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# Interview: Rebecca Stone - Telehealth Platform VP Sales ## Metadata **Date:** November 14, 2024 **Duration:** 30 minutes **Interviewer:** Marcus Chen, Solutions Engineer, Salesloft + Clari **Interviewee:** Rebecca Stone, VP Sales, Meridian Telehealth (formerly known as TeleDoc Solutions) **Company:** Meridian Telehealth **ARR:** $55M **Employees:** 285 **Market:** Virtual primary care, urgent care, dermatology, psychiatry --- ## Interview Transcript [MARCUS] Rebecca, thanks for taking the time this morning. I've been really curious to dig into how you're thinking about go-to-market in the telehealth space right now. There's so much noise in this category. [REBECCA] Yeah, happy to chat. Honestly, Marcus, it's a wild time. We went from being the "hot thing" to suddenly competing with everyone under the sun. Just last month, I looked at a competitor spreadsheet we maintain—we're at 217 competitors now, and that was three weeks old. It was probably 180 when I started in this role two and a half years ago. [MARCUS] 217? That's staggering. How do you even think about differentiation at that scale? [REBECCA] That's the million-dollar question, isn't it? And I mean that literally—we've spent probably half a million on positioning work in the last 18 months. Here's what we've landed on: we're not trying to be everything to everyone anymore. We used to position as this horizontal platform for any use case. That was killing us because every customer saw us as a generalist competing on price with these specialized point solutions. We've narrowed down to employer-sponsored and health plan partnerships for specific verticals—dermatology, OB/GYN, behavioral health, and primary care triage. It sounds narrow, but honestly? Within those verticals, we have actual differentiation. Our dermatology integration with EHR systems is genuinely better than three of our competitors. Our behavioral health compliance posture is tighter than most. [MARCUS] So you've moved to vertical specialization rather than horizontal expansion. [REBECCA] Exactly. And our sales team is organized around that now. We have vertical-specific account execs. They speak the language of the customer. A VP of Employer Benefits at a Fortune 500 doesn't care that we "also do" urgent care. She cares that we've worked with 23 other large employers in her vertical and we have the compliance and workflow integration locked down. The problem is, this messaging discipline—it's constant work. The pressure from the board, from product, from field to "just add this feature" or "just support this workflow" is relentless. Like, right now, product wants to go after direct-to-consumer mental health. That's a completely different buying committee, different regulatory profile, different GTM. It's a distraction. [MARCUS] How are you managing that pressure? Is it a sales/product alignment issue? [REBECCA] It's part of that, but it's also a capital efficiency conversation. When you're competing with 217 companies, including five unicorns with deep pockets, you can't win by being mediocre at everything. Our CEO gets it, but the quarterly revenue targets don't always align with "let's slow down and deepen expertise in three verticals." We had one customer—big health plan—take us into a reference call with a competitor. The competitor had four different reps asking about four different product lines. We had one rep, deep in their specific workflow. We won that deal because of specialization, but it took discipline to not pitch our six other modules. [MARCUS] That's a real case study. Let me pivot a bit—I know reimbursement policy has been a huge factor in healthcare in general. How's that playing into your sales cycles? [REBECCA] Oh man, it's huge. And it's gotten more acute in the last nine to twelve months. When we're selling into health plans, there's this underlying anxiety about reimbursement rates changing. Medicare Advantage is under scrutiny. Private payer policies are shifting. We had a deal close in Q3 where the customer literally said, "We're moving forward, but we're adding a clause to our contract that lets us reduce our utilization if reimbursement drops below X percent." They wanted an escape hatch. And I get it—if they've built their financial model around a certain reimbursement rate and that drops, the economics of using our platform change. [MARCUS] How do you handle that in the sales conversation? [REBECCA] Carefully. Our contracts team and legal have gotten much more creative. We used to just push back on flex terms. Now we're building in what we call "policy change" clauses. It's not free—they're typically tied to specific drops, like if CMS changes reimbursement for a specific code by more than 15%, then