Nowadays Telemedicine platforms boom due to well-known reasons. 
In this article, we are going to review the biggest Telemedicine platforms, find out what they use for video calls and calculate their average expenses per month specifically for video calling infrastructure. According to the almighty Google, Top 3 biggest Telemedicine platforms are
| Teladoc | 3000 employees |
| Amwell | 521 employees |
| MDLive | 396 employees |
After a short investigation, we found out that those platforms use different video streaming software. 
Teladoc uses Vonage CPaaS video streaming service provider. 
MDLive works with Twilio 
And looks like Amwell works with a custom WebRTC video calling implementation they acquired from Aligned Telehealth.
So how many patients make virtual visits on those platforms?
TelaDoc says in 2020 they had between 9.8 and 10.3 millions of visits. Amwell stated they got 1,414 mln in Q3, so we will round that up to 5.6 mln in 2020. And MDLive mentioned 7.5K visits per day, that’s roughly 2.7 mln visits per 2020. Number of visits per 2020
| Teladoc | 10 mln |
| Amwell | 5.6 mln |
| MDLive | 2.7 mln |
What would be the costs for the video calls infrastructure?
According to statistics, every visit lasts on average around 15 minutes. 
Teladoc uses Vonage and their pricing is $0.004/subscribed minute. What does it mean? Well, if you have 2 users on a call, you would need to pay $0.004/minute * 2 users = $0.008/minute. And now we will multiply by average visit 15 minutes and we get $0.008/minute * 15 minutes = $0.12/visit. So for the whole year, Teladoc paid to Vonage 10 mln visits * $0.12/visit = $1.2 mln. For your information that’s the base price only. For sure they used an Enterprise support plan, which costs additional funds. Probably they make video recordings which could add at least the same amount of costs. 
MDLive is using Twilio. And Twilio has a special price for peer-to-peer video calls, which is $0.0015 per minute. Ok, with the two participants, one video call will cost $0.0015/minute * 2 = $0.003/minute, and then multiply by 15 average visit minutes, $0.003/minute * 15 minutes = $0.045 for a visit. That’s roughly 3 times less than Teladoc pays. And for the 2020 year, MDLive spent around 2.7 mln * $0.045/visit = $121K. Again, this is a base price. And maybe some calls contained more than 2 participants. Again, probably they store recordings, and those conditions will increase the costs several times. 
Now let’s calculate Amwell’s costs. They use a custom WebRTC implementation, meaning they are running their own servers. They had 7500 visits per day on average. I would guess during peak times they would handle 3000 visits per hour. For that amount of users, they would keep 10 web servers, and 30 so-called TURN servers running. For calculations example let’s use the OVH cloud server provider, they have free bandwidth included. From OVH we can rent “Elite” server for $34/month. 40 servers * $34/server = $1.4K/month. Or $1.4K/month * 12 months = $16.8K per year. This is a base price. It doesn’t keep any recordings or any advanced functionality. In general, the 3-rd party services like Vonage or Twilio will provide you with the stability, but if you set up your own custom servers right, it would work as great. 
Conclusion
Understanding the technology and costs behind the video calling infrastructure of leading telemedicine companies is crucial for any business looking to enter or enhance their presence in the telehealth market. Leveraging the right video streaming technologies can significantly improve the quality and reliability of telemedicine services, ultimately leading to better patient care and engagement.
At Trembit, we specialize in developing custom WebRTC platforms tailored to meet your specific needs. Our expertise in peer-to-peer video calling solutions ensures that you receive a robust, scalable, and secure platform designed to support high-quality telehealth services. We are committed to helping you implement the best technology to drive your business forward.
Get in Touch
If you’re looking to buy a ready custom WebRTC platform for peer-to-peer calls, or if you need expert advice on enhancing your video streaming capabilities, don’t hesitate to reach out. Contact us at sz@trembit.com to discuss your project and discover how Trembit can provide the solutions you need to succeed in the competitive telemedicine landscape.
