait times, and manage the rising volume of chronic disease patients without adding headcount. The growth driver here is not innovation — it is capacity pressure. Workforce shortages and an ageing patient population (Americans aged 65 and over are projected to grow 47% by 2050) mean providers need telehealth to do more with what they already have.[Intuition Labs]

Payers — commercial insurers and government programmes — are buying telehealth as a cost-containment instrument. The logic runs through readmission prevention, earlier intervention in chronic conditions, and reducing unnecessary emergency department use. CMS reimbursement codes for remote patient monitoring (codes 99453–99458) saw a 3,000% increase in claim volume over four years, which tells payers both that the model works and that it is becoming a standard of care they cannot ignore.[IQVIA] Payer procurement is slower and more committee-driven than provider buying, but the contracts are larger and longer.

The patient segment — individuals accessing telehealth directly or through employer-sponsored programmes and wearable-linked monitoring — is the smallest in current spend but the fastest-growing. MarketsandMarkets projects the RPM-linked patient function at a 38.4% CAGR through 2030.[MarketsandMarkets] The 19–40 age bracket drives nearly half of current telehealth claims,[FAIR Health] a cohort that expects on-demand digital access as a baseline, not a premium. Employers sit adjacent to this segment — they fund telehealth benefits but rarely appear as named buyers in procurement data, which is a data gap this research cannot resolve.

The pattern across buyer types is consistent: months of passive evaluation, followed by a single visible event that forces a decision. For health systems, the most common forcing events are a regulatory deadline — CMS reimbursement policy changes with a hard effective date — or an operational failure that becomes visible to leadership, such as a no-show rate that hits the CFO's dashboard or a compliance audit that flags a workflow gap. For payers, the trigger tends to be a utilisation spike in a benefit category they are not yet managing virtually, which shows up in claims data before it shows up in strategy.

The CMS regulatory environment has created a specific forcing dynamic: 'policy cliff' deadlines. The at-home telehealth flexibility for non-mental health Medicare visits faced expiry at September 30, 2025, and the DEA audio-only prescribing rule for controlled substances was unresolved into 2026.[HHS Telehealth Policy][Federal Register] Each deadline triggers a wave of procurement activity from providers and payers who need to know their platform can handle whatever the new rules require. Alliance for Connected Care flagged in December 2025 that CMS eliminating home-based billing flexibility would increase administrative burden — the kind of statement that turns into a procurement brief inside health systems.[Alliance Connected Care]

EHR integration failure is the third class of trigger — and the most underappreciated. When a health system runs telehealth on a standalone platform that does not sync with its primary EHR, the friction compounds daily: duplicate documentation, billing mismatches, and patient data that lives in two systems. According to a PMC survey of over 4,000 physicians, 63% already say EHRs add to their daily practice burden.[PMC] Adding a non-integrated telehealth layer turns a chronic frustration into an active political problem inside the organisation — and that is when the RFP gets written.

Across G2 and Capterra reviews for the four largest named telehealth platforms — Teladoc, Amwell, MDLive, and Wheel — the most consistent praise theme is not the feature that buyers specified in procurement. It is an operational benefit they did not anticipate. A clinic manager reviewing Teladoc described cutting their no-show rate by 40%, with a direct revenue impact they described as unexpected. A pediatrician on Capterra cited Teladoc's Epic sync saving two hours a day in documentation. These are not marketing claims — they are the specific, quantified outcomes that appear unprompted in post-deployment reviews.[Capterra]

Amwell scores highest on hybrid care flexibility among named reviewers — an ACO executive described post-operative follow-ups moving 95% virtual with a 25% reduction in readmissions.[KLAS] Wheel, which serves primarily health plans and direct-care practices, draws praise for compliance-first design: a direct primary care owner cited its audio-only function for DEA rule compliance in rural controlled substance prescribing — exactly the regulatory anxiety that drives procurement decisions. Wheel's shift-filling efficiency (95% of provider shifts filled within two hours, per a December 2025 G2 review) addresses a workforce shortage problem that buyers often do not articulate until after a platform goes live.[G2]

MDLive's strongest praise category is speed and affordability in urgent and behavioural care — a payer representative described real-time claims adjudication with zero denials across 200-plus visits per month, which removes a back-office burden that typically sits outside any telehealth RFP criteria. The pattern across all four platforms is the same: buyers specify EHR integration, access, and compliance in their procurement criteria, and then praise speed, unexpected cost savings, and workflow relief once the platform is live. That gap between stated purchase criteria and experienced value is where product differentiation actually lives.