there's a reconciliation mechanism. But it's a trust-building move. Customers know we understand their risk. We're not pretending that policy uncertainty doesn't exist. The honest thing is that this actually slows down deals. It opens up conversations about their reimbursement mix, their dependency on certain payer types. We did an analysis on a prospect—looked like a $2M deal. Once we dug into their reimbursement exposure, we realized they were overweighted in one payer type. We actually told them that. [MARCUS] You told them to fix their customer mix before buying? [REBECCA] We suggested it, yeah. The AE nearly had a stroke. [laughs] But here's the thing—if we sell them something and they hit that reimbursement cliff in six months, we lose the customer and the credibility. Instead, we've positioned ourselves as a strategic advisor. They're now working with us on a 18-month pilot instead of a five-year deal, which is lower revenue this year, but much more likely to expand. [MARCUS] That's a really mature sales approach. Do your reps understand why you're doing that? [REBECCA] Not all of them. We have some legacy hunters who are used to closing deals at all costs. That's been a conversation. I've had to pretty explicitly say, "Your job is not just to close—it's to close well. We care about net revenue retention more than new ACV now. That's literally my comp philosophy this year." Actually, that's a bigger shift for us. Our comp changed. ACV is still important, but we're putting real weight on NRR. It changed behaviors immediately. AEs are more focused on onboarding, on scoping realistic implementations. [MARCUS] That's smart. Let's talk about implementation—because that ties to the IT overwhelm piece I know you're dealing with. Tell me about the IT dynamic when you're selling into enterprise health plans. [REBECCA] [sighs] It's rough. IT is drowning. These health plan IT teams are lean, and they're managing dozens of vendor integrations, dozens of ongoing support issues. When we come in trying to do an EHR integration, their IT director is thinking, "This is another project. Do I have resources? When will this actually go live?" And our sales team doesn't know how to talk to IT. They're talking to the Chief Medical Officer or the VP of Delivery, and IT is in the room saying, "Yeah, we can do this, but we need three months for discovery, we need to scope out the integration, we need to make sure it doesn't break our existing workflows." And all of a sudden, the deal that was supposed to close in 60 days is now a 6-month implementation. [MARCUS] How has that changed your sales approach? [REBECCA] We've actually brought IT into the sales conversation earlier. One of my AEs now starts with, "Who's your IT integration lead?" and gets them in the discovery call. Sounds simple, but it's a shift. We used to do that at contracting. We've also built out some self-service resources. We have a customer portal where they can see integration documentation, set up API keys, manage their own data mapping. It's not perfect—some customers still want hand-holding—but it takes pressure off IT. We tell them, "Your team can configure 80% of this. Our team jumps in for the complex pieces." The bigger thing is we're offering what we call "implementation packages." Customers can choose: full white-glove (our team does everything), hybrid (they do what they can, we fill gaps), or self-service. The pricing is different, and honestly, some customers are choosing self-service because they have resources and want to save 50K on implementation fees. [MARCUS] That's interesting. So you're giving them optionality? [REBECCA] Yeah. And it actually improves our unit economics—self-service has higher margins. But it also means our implementation team is more focused on the complex deals where they add real value. The thing that's been hard is IT sometimes feels like we're dumping work on them. We had one customer where IT literally said, "This is a non-starter because we don't have the capacity." We ended up recommending a partner integration firm. It wasn't our margin, but it unblocked the deal. Customer ended up paying more, but at least they could move forward. [MARCUS] Speaking of integration—EHR is such a minefield in healthcare. Talk about what you're seeing with EHR integration requests. [REBECCA] [laughs] Minefield is the right word. So we have three pre-built integrations: Epic, Cerner, and Medidata. Those are probably 60% of our deals. Pretty straightforward scoping, most of the setup can be done in-house or with our team in 6-8 weeks. But then you get customers using Athena, or smaller regional EHR systems, or custom-built EHRs. One prospect is on a system from 2002 that they've heavily customized. Our engineering team looked at it and