Beyond Hims and Felix — The Hidden Infrastructure Opportunity for Clinics
What Clinics Already Have (That Startups Spend Millions To Get)
Over the past few years, the meteoric rise of direct-to-consumer (DTC) telehealth brands like Hims (for men’s health/hair loss/ED) and Felix (for various online prescriptions in Canada) has inspired many in the medical community. Some forward-thinking physicians and clinic owners saw these models and thought, “Should we try to do the same? If Hims can sell hair loss meds online, why not me?” Indeed, the allure is strong: huge revenue valuations, slick marketing, and the ability to reach patients nationally through an app or website.
This led to a rush of copycats – numerous small ventures trying to become “the Hims of X specialty” or clinics spinning off little eCommerce websites of their own, hoping to emulate that success. Unfortunately, most of these attempts have floundered or outright failed. It turns out that copying the front-end of a DTC model (website, ads, etc.) without the back-end infrastructure and resources is a recipe for frustration. The problem isn’t lack of patient demand – the demand is there – it’s that clinics typically don’t have the bandwidth or capital to truly compete as DTC startups. And even if they did, they might be better off taking a different approach entirely.
Let’s break down why copycat DTC efforts often stumble, and more importantly, illuminate the hidden infrastructureopportunity that clinics can leverage to achieve the core goals without falling into the copycat trap.
The DTC Gold Rush and Why Many Fizzle Out
First, consider what made companies like Hims, Roman, or Felix succeed at scale:
They poured millions into branding and marketing. Hims & Hers blanketed subways, podcasts, TV, and the internet with ads featuring stylish, approachable messaging about topics like ED and hair loss. Felix ran subway ads in Toronto and a heavy digital campaign to normalize getting birth control or acne meds online. Branding isn’t just a logo; it’s also destigmatizing conditions and making telehealth seem “cool” or at least normal.
They built robust technology platforms – custom websites, mobile apps, automated patient intake flows, prescription routing systems, etc. Essentially, they became software companies as much as telehealth companies. They had teams of engineers refining the user experience, ensuring e-commerce stability, and optimizing conversion rates.
They navigated the legal and pharmacy logistics to actually fulfill prescriptions at scale across many jurisdictions. This included partnering with mail-order pharmacies or even acquiring pharmacy capabilities (Roman, for example, acquired a pharmacy or built distribution centers). They had legal teams making sure each state’s telemedicine and prescribing laws were followed, that proper physician-patient relationships were established online, etc.
They had to earn trust from scratch. When Hims launched, it had no existing patient base. It had to convince men scrolling Instagram that this new company was legitimate and worth trying instead of just seeing a doctor in person or picking Rogaine up at CVS. That’s a high barrier – healthcare isn’t like selling T-shirts; trust is crucial. Through branding and PR, they slowly built that trust (celebrity endorsements, user testimonials, etc., played a role).
Now, think of a small clinic or an individual doctor trying to mimic this. They set up a website, maybe spend on Google/Facebook ads, possibly outsource an app development. They quickly find:
Customer Acquisition Cost (CAC) is huge – just like Hims discovered. If Hims is spending $500+ to acquire a customer, a small clinic doesn’t have that kind of cash to burn. You might spend a few thousand on ads and get only a handful of sign-ups if any. Competing for online attention in the healthcare space is expensive; you’re up against both big startups and traditional players like online pharmacy ads.
Time and Capital – Most clinics or physicians don’t have venture capital backing to operate at a loss for a year or two while scaling. Startups expected to lose money initially; they raised funds for it. A clinic trying a DTC side venture likely expects it to be profitable quickly, which is hard. Plus, the physicians still have a day job seeing patients – building a new brand is a full-time endeavor in itself. Many quickly feel stretched too thin.
Operations Breakdowns – A common scenario: a clinic launches a small eCommerce site for, say, cosmetic skincare. They advertise a bit, get some orders initially (maybe from existing patients). But then the reality hits – who is managing inventory? Who answers customer service questions at 10pm when someone’s order is delayed? If something goes wrong with shipping, or if volume unexpectedly spikes, does the clinic staff have the capacity to handle it? Often, they don’t, and service suffers. A few bad customer experiences (like delayed shipments or lack of response) and the whole thing loses credibility. Running an online operation requires 24/7 attention that clinics aren’t set up for.