The most documented frustration in the US telehealth market is not a product failure — it is a systems failure. A 2025 NIH systematic review identified inadequate infrastructure, lack of financial reimbursement, and privacy concerns during video visits (specifically the risk of eavesdropping in non-private home settings) as the primary barriers reported by both clinicians and patients.[NIH] These are not objections raised during sales cycles. They surface after deployment, in public reviews and peer conversations, when the gap between the vendor demo and the clinical reality becomes clear.

The EHR integration complaint is structural. According to a PMC survey of over 4,000 physicians, 63% agree that EHRs add to their daily practice burden — and that is before adding a telehealth layer.[PMC] When a telehealth platform does not integrate cleanly with the primary clinical record, the result is double documentation: a clinical note in the EHR and a separate encounter record in the telehealth system. Billing codes need reconciling across both. Patient history is incomplete in one or both systems. This is the complaint that does not appear in the RFP because buyers assume integration as a baseline — and discover it is not when they are already live.

Reimbursement workflow complexity is the third category of frustration, and it falls hardest on providers who lack billing teams. CMS RPM codes (99453–99458) require device setup documentation, monthly monitoring records, and time-based billing logs. For small practices and FQHCs that adopted telehealth during COVID with minimal billing infrastructure, the administrative overhead of correct RPM billing is significant — and platforms that do not automate this workflow leave providers exposed to claim denials. The CMS 2026 Physician Fee Schedule added caregiver training services and proposed new RPM/RTM reimbursement structures,[Federal Register] each addition increasing the compliance surface area that platforms must cover.

The Federal Register's November 2025 publication of the 2026 CMS Physician Fee Schedule is the most consequential document in the US telehealth procurement market right now.[Federal Register] It extended audio-only behavioural health billing for rural health centres and FQHCs. It added caregiver training as a billable telehealth service. It proposed new reimbursement structures for remote patient monitoring and remote therapeutic monitoring. Each of these decisions tells a health system, payer, or practice what their telehealth platform must be able to do in the next twelve months — and whether their current vendor can do it.

The pattern of 'policy cliff' deadlines has created a distinctive buying cycle. Health system administrators describe a recurring dynamic: months of watching regulators deliberate, followed by a rush to assess vendor compliance when the rule finalises. The Alliance for Connected Care noted in December 2025 that eliminating at-home non-mental health billing flexibility would increase administrative burden — a statement that translates directly into a platform requirement.[Alliance Connected Care] Providers who relied on at-home visit flexibility for chronic disease management now need either a new workflow or a platform that automates the in-person scheduling alternative.

For founders building in this market, the regulatory calendar is the product roadmap. A platform that can certify compliance with new CMS billing codes within weeks of publication — not months — has a meaningful procurement advantage. The buyers who have experienced one 'policy cliff' scramble are the ones who make compliance-readiness a named criterion in their next RFP.

The telehealth market's competitive dynamics have shifted fundamentally since 2022. When access was the primary value driver — during COVID, when any virtual visit was better than none — platforms competed on availability and speed. In 2025–2026, the competition is on integration depth and regulatory competence. A platform that cannot certify CMS billing compliance within weeks of a new PFS publication, or cannot prove bidirectional EHR sync with Epic, Cerner, and Oracle Health, is losing procurement decisions it may not even know it entered.

Buyer power has increased. Health systems that adopted telehealth during COVID on short-term contracts are now renewing — or not — with full data on utilisation rates, no-show rates, billing error rates, and EHR friction. They are negotiating from a position of operational experience, not theoretical expectation. This is the moment when platforms that delivered on their integration promises retain contracts, and platforms that overpromised in 2020–2022 face displacement. The switching cost is real — EHR integration migrations are painful — but it is not infinite, and buyers who have experienced chronic integration failures are willing to absorb it.

The threat of substitution is growing at the edges, not the centre. Epic and Oracle Health are building native telehealth modules into their EHR platforms, reducing the need for a separate telehealth vendor for health systems already running those systems. For these buyers, the question is shifting from 'which telehealth platform?' to 'why do we need a separate telehealth platform at all?' This is the existential competitive pressure for standalone telehealth vendors in the health system segment — and it is accelerating.