What Every Dietitian Should Know About the Large Telehealth Tech Companies

If you’re a dietitian weighing a job with Nourish or another large telehealth company, there’s a lot the recruiting pitch doesn’t tell you. I’ve spent 12+ years in private practice and almost a decade supporting dietitians in building theirs. Here’s (some of) what I think every dietitian needs to know about the large telehealth nutrition companies: how these companies are funded, how insurers are reacting, how much they keep from every session, and who owns your clients and data.

I just got back from San Antonio, the site of this year’s FNCE. As always, it was a LOT. Mostly good, some not so good (ugh, migraines!!), and so much to process.

Jasmine and I got to see several of our TLC alumni and community IRL, which is hands-down my favorite part of FNCE. There is nothing better than being in the same physical room with someone you’ve spent so much time with in a Zoom room.

I also had so many incredible, deep, and sometimes heated conversations with other dietitians, in sessions, at events, and in the middle of the expo floor. One topic came up over and over (and over) again: the impossible-to-miss presence of Nourish, and the rise of large, VC-funded telehealth companies for dietitians more broadly.

If you’ve spoken to me in the past few years, chances are you’ve heard my opinions on the large telehealth tech companies that have “disrupted” the nutrition space. I haven’t written much about it, partly because of bandwidth and partly because I wanted my thoughts to be more coherent before putting them in writing. I’m not sure how much more coherent I am now, but after FNCE, I couldn’t not start sharing them, beginning with you, here 🙂

First, let me say this once, clearly: if you work for any of these telehealth companies, or you’re thinking about it, I am not here to shame or blame you. I get it. These companies take many of a dietitian’s most hated tasks off your plate (insurance credentialing, billing, and marketing). Clients come through the door, and you get paid $50 an hour (well, $35-75-ish depending on the company, when you signed on, and how the clients are acquired).

If your choice is a $30/hour clinical job where you’re onsite five days a week or a $50/hour job from home with more flexibility, that sounds great. Alissa 15 years ago probably would have jumped at it too (and honestly, so would Alissa right now, in the throes of postpartum/perimenopause/auto-immune condition/having a toddler, if I didn’t already have my business set up!).

This is a systemic problem in our profession.

We’re historically underpaid, we get little to no business or financial training, and many of us leave school with massive student loans for entry-level salaries barely above minimum wage. Building a private practice is hard. I’ve done it for over 12 years and supported other dietitians in theirs for almost a decade, and it’s not for everyone. So when a company offers to take the “hardest” work off your hands, send you clients, go in-network with every insurer, let you work from home, and pay more than most entry-level jobs? Seems like a slam dunk.

And I still think we need to talk transparently about how these companies work and the impact we’re already seeing on our profession, insurance reimbursement, and patient care.

Here’s what I think every dietitian needs to know about the large telehealth nutrition companies: how these companies are funded, how insurers are reacting, how much they keep from every session, and who owns your clients and data.

1. The Business Structure

Most of the large telehealth tech companies are venture-capital (VC) funded, meaning they’ve raised money from VC firms or individual investors rather than a bank loan. In exchange, the VCs get an ownership stake (equity).

That money lets companies scale fast. In just four years, Nourish has raised $215 million and hired over 10,000 dietitians (side note: that’s about 10% of all RDs in the US).

It also comes with strings: the expectation of massive returns. At our FNCE session, Jessica Jones shared the growth targets VCs typically set: in the first four years, revenue should triple, triple, double, then double again, year over year. With AI, some investors now expect companies to 10x revenue in a single year.

Here’s the big problem: that growth comes at the expense of dietitians and patients. These companies are beholden to their investors, so decisions are made based on what will make the investors the most money, not on what’s best for patients or for their dietitian employees.

We’re already seeing:

• Cuts in compensation: hourly pay rates for RDs have dropped year over year at many of these companies
• Top-down control of clinical care: the company, not the clinician, dictates how often patients are seen and how long sessions last
• High patient volume quotas and unpaid charting and onboarding time

It’s also worth looking at who leads these companies. For most of them: 1) the founder is a young man in his 20s with a business degree, 2) no founders have a healthcare background, and 3) there are few to no dietitians at the higher levels of the organization. These men saw an industry to disrupt (and an insurance reimbursement benefit to ​strip-mine​), and they went for it.

2. Insurance companies are aware, and it’s already affecting coverage and reimbursement

In just a couple of years, these companies have substantially increased the utilization of MNT benefits, and insurers have noticed. Yes, this is also a problem with our country’s private insurance system. But when sessions billed to MNT benefits skyrocket overnight, insurers dial back coverage and reimbursement.