said, "This is custom integrations work. It's possible, but we're talking 4-6 months and probably $150-200K to build and maintain." That's where things get really awkward. The customer wants to be on our platform. Their executive team is excited. But IT is looking at $150K and 6 months of engineering capacity, and the business case doesn't pencil. [MARCUS] What's your answer in that situation? [REBECCA] Honestly, sometimes it's "not yet." We tell them, "Here's what we can do with your current EHR—we can do file-based imports, we can work with your IT to understand the data structure, but a full native integration isn't the right investment right now. Let's get value on the non-integrated workflows first, and then revisit." That feels like losing, but it's not. We get them on a smaller deal, we prove value, and then the business case for integration gets stronger. Where we've had to adjust our positioning is on the "pre-built integration" promise. We say it, but it really means "Epic, Cerner, Medidata are pre-built and relatively straightforward." Everything else requires scoping. We had some deals fall apart because customers heard "pre-built" and thought "easy." Then they got into implementation and realized, no, this is complex. [MARCUS] Have you changed your sales messaging around that? [REBECCA] We're working on it. Now when we talk about integrations, we're very explicit: "We have out-of-box support for Epic, Cerner, and Medidata. For other systems, we offer custom integration services. Let's scope that together." It's less sexy, but it's honest. And we're actually pricing the custom integration work more aggressively now. We used to view it as a cost center—"Here's what it costs to integrate." Now we're pricing it as a service. A $500K deal with a $120K integration component, we're more comfortable with that because it reflects the actual value and effort. [MARCUS] Let me ask you about something that feels like it might be even bigger picture for you. Retention. Earlier you mentioned moving the comp model toward NRR. What's driving that? [REBECCA] [pauses] Because we can't afford to lose customers. Look, we've built our growth on net new. The talent, the comp, the board expectations—all oriented toward "sell more." But churn is real, and it's not slowing down. We're churning somewhere between 8 and 12% annually on health plan customers. For a $55M ARR company, that's not sustainable. That's 4.4 to 6.6 million in lost revenue every year. And frankly, it's getting worse. The customers we signed three years ago are more likely to churn than the customers we signed two years ago. [MARCUS] Why? [REBECCA] A few reasons. First, our early customers were mostly risk-takers. They were buying a new category. They had budget, they were excited to experiment. Now, we're selling to more conservative customers with tighter budgets and less patience for proving ROI. Second, we've been bad at getting value realization. A customer signs a contract for $500K. Everyone's excited. Then they hit implementation, they hit the reality of integrating with their EHR, they realize they need to change workflows. Six months in, they're thinking, "Are we actually using this? Are we getting ROI?" And if we haven't helped them get a quick win in the first 120 days, they're in a bad mood. [MARCUS] What does "getting a quick win" look like? [REBECCA] It depends on the use case. For a health plan, maybe it's enabling a behavioral health vertical that drives utilization up by 5% in 90 days. For an employer, maybe it's reducing urgent care utilization because telemedicine is capturing demand earlier. But it's concrete. It's their metric. We've actually changed how we scoped implementations. We used to try to light up everything—all the integrations, all the workflows, all the reporting. Now we do what I call "crawl, walk, run." First 30 days, get one major workflow live and working. 60 days, add a second. 90 days, measure impact and plan expansion. [MARCUS] Has that changed your implementation timelines? [REBECCA] It actually shortened them. Not in terms of "everything is live," but in terms of "something valuable is live." That was huge. The delay between contract signed and first value is our biggest churn risk. [MARCUS] What does the CS team look like supporting that? [REBECCA] We've doubled our CS investment in the last year. We went from a ratio of about 1 CS rep for every 8-10 customers to 1 for every 6. For a $55M company, that's meaningful investment. But our CAC payback is getting longer, so we need to get that payback back through retention and expansion. The other thing is we've created a "critical onboarding" program for our larger deals. Anything above $250K gets a dedicated onboarding manager for the first six months. They're