Legal Complexities – If not done carefully, a copycat DTC might run afoul of regulations. For instance, shipping prescription meds across state lines without proper pharmacy coordination, or not having a solid telehealth consent process, etc. Startups invest in lawyers and compliance; a clinic might not realize a particular nuance and could get a nasty surprise. We’ve seen instances where well-meaning doctors started selling medicine online only to get warned by boards about jurisdiction issues or controlled substance rules. This is not to scare – it’s all navigable, but if you DIY without full knowledge, it can trip you up.
Because of these challenges, many clinics’ DTC ventures flame out after a short time. They realize that it’s not as simple as “build a website and patients will come.” Demand may be there, but reaching and servicing those patients effectively is a whole discipline. So is the takeaway that clinics should just give up on this arena? Not quite – rather, they need to approach it differently, playing to their strengths.
What Clinics Already Have (That Startups Spend Millions To Get)
It turns out, most clinics are sitting on assets that DTC startups would kill for and indeed spend fortunes to emulate. Instead of trying to become a “me-too Hims” in marketing, a clinic should leverage these inherent advantages:
A Trusted Brand and Reputation: If you’ve been practicing for a while, especially if you have a reputable clinic, you have community trust. Real patient testimonials, word-of-mouth, perhaps a local media presence – these are things Hims had to artificially create with branding. Patients generally trust their personal doctor or a well-known clinic more than an unknown app. Trust is the hardest currency to earn in healthcare, and clinics often already have it in abundance with their patient base.
Existing Patient-Provider Relationships: This is gold. A startup might have a slick website, but they lack personal relationships. As a clinician, you might have hundreds or thousands of patients who know you, have been counseled by you, and would be willing to follow your guidance on products or treatments. Convincing someone to use a new service is far easier if it’s coming from their own doctor or a clinic they already visit. Essentially, clinics have a built-in initial market at zero marketing cost.
Clinical Credibility: Beyond just trust, clinics have actual medical credibility. DTC startups often have to battle skepticism (“Are those real doctors or some shady internet thing?”). Clinics can proudly say – yes, we are board-certified physicians, we have a physical presence, we follow standard of care, etc. That credibility can be infused into any online offering, making patients (and their families) more comfortable using it. Also, it means you can tackle conditions that require more nuanced care. Startups often stuck to simple, discrete issues (ED, hair loss, birth control) because they needed to minimize complexity. A clinic could extend into more complex territory with an online program because they have the expertise – for example, a rheumatology clinic could manage biologic therapy follow-ups or specialty drugs through an online portal, something a generic startup wouldn’t dare due to complexity.
Organic Demand: Many clinics have something startups envy: a waiting room (physical or virtual) of people with needs. You might not realize, but if 50 patients walk through your door today, perhaps 20 of them have some additional need or question that could be served with an ancillary product or better follow-up – if only it were available. Startups try to generate demand through advertising. Clinics witness demand naturally in practice. For example, if patients keep asking “Doc, what sunscreen should I use after this laser treatment?” that’s organic demand for a product – which you could fulfill via your own eCommerce instead of sending them to a drugstore.
So, rather than trying to become the next Hims in terms of flashy marketing, the smarter strategy is for clinics to use what they already have and fill in what’s missing (the tech and infrastructure). Essentially, don’t try to compete on marketing or brand glitz – instead, compete on care integration and convenience where you are already strong.
This is where the hidden opportunity lies: building the infrastructure behind the scenes to capitalize on your strengths, instead of building a whole new outward-facing brand from scratch. In other words, don’t build a new Hims; build the machinery that powers a Hims-like service within your existing clinic brand.
The Rise of Infrastructure-as-a-Service for Clinics
We’ve discussed CCI and similar offerings – that’s exactly what this is about. It’s about clinics not reinventing DTC companies, but plugging into the infrastructure that gives them the same power.
Think of it like this: In the early days of e-commerce, a small boutique might think, “I can’t compete with Amazon, I give up.” But then Shopify came along with a platform that let any small store have a robust online store, payment processing, and even integration to shipping – suddenly that boutique can sell globally without building everything themselves. Similarly, for clinics, the infrastructure providers (like CCI) are the Shopifys of healthcare. They give you the engine – branded eCommerce storefront, compliance, automated refills, analytics – so you can focus on applying it to your domain.
The key elements typically offered (and necessary) are:
Branded Online Storefront: It’s your clinic’s name and look, but powered by the platform’s tech. So it looks like you built a fancy website or app, but really you didn’t have to code it.
