Build vs Buy for Telehealth: The Hidden Costs of Custom Builds

This guide provides a comprehensive framework for making the build versus buy decision for telehealth platforms, including detailed cost comparisons and implementation timelines.

Key Factors for Deciding to Build or Buy Telehealth Solutions

This choice sets your spend, your launch timeline, and how fast you can scale. Treat it like picking the right vehicle for the road ahead.

What Is the Total Cost of Ownership for Build vs Buy?

Start with the total cost of ownership, or TCO. TCO combines all costs to build, run, and improve your platform over time. For new GLP-1, TRT, or ED programs, compare costs across 24 to 36 months to see the real picture.

Use this side-by-side view to plan with confidence.

Notice how upfront spend differs yet subscription fees rise over time. If you run on a tight budget or need proof of market fit first, off-the-shelf can keep you lean.

How Fast Do You Need to Launch?

Time to market matters. In primary care or specialty programs like GLP-1, you may lose patients to competitors who ship faster.

• Custom platforms: Expect 6–18 months from requirements to go-live. If you hire developers who need compliance training or third-party integrations for lab ordering or pharmacy, you could add more months.
• Off-the-shelf solutions: Many vendors promise 2–8 weeks to launch, including sandbox tests and basic compliance. You plug in branding and workflows, then start onboarding patients.

Ask yourself if market conditions demand speed or if a longer build will still beat competitors on features.

What Level of Integration with EHR Systems Do You Need?

Your EHR ties into patient charts, lab orders, billing, and prescribing. If you want deep customization or unique workflows, custom code may be the only path.

• Minimal integration: You only need patient demographics or visit notes. Most off-the- shelf platforms can handle that via HL7 or FHIR connectors.
• Moderate integration: You sync prescriptions, lab results, and maybe some imaging. Some vendors support this, but check each EHR for compatibility.
• Advanced integration: You need custom data transformations, complex workflows, or proprietary systems. Building your own gives you full control but adds complexity.

If your clinic relies on Epic, Cerner, or another major EHR, verify how each option handles those integrations before signing contracts.

How Important Is Long-Term Scalability?

Think ahead to 10,000+ monthly visits. Will your architecture handle the load? Custom platforms let you fine-tune performance, while off-the-shelf solutions rely on vendor infrastructure.

• Custom: You control the codebase and can optimize for your specific traffic patterns. But you also carry the burden of scaling servers, load balancers, and database performance.
• Off-the-shelf: Vendors handle infrastructure upgrades. If they limit your monthly visits or charge high per-visit fees, you may hit a ceiling.

Compare the vendor's max capacity against your growth plans. A $2 per-visit fee sounds small until you hit 5,000 visits a month.

The Hidden Costs of Building Custom Telehealth Platforms

Many teams underestimate the work that comes after the first MVP. Here is what people forget.

Engineering Hours and Team Size

An MVP for a basic telehealth platform can demand 1,400+ engineering hours. That covers front-end UI, back-end APIs, video calls, scheduling, billing, and basic compliance. Add a pharmacy integration or advanced security and you can double that number.

You also need UX designers, project managers, and QA testers. If you hire a full-time team of five people, you could spend $50,000–$75,000 per month in salaries alone before your platform goes live.

Ongoing Maintenance and Updates

Once you ship v1, expect ongoing updates. Healthcare regulations change. Security patches roll out. Bugs surface as usage grows.

• Software updates: Plan for quarterly or monthly sprints to fix issues and add features.
• Infrastructure costs: Cloud hosting, database storage, and CDN fees rise with patient volume.
• Compliance audits: HIPAA, state licensing, or SOC 2 audits can cost $5,000–$10,000 each year.

Some teams budget only for initial development and then scramble when they face these recurring costs.

Compliance and Security Overhead

Building a HIPAA-compliant platform is not as simple as encrypting data. You need a Business Associate Agreement (BAA) with every vendor that touches patient data. You must track access logs, maintain audit trails, and implement breach notification processes.

Many startups spend $5,000–$25,000 for their first compliance review. Annual audits or re-certifications can cost another $5,000–$10,000. Off-the-shelf vendors often include basic compliance support in their subscription, saving you that overhead.

Opportunity Cost of Delayed Launch

Every month you spend building is a month you are not serving patients. If competitors launch faster, they grab market share while you finalize your code.

Calculate lost revenue: if you expect 500 visits per month at an average of $100 per visit, a six-month delay could mean $300,000 in foregone revenue. That number can exceed your entire development budget.

The Hidden Costs of Buying Off-the-Shelf Solutions

Off-the-shelf platforms look cheap at first glance, but watch for rising fees and limited flexibility.

Per-Visit or Per-User Subscription Fees

Many vendors charge per visit or per active user. A $2 per-visit fee seems minor until you scale to 5,000 visits a month. That is $10,000 monthly, or $120,000 a year.

Compare that to a custom build that might cost $100,000 upfront with $1,000–$5,000 annual maintenance. After two years, the subscription model could exceed the cost of building your own platform.