not selling, they're not upselling, they're just making sure that implementation stays on track and that the customer hits their first milestone. [MARCUS] That's a big investment. [REBECCA] It is. And honestly, we're still figuring out the ROI. But qualitatively, our largest customers—the ones with dedicated onboarding—are happier. We're seeing better expansion rates, and we're seeing lower churn in that cohort. [MARCUS] Let me ask about this holistically. You've shifted from a 217-competitor wild-west positioning to vertical specialization. You're adjusting your contracts to account for reimbursement risk. You're bringing IT into sales earlier. You're being honest about EHR integration complexity. And you're front-loading CS investment. That's a big shift in GTM philosophy. [REBECCA] [laughs] When you put it that way, it sounds like we actually know what we're doing. The truth is, a lot of this came from pain. We had a wake-up call about two years ago where we looked at our cohort retention and realized we had a retention cliff. Customers signed in year one, and by the end of year two, we were hemorrhaging them. That was scary. We went back to our largest customer logos—the ones that were succeeding—and did these deep win/loss calls. What did they have in common? They had IT support built into their budget. They had realistic implementation timelines. They had early value realization. They were in verticals where we had real differentiation. That analysis became the foundation for everything we changed. [MARCUS] Can you give me a specific example of a customer you saved or turned around? [REBECCA] Yeah. We have a customer, Blue Cross affiliate in the Midwest, about 900K lives. We sold them on this big vision of being our flagship customer. We were going to do everything—all five verticals, full EHR integration, massive deployment. It was a mess. Implementation was dragging. They were frustrated. By month seven, the CMO was calling our CEO saying, "This isn't working, we're evaluating alternatives." We pulled back. We brought in our VP of Customer Success, our VP of Product, our SVP of Delivery. We sat down with their team and said, "Let's restart. What do you actually need in the next 90 days to prove this is working?" Turns out, they just needed dermatology enabled and working well. That was their highest-margin payer use case. Everything else was secondary. We refocused the whole implementation around dermatology. We had it live in six weeks instead of six months. Utilization went up 8% in month one. Their finance team saw the ROI. Suddenly, they're not evaluating competitors, they're asking what's next. That customer is now $1.2M ARR and expanding. But that should have been the scoping conversation. We shouldn't have had to pull back from the brink. That's on us. [MARCUS] What changed in how you scope going forward? [REBECCA] We got more disciplined about the discovery process. We're asking harder questions: "What's your must-have in year one? What's nice to have? What's we-don't-care?" And we're building timelines around must-haves, not around feature completeness. We're also being more honest about tradeoffs. Like, "If you want a full EHR integration AND you want to launch in six months, and your IT has limited capacity, one of those has to give." [MARCUS] Rebecca, I want to ask about the sales team. You've been building sales for this specialized, more complex motions. What's been the talent challenge? [REBECCA] [sighs] It's real. We had a generation of AEs who were great at hunting, at closing deals fast. They're struggling with this new model where the sales cycle is longer, the deal scoping is tighter, and the support for CS is more critical. I've had to transition some people. Some thrived—they like the consultative selling. Some didn't, and we've made changes. The new AEs we're hiring are looking for a very different profile. We want people with healthcare background, people who understand compliance and integrations, people who are comfortable having technical conversations. That's a smaller pool than "great closers." We've also invested in training. Our old onboarding was sales methodology—discovery, qualification, close. Now it's 40% sales methodology, 40% healthcare domain knowledge, and 20% technical fundamentals. We want AEs to understand what an API integration entails, what HIPAA compliance means, what reimbursement risk looks like. [MARCUS] Are you promoting from within or hiring from outside? [REBECCA] Both. We have some legacy AEs who've developed the domain knowledge and adapted. We're promoting those into lead roles. But we're also hiring from competitors, from healthcare tech startups, from health systems even. Different backgrounds, but they all have some healthcare credibility. [MARCUS] Let