This year alone, we’ve seen insurance companies:

• Add visit limits for MNT sessions
• Add prior authorization requirements
• Decrease reimbursement rates

In many states and zip codes, individual dietitians face closed panels and/or frozen or suppressed rates, while these large platforms get broad in-network access and (often) higher rates. That leaves many dietitians no choice but to work for a platform if they want to provide insurance-based care.

3. Reimbursement rates vs. Dietitian hourly pay

Getting $50 an hour instead of $30 (or $0 when there are no other job opportunities or your practice slows down) sounds great. But dietitians deserve to know how much these companies make off their labor.

At our FNCE session, Tamara Melton shared big news: a new transparency in coverage law that took effect earlier this year makes everyone’s (yes, EVERYONE’S) insurance reimbursement rates public.

I haven’t sifted through all the data yet, and it varies by state and payer, but here’s one data point I saw: a dietitian credentialed in Georgia, on a private payer, through one of these companies, with a rate of ~$55 per 15-minute unit for 97803 (follow-up visit).

• Billed to insurance for a 1-hour follow-up (4 units): $220
• Paid to the dietitian: $50
• Kept by the company: $170, or about 77%

Another way to look at it: you’re paying them roughly 77% of the contracted rate to manage your credentialing, billing, and marketing.

Even at a lower rate of $35 per unit ($140/hour), they pocket $90 per session, about 65%. At 20 visits a week, that’s $1,800 a week. Over 48 weeks (one month off), that’s over $86,000 the company makes from just ONE dietitian’s sessions. (I’ll let you multiply that by 10,000…)

Again, not everyone wants to work for themselves, and that’s absolutely fair. But it’s important to understand the numbers.

4. They own your clients and your data (and are building AI tools with it)

Some platforms advertise themselves as a way to “start your private practice.” In reality, you’re credentialed under the company’s NPI, and the company owns all of the clients, client information, and session data. If they sell or shut down tomorrow, your client information is gone. And while non-competes typically don’t hold up legally, if you leave, can or will your patients follow you?

There’s also a data issue: these companies are using recorded dietitian-patient sessions to train their AI models. AI scribes can cut charting time, but the big companies have been building and training AI tools on all of this data. (​Here’s one recent example​ with the Berry Street/Healthify merger: “Healthify’s (AI) platform has been honed on hundreds of millions of real dietitian-to-patient interactions.”)

What will this mean for our profession? And for the care people receive? AI tools may increase access, but who might they harm or leave behind? Whatever your view, the fact is these companies own all the data and can do with it whatever they want.

Final Thoughts

At the end of the day, the dietitian bears the professional risk. A company sends you a client from a state you’re not licensed in? That’s on you. The AI scribe makes a documentation error? Also on you. A board complaint? It goes to your license. An insurance audit on claims billed under your NPI 1? Check your contract for who’s on the hook. Is their malpractice policy covering you, and for how long after you leave?

These companies leave dietitians with few real alternatives. They can change your rate, cut your referrals, or end the contract, often with little notice. You lose the income, and your clients lose their dietitian.

And we only have to look at mental health to see what’s coming. VC-backed therapy companies (Headway, Alma, etc.) have a 3-5 year head start on nutrition, and here’s what’s happening there:

Fast platform growth → pay cuts for clinicians → insurance audits and coverage changes (impacting clinicians and patients) → more pay cuts

What Can You Do

This is a massive systems problem (the private insurance system and the VC-based business system), and there’s only so much any of us can do individually.

AND our decisions, our voices, and our labor absolutely matter. Some options to consider:

• Credential with insurance companies yourself (optional: pay a biller 5-7% of each claim)
• Work for a dietitian-led/owned group practice. Pay may be lower, but you may get supervision, case management support, profit reinvested in clinicians and patient care (instead of investors), sustainable caseloads, community, and values alignment

Free Business Resources

Yes, I’m a business coach and charge for some of my services AND I’m committed to lowering the bar to entry on private practice, and not gatekeeping.

All dietitians should be learning business and financial skills, even if you never work for yourself (a hill I will die on!).

If you are looking for support starting your own business, here are some free resources:

1. ​5 Steps to Start a Private Practice​ Video Workshop – Free 1-hour workshop (and 1 CEU)
2. ​Insurance Credentialing 101​ Video Workshop – Free 1-hour workshop (and 1 CEU)
3. Free Checklist: ​Start Your Business​
4. Free Checklist: ​Credential with Insurance​

My hope is that every dietitian can have informed consent about the current and potential future impacts these companies are having on our profession, and then make a choice based on your values, your life circumstances, and your financial needs.

Phew okay. This is the first time I’m writing about this, and I know it’s a BIG topic. More to come on this — I have a lot more to say, and I’m just getting started.

In the meantime: what questions or thoughts came up for you? Please comment and let me know, or send me an email.