Compliance-Ready Fulfillment: The platform ensures that prescriptions flow to a licensed pharmacy, that patient data is handled properly, and that all legal boxes are checked. They essentially act as the middle/back office. This removes a huge burden – you’re not coordinating with a dozen pharmacies, the system does it.
Refill & Subscription Logic: Infrastructure for recurring revenue – auto-bill, auto-ship – which is what makes DTC models financially successful (lifetime value). Manual refills via phone are a pain; automated refills via tech keep patients on therapy and keep revenue flowing.
Analytics Dashboard: Data is critical. A good infrastructure lets you see what’s selling, who’s adhering, etc., so you can optimize. Startups live by data; now clinics can too, without hiring data scientists – the platform will surface key metrics.
By using such an infrastructure, a clinic can in a sense “skip the line” – you skip the years and millions it took DTC companies to build the engine, and you get to just use it from day one.
So the smart clinic says: “Instead of starting a whole separate startup, I’m going to turn my clinic into a modern clinic+eCommerce hybrid by leveraging this service.” It’s a more subtle shift, but far more likely to succeed because you’re not leaving your wheelhouse; you’re upgrading it.
One might say, isn’t this just the same goal as the DTC startup had? Yes, the end goal (sell prescriptions direct, increase revenue) is similar, but the approach is different: collaboration and enablement vs competition. You’re not competing with Hims on Instagram for eyeballs; you’re serving your own patients and maybe extending your reach via referrals because you have a better offering now. It’s a quieter, more infrastructure-centric approach – hence we call it the “hidden” opportunity, because it’s in the plumbing, not necessarily in splashy ads.
Real-World ROI: From Zero to Rx Revenue
Let’s get concrete with numbers for a typical clinic scenario, to illustrate just how quickly a clinic can ramp up revenue using infrastructure vs trying to do a pure DTC approach.
Imagine a mid-sized dermatology clinic with, say, 2 or 3 dermatologists, that sees around 60 new patients a month (not counting follow-ups). Many of those new consults will result in a prescription for something – acne meds, anti-aging creams, rosacea gels, etc. Let’s use the conservative figure from the example: 40% of them get a topical Rx or similar. That’s 24 prescriptions for new patients per month. Additionally, existing patients may get refills or new scripts too, but we’ll keep it simple at first.
Say the average order value (AOV) for a prescription (or bundle of prescriptions/products) via the clinic’s platform is $200. Dermatology compounds or brand-name creams can be pricey, and maybe the patient also buys a sunscreen or cosmetic product along with it on the checkout.
So in the first month, if 24 prescriptions are filled through the clinic at $200 each, that’s $4,800 in revenue. This is essentially newfound revenue, because previously those 24 prescriptions would have been filled at Walgreens or elsewhere with $0 to the clinic.
Now, here’s where the magic of the recurring model kicks in. Let’s assume these medications typically need refills monthly or bimonthly. If we have an automated refill logic in place, and let’s say a realistic retention rate is 70% (meaning 70% of those who got a prescription will refill at least for several months – some drop off due to various reasons). That means out of 24, about 17 continue to refill into the next month.
Those refills in the second month produce MRR of 17 * $200 = $3,400. Meanwhile, the clinic is still adding new patients and new prescriptions in month 2, presumably another ~$4,800 from another 24 initial scripts.
So month 2 total = $4,800 (new) + $3,400 (refills) = $8,200.
Month 3: Another ~$4,800 new + refills from month1 & month2 cohort (month 1 who refilled in month 2 might refill again month 3, etc.). Over a 6-month horizon, as the original post calculates, you could reach $25k+ per month in Rx revenue by month 6. That includes both the accumulated recurring refills and the new ones each month.
This is plausible: by month 6, you have months 1-5 patients all in the refill cycle plus month 6 new ones.
Crucially, this scenario did not require adding new staff or extending clinic hours. It’s leveraging the existing patient flow and simply capturing value that was previously lost. Without an integrated platform, even though the doctor wrote those scripts, the clinic’s revenue from them was zero. With the platform, now it’s tens of thousands per month. And patients likely are happier too because it’s convenient (one less trip to the pharmacy, plus they might like the clinic-branded experience or perceive it as more tailored).
