A Take Rate Is Not a Marketing Department
What the platform’s cut buys, who owns the patient, and what happens the day you leave.
- ALLOWED
- 150
- THEY PAY YOU
- 105
- THEY KEEP
- 45
- BOOKED
- 80
- SHOWED · PAID
- 68
- 68 × 105
- 7,140
- 68 × 45
- 3,060
Composite. Not their rate sheet. Not your agreement. Read yours.
Take rate
Healthcare strategy · two-sided marketsThe share an intermediary keeps of every transaction it stands between.
Some businesses sell you something. Others stand in the middle and keep a slice of everything that passes through. The slice has a name: the take rate.
That is the whole business model of a marketplace. It does not have to own the supply. It does not have to own the demand. It only has to own the transaction.
Here is one month, composite. The full price was $150. They paid me $105 and kept $45. I booked 80. Sixty-eight showed and paid. So I earned $7,140 — and they earned $3,060, on the same sixty-eight. That is one month. Multiply it.
A take is not a fee. A fee ends when the work ends. Somebody does a job, sends a bill, and it is over. A take keeps going for as long as the relationship does.
So is 30% fair is the wrong question. The right one is: what does the $3,060 buy, and how long does it keep buying it? The answer turns on one thing. Who owns the customer?
If they found the person, hold the contact, and could send them elsewhere tomorrow — you are renting an asset you do not have. The take is the rent. If you own