Limited Customization and Feature Lock-In

Vendors offer a fixed set of features. If you want a custom workflow for prior authorizations or a unique patient onboarding flow, you may be out of luck.

• Some vendors let you customize front-end branding but lock core logic.
• Others charge extra for API access or advanced integrations.
• If your business model depends on a feature the vendor does not support, you either compromise or build it yourself.

Vendor Dependency and Exit Costs

Once you commit to a vendor, migrating away can be painful. Patient data must be exported, staff retrained, and workflows rebuilt. Some vendors make data export difficult or charge exit fees.

Before signing, check the vendor's data portability policy. Can you export all patient records in a standard format? What happens if the vendor raises prices or shuts down?

Integration Limitations

Off-the-shelf platforms may not integrate with your existing EHR or billing system. If integration is critical, verify compatibility before you commit.

Some vendors charge thousands for custom integrations. Others only support a limited list of EHRs. If your clinic uses a niche system, you might end up building custom middleware to bridge the gap.

How to Make a Data-Driven Build vs Buy Decision for Telehealth

Use a structured process to avoid emotional or rushed choices. Here is a step-by-step framework.

Step 1: Define Your Must-Have Features

List the core features you cannot launch without. Separate them from nice-to-haves. For example:

• Video visits (synchronous care)
• Asynchronous messaging for follow-ups
• Prescription management and e-prescribing
• Lab ordering and results delivery
• Patient scheduling and reminders
• Billing and insurance claims

If most vendors support your must-haves, buying may be faster. If you need unique workflows, custom might be the only path.

Step 2: Calculate Your Total Cost of Ownership

Use this formula:

Run the numbers for 24 and 36 months. If the custom build breaks even after three years, consider whether that timeline aligns with your growth plans.

Step 3: Assess Your Team's Technical Capacity

Do you have experienced developers on staff? Can they handle HIPAA compliance, video infrastructure, and ongoing updates?

• Strong in-house team: Building may be feasible if you have the bandwidth.
• Limited technical staff: Off-the-shelf removes the burden of managing infrastructure.

If you have to hire contractors or an entire dev team, factor those costs into your TCO.

Step 4: Evaluate Vendor Lock-In and Exit Strategies

Before signing with a vendor, understand the exit process. Ask:

• Can I export all patient data in a standard format (e.g., FHIR)?
• What is the notice period for cancellation?
• Are there penalties for early termination?
• How long does data migration take?

A vendor with easy data portability reduces your long-term risk. If they make migration difficult, you may be stuck paying rising fees.

Step 5: Pilot with a Hybrid Approach

Consider starting with an off-the-shelf platform for your MVP, then gradually build custom features as you scale. This hybrid approach lets you:

• Launch fast and validate market demand
• Learn what features patients actually use
• Invest in custom development only for high-ROI features

Tools like Specode, Twilio, or custom APIs can extend vendor platforms without rebuilding everything from scratch.

Real-World Examples: Build vs Buy Decisions in Telehealth

These case studies show how different clinics approached the build-or-buy decision.

Example 1: Primary Care Clinic Chooses Off-the-Shelf

A 10-provider primary care practice wanted to add telehealth during COVID-19. They had no in-house developers and needed to launch in weeks.

• Decision: Buy an off-the-shelf platform
• Cost: $500/month subscription + $1 per visit
• Launch time: 3 weeks
• Outcome: Served 200 patients in the first month. Subscription fees stayed manageable, and they avoided hiring developers.

Example 2: Specialty Clinic Builds Custom Platform

A dermatology group wanted deep integration with their proprietary imaging system and custom workflows for prior authorizations.

• Decision: Build a custom platform
• Cost: $200,000 upfront + $3,000/year maintenance
• Launch time: 12 months
• Outcome: Full control over features and data. After two years, they spent less than they would have on per-visit fees from vendors.

Example 3: Startup Uses Hybrid Approach

A GLP-1 telehealth startup needed to launch fast but wanted custom branding and advanced analytics.

• Decision: Start with an off-the-shelf platform, then build custom features
• Cost: $1,000/month vendor fee + $50,000 for custom analytics dashboard
• Launch time: 4 weeks for MVP, 6 months for custom features
• Outcome: Validated market demand quickly, then invested in custom features that differentiated them from competitors.

Key Takeaways and Next Steps

Your build-or-buy decision depends on budget, timeline, technical capacity, and long-term scalability. Here is what to remember:

• Custom builds give you full control but require significant upfront investment and technical expertise. They make sense if you need deep EHR integration or unique workflows.
• Off-the-shelf solutions let you launch fast and avoid compliance overhead, but watch for rising subscription fees and vendor lock-in.
• Hybrid approaches balance speed and customization, letting you validate demand before committing to a full custom build.

Before you commit, calculate your total cost of ownership for both options. Factor in opportunity cost, ongoing maintenance, and potential exit fees. If you are unsure, pilot with an off-the-shelf solution and scale into custom features as you grow.