Scaling telehealth businesses | 45,000+ patient sign ups | $100m+ rev generated: https://xitter.gq/t.co/tssP87B9TU
Newport Beach, CA
Joined January 2011
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What a commercial behemoth the Hims intake is.
There's a stat between the medical questions. a before/after between the stat and the next question. a "what would this mean for you?" right before the price.
There ain't one screen in that quiz that isn't selling.
If you had 24 hours to get more patients out of the traffic you already have, you wouldn't:
⦁ double your ad spend
⦁ launch a new treatment
⦁ redesign the logo
⦁ rebuild the whole funnel
You'd write one plain-text email that goes out 30 minutes after someone bails on your intake, with a link that drops them back on the exact question they left.
A lot of your "traffic problem" is sitting right there.
Daniel Walton retweeted
You do NOT need more traffic.
You need the people already starting your intake to actually finish it.
Most founders I talk to are paying $50-100 for every quiz starter and then doing nothing when half of them walk away. That's a paid lead you're just letting evaporate.
You might literally be:
⦁ 1 question that makes them feel seen
⦁ 1 proof slide that makes it real
⦁ 1 plain-text email sent while they're still warm
⦁ 1 link that remembers where they stopped
away from a COMPLETELY different month.
Daniel Walton retweeted
Your goal for the next 6 months as a telehealth founder shouldn't be a bigger ad budget
it should be a longer average patient lifespan
Acquiring a patient at $400 CAC who stays 3 months = broke
Acquiring the same patient at $400 CAC who stays 12 months = printing
Daniel Walton retweeted
Just saw a telehealth founder on Twitter bragging about his 3x ROAS.
Sounds great until you check the retention. 45% still around at month 2.
Which means he's paying $400 to acquire patients and losing more than half of them before the second charge even hits.
He's rich right now.
He'll be broke in 12 months.
3x ROAS with brutal churn is just financing your competitor's growth.
Because 50% of those churned patients will restart telehealth within a year, and they won't be restarting with him.
Every day the lord tempts me to stick a 40% off code in the very first abandonment email, train every patient to wait for a discount, and wonder why nobody pays full price anymore.
But I resist this temptation.
Offers belong later in the flow.
The first email just gets them back.
The best-converting email I've ever seen in a telehealth abandonment flow had no logo, no images, and three sentences.
Someone bailed on their intake. Half an hour later they got a note from a doctor's name saying they noticed the visit wasn't finished, here's the link to pick up where you left off.
That's it. Reads like a person typed it between appointments.
The designed emails still have a job. They just show up later, once you're walking people through the process and handling the doubt. The first touch isn't there to impress anyone. It's there to get them back.
Founder expectation:
• run ads
• patient starts quiz
• patient finishes quiz
• patient pays
Founder reality:
• run ads
• patient starts quiz
• gets to the date of birth question
• kid starts crying in the other room
• closes the tab
• gets a "you left something in your cart 🛒" email 2 days later
• forgets you exist
• sees a Hims ad on Instagram that night
• finishes their quiz in 4 minutes
• you blame Meta
Daniel Walton retweeted
Why do you want to launch on the fanciest white label? Why do you want the $50K/month enterprise contract?
Seriously, why?
Are you actually building a brand you can scale, or are you hiding behind a shiny platform to feel legit?
These are questions you need to ask yourself.
The best-performing brands I audit are running on boring, functional infrastructure that costs 20% of the flashy option.
Daniel Walton retweeted
Back when I started running telehealth ads in 2022, the norm was 3-month LTV and everyone celebrated.
Now the winners are running 12-month LTV.
Not because their ads got better.
Because they built ecosystems, cross-sell flows, and maintenance protocols while everyone else was still fighting over cheaper CPMs.
The game changed.
Unfortunately most founders didn't.
Daniel Walton retweeted
"Why do you focus so much on the day 12 email?"
Because that's when the side effects have hit, the scale hasn't moved yet.
And your patients quietly Google "how to cancel [your brand]."
If you're not in their inbox at that exact moment with a story from someone who felt the same way and stuck it out, you're not in their consideration set anymore.
I've had a few agencies pitch my clients this month claiming they "built the Hims abandonment flow."
Not knowing anyone can start the Hims quiz, quit halfway, and read the whole flow in their inbox for free.
Does every agency just say whatever now?
You do NOT need more traffic.
You need the people already starting your intake to actually finish it.
Most founders I talk to are paying $50-100 for every quiz starter and then doing nothing when half of them walk away. That's a paid lead you're just letting evaporate.
You might literally be:
⦁ 1 question that makes them feel seen
⦁ 1 proof slide that makes it real
⦁ 1 plain-text email sent while they're still warm
⦁ 1 link that remembers where they stopped
away from a COMPLETELY different month.
Your goal for the next 6 months as a telehealth founder shouldn't be a bigger ad budget
it should be a longer average patient lifespan
Acquiring a patient at $400 CAC who stays 3 months = broke
Acquiring the same patient at $400 CAC who stays 12 months = printing
Just saw a telehealth founder on Twitter bragging about his 3x ROAS.
Sounds great until you check the retention. 45% still around at month 2.
Which means he's paying $400 to acquire patients and losing more than half of them before the second charge even hits.
He's rich right now.
He'll be broke in 12 months.
3x ROAS with brutal churn is just financing your competitor's growth.
Because 50% of those churned patients will restart telehealth within a year, and they won't be restarting with him.
Why do you want to launch on the fanciest white label? Why do you want the $50K/month enterprise contract?
Seriously, why?
Are you actually building a brand you can scale, or are you hiding behind a shiny platform to feel legit?
These are questions you need to ask yourself.
The best-performing brands I audit are running on boring, functional infrastructure that costs 20% of the flashy option.
Back when I started running telehealth ads in 2022, the norm was 3-month LTV and everyone celebrated.
Now the winners are running 12-month LTV.
Not because their ads got better.
Because they built ecosystems, cross-sell flows, and maintenance protocols while everyone else was still fighting over cheaper CPMs.
The game changed.
Unfortunately most founders didn't.
"Why do you focus so much on the day 12 email?"
Because that's when the side effects have hit, the scale hasn't moved yet.
And your patients quietly Google "how to cancel [your brand]."
If you're not in their inbox at that exact moment with a story from someone who felt the same way and stuck it out, you're not in their consideration set anymore.
Daniel Walton retweeted
I wish I could pay you $1,000 to read this.
Because this thread breaks down the 3 rules separating telehealth brands scaling to $500K/month from the ones stuck at $50K/month wondering why their CAC won't drop.
(Hint: 2 of these have nothing to do with your ads.)
If you're running a telehealth brand in 2026, this will save you $250K in wasted spend 🧵
Daniel Walton retweeted
Most brands ask "why are you canceling?" and let patients pick "other."
That's why they can't reduce churn.
The 8 reasons real telehealth cancellations fall into:
1. Can't afford it (offer a multi-month plan discount)
2. Found a cheaper alternative (show your full ecosystem, not just price)
3. Getting it another way (channel switch — recover later)
4. Reached goal (offer maintenance dosing, not goodbye)
5. Not seeing results (education + provider touch)
6. Side effects too much (clinical response, not discount)
7. Still have medication left (delay next shipment, not cancel)
8. Experience wasn't what I expected (internal care team triggers within 24 hours)
Map every cancellation to the right response.
Watch churn drop 30% without touching your ads.