Now compare that with trying to start a DTC brand from scratch: In month 1, a typical new startup might spend a bunch on marketing and maybe get a few hundred customers nationwide if they’re lucky (and at a high cost). They’d likely losemoney in month1 because acquisition cost > revenue initially. It might take a year or more to reach $25k/month in net revenue, and they’ll have spent heavily to do it. The clinic in our scenario basically started netting positive revenue immediately with minimal marketing (just converting in-clinic patients).
This example highlights the power of leveraging what you already have (patient flow, trust) with new infrastructure. It’s low-hanging fruit financially.
The Strategic Advantage for Clinics
Apart from the raw numbers, building infrastructure (versus building a new brand) changes the strategic position of the clinic in several ways:
Patient Retention and Protocol Adherence: As mentioned, with your own fulfillment, patients stay “on protocol” longer. If you prescribe a 6-month course of something, you can actually see them through it, rather than hoping they stick to it. This means better outcomes (which patients appreciate) and they’re more likely to return for other services. No more giving up control right after writing the script. You essentially extend your care into their home.
Control of Sales Channel: If you own the transaction, you also own the opportunity to present other services or information to the patient at that moment. For example, on your checkout page for acne medication, you could suggest, “Also consider our clinic’s gentle cleanser – add to your order.” If the patient trusts you, they might take that recommendation. You can’t do that if they go to a pharmacy – the pharmacist might even recommend some other dermatologist’s skincare line or just a random OTC. By controlling the channel, you curate the patient’s options in line with your care plan. It’s a bit like how owning an e-commerce channel lets a brand avoid being at the mercy of retailers who might push a competitor’s product.
Reduction of Drop-Off: How often have you handed someone a script and never seen them again? Perhaps they moved to a different doctor or they just didn’t follow up. When they are refilling via your system, you have regular touchpoints to them (refill reminders, etc.). If they indicate they want to stop the medication, you can get feedback or try an alternative. It’s much less likely they just vanish. Even if a patient moves away, if your system can deliver to where they move, they might remain your pharmacy customer or even do telehealth follow-ups with you, rather than immediately finding a new local doctor. That stickiness is valuable in an era where patients are more apt to shop around for healthcare.
Margin and Brand Equity Retention: Instead of handing over margin to third-party pharmacies or letting a DTC startup scoop the business, you’re retaining it. Also, each product delivered with your branding reinforces your brand. Many clinics that implement their own product lines find that their brand starts to carry more weight – for instance, “Oh, you go to Clinic ABC? I’ve heard they have their own skincare products that are really good.” It elevates perception from being just a service provider to being an authority in the field that produces or endorses products. It’s a subtle but powerful shift in brand equity. Contrast this with launching a separate DTC brand – that brand might not even be obviously connected to your clinic, so it doesn’t directly boost your clinic’s profile if it remains small. Keeping it unified (infrastructure under your existing brand) means every success in the online part is also a success for the core brand.
All these strategic advantages – keeping patients on protocol, controlling the sales channel, preventing drop-off, retaining margin and brand – can be summarized as creating a moat around your practice. It makes your clinic more resilient and competitive.
No longer are you just sending people out and hoping they come back; you’re actively managing and engaging them between visits. This is something that is tough for competitors to disrupt, especially if they are just standard clinics without such integration. Even if a new doctor opens next door, your patients might be less inclined to switch because switching would mean losing the integrated service they are used to (“If I go to Dr. X, I’ll have to go back to picking up my meds at the pharmacy and I won’t get those custom formulations.”)
One could say, you’re winning on margin, scale, and defensibility rather than on marketing gimmicks. DTC startups fight tooth and nail with marketing dollars for each customer (like a retail war). But a clinic can win by building a deeper relationship and infrastructure – things that aren’t easily taken away by a competitor swooping in, because those are built over trust and time.
Beyond Hair and Derm: Cross-Specialty Growth
We’ve touched on several specialties earlier, but it’s worth reinforcing: nearly any clinic that writes prescriptions can deploy this infrastructure. It’s not just for the obvious dermatology or aesthetic or sexual health areas.
Consider some less obvious ones that could benefit:
Hormone Clinics (Endocrinology or Wellness): They might prescribe thyroid meds, adrenal supplements, bioidentical hormones, etc. Having a dedicated dispensary ensures patients get the exact formulations (for instance, a compounded thyroid capsule with T3+T4 in custom ratio) without confusion. It also offers them privacy – some people don’t want to pick up testosterone or estrogen at a local pharmacy due to potential judgment.