me ask one final thing. If you're talking to a prospect right now—a mid-sized employer or health plan in one of your vertical specialties—what's the first thing you want them to understand about working with you versus your 217 competitors? [REBECCA] [pauses] I'd say three things, and they're all about reality. One: we're specialists in your vertical. We know your workflows. We're not a generalist. Two: we understand the integration reality. We're going to be honest about complexity, timeline, and cost. You're not going to surprise us with your legacy EHR system, because we've probably seen something like it before. And three—this is maybe the most important—we're invested in your success after you sign. Not just in year one, but in year two and three. We're going to help you realize value, we're going to adapt if reimbursement policies change, and we're going to support you through the messy middle of implementation. That's not sexy compared to "AI-powered platform" or whatever the pitch is nowadays. But it's true. And for a health plan or employer making a real investment, that's what matters. [MARCUS] Rebecca, I appreciate you being candid about all of this. [REBECCA] Happy to. Honestly, it's helpful to say it out loud. A lot of this is still in-progress. We're not perfectly executing this strategy yet. But it feels like we're moving in a better direction. And the retention numbers are starting to show it. --- ## Key Takeaways **Competitive Positioning & ICP Clarity:** - 217 active competitors in telehealth; differentiation requires vertical specialization, not horizontal expansion - Moved from generalist positioning to specialist approach (dermatology, OB/GYN, behavioral health, primary care) - Sales organization now structured around verticals with deep domain expertise - Messaging discipline is constant work; requires resistance to feature creep and board pressure **Reimbursement Policy & Risk Mitigation:** - Customer anxiety about reimbursement policy changes is a major deal factor, especially with CMS and Medicare Advantage scrutiny - Introduced "policy change" clauses in contracts to build trust and provide flexibility - Customers now building exit clauses tied to reimbursement drops; requires legal and product flexibility - Discovery process now includes reimbursement mix analysis to ensure customer viability - Willingness to recommend pilots or longer sales cycles to mitigate risk builds credibility **IT Complexity & Resource Constraints:** - IT teams are lean and overwhelmed; lack of integration capacity is a legitimate blocker - Changed sales approach to bring IT into discovery earlier rather than at contracting - Developed implementation packages (white-glove, hybrid, self-service) to reduce IT burden and improve margins - Self-service resources and customer portal reduce dependency on vendor support for routine tasks - Honest scoping that acknowledges IT capacity limitations actually unblocks deals **EHR Integration Reality:** - Only 3 pre-built integrations (Epic, Cerner, Medidata) cover ~60% of deals; everything else requires custom work - Custom integrations can cost $150-200K and take 4-6 months, killing deals with weak business cases - Messaging around "pre-built" misleading; now explicit about which systems are truly plug-and-play vs. requiring scoping - Created "crawl, walk, run" implementation model to deliver value incrementally rather than full deployment - Sometimes best answer is "not yet"—get value on non-integrated workflows first, revisit integration later **Retention & Value Realization:** - 8-12% annual churn on health plan customers is unsustainable for $55M ARR company - Shifted comp model to weight NRR alongside ACV; changed AE behavior immediately - Doubled CS investment; moved from 1:8-10 CS ratio to 1:6 - Critical onboarding program for deals >$250K; dedicated onboarding manager for first six months - Delay between contract signature and first value is biggest churn risk; reducing that window is priority - Early customer cohort (risk-takers) had higher retention; later customers (conservative, budget-focused) have higher churn - Example: Blue Cross customer nearly churned before pulling back to single-vertical implementation; once they saw 8% utilization lift, they stopped evaluating competitors **Sales Motion Evolution:** - Hiring profile shifted toward healthcare domain knowledge and technical comfort vs. pure closing ability - Sales training now 40% methodology, 40% healthcare knowledge, 20% technical fundamentals - Longer sales cycles and complex scoping requires different talent profile; some legacy AEs didn't adapt - Promotion of domain-specialized AEs into leadership roles - Consultative selling with realistic scoping builds trust and improves deal quality