Weight Loss Centers: We mentioned GLP-1s, but also things like appetite suppressants or nutraceuticals. These clinics often have high dropout rates (weight loss is hard!). If a patient is on an auto-refill for their medication and maybe a protein supplement via the clinic, they are more likely to stick with the program rather than yo-yo out.
Dental/Oral Surgery (DSOs): They can supply things like prescription mouthwash, fluoride trays, analgesics, even orthodontic supplies through an online portal to patients post-visit. As DSOs grow, they look for revenue beyond just the procedure – selling aftercare kits is one option.
Women’s Health/Fertility: Fertility clinics can coordinate the myriad of injections and pills a patient needs so they arrive in one package with instructions, rather than giving the patient a list and hoping the specialty pharmacy delivers everything on time. Same with OB/GYN offices that could have an online store for prenatal vitamins, prescription nausea meds, etc., making it easy for pregnant patients to get what they need without pharmacy trips.
Aesthetics/Med Spas: They can bundle prescription skincare (tretinoin, hydroquinone, etc.) with in-clinic treatments and have patients continue maintenance between visits. Many med spas already sell retail skincare; adding Rx compounds ups the ante (like a stronger retinol only available via prescription).
Chronic Disease Management: Think of a rheumatology clinic that could coordinate specialty meds (maybe via specialty pharmacy integration) or at least monitor refills of methotrexate or biologics to ensure patients don’t lapse. Or a GI clinic that treats IBD and could provide certain compound suppositories or mesalamine formulations directly. Usually, these involve insurance, so it’s trickier, but even if you just coordinate through a platform for convenience (with insurance billed behind scenes), it could keep patients tied to your center.
The underlying point is any prescription is an opportunity to deepen the care and capture value. Historically, clinics didn’t think that way, but this is changing. We’re moving into an era of healthcare where providing a good “product experience” is part of good care, not separate from it.
Conclusion: Own the Rails, Not Just the Brand
Copying Hims or Felix superficially – making a website, advertising online – might seem like the way to tap into the booming telehealth market. But as we’ve argued, that path is fraught with pitfalls and often unsustainable for a clinic. The good news is, you don’t need to copy their consumer brand playbook to achieve what you really want (which is increased revenue, better patient retention, modern service).
The smarter strategy is to focus on infrastructure: integrating the same kind of systems and capabilities those startups have, but within your existing practice. This way, you win on fundamentals – clinical trust, recurring revenue, efficiency – rather than trying to out-market the marketers.
By building or adopting an infrastructure, you essentially get the benefits that made Hims and Felix successful (recurring revenue, high customer lifetime value, national reach perhaps) without the huge upfront costs and risks. It’s playing a different game – one that’s more suited to the strengths of clinics.
We can sum it up like this: Copying Hims means competing on marketing. Building infrastructure means you win on margin, scale, and defensibility. Marketing fads can come and go, but if you have a solid platform delivering value, that’s a lasting competitive edge.
And here’s a kicker: if many clinics do this, they collectively decentralize the dominance of any single DTC company. Instead of one Hims serving everyone, you have hundreds of clinics each serving their patients with similar convenience. That might actually be better for patients – because they get both convenience and local physician oversight.
From a financial perspective, adopting such an infrastructure typically requires no significant dev lift on your part (the tech is provided), negligible compliance risk (the platform covers it), and no heavy marketing spend (since you leverage existing relationships). It’s hard to imagine a more elegant way for a clinic to boost its business.
So, to the clinic owners and physicians pondering how to grow and stay competitive: don’t chase being an Instagram-famous startup; instead, quietly empower your clinic with the same tools those startups use. Let the Hims and Felix of the world keep battling for ad impressions and market share. You already have what they covet – patient trust. Now you just need the rails to deliver on that trust in a modern way.
By owning the rails (the infrastructure) of prescription fulfillment and patient engagement, you position your clinic not just to survive but to thrive in the next evolution of healthcare delivery. It’s a hidden opportunity, but now that you see it, it’s time to seize it.
Let’s build your platform — and your moat.
Sources:thehealthcarebreakdown.com Healthcare Breakdown – Calculated CAC for Hims in 2023 was ~$785 per new subscriber acquired, reflecting huge marketing spend. krokerequityresearch.substack.com Kroker Equity Research – Hims marketing expense in 2024 was $679M (approx), highlighting their marketing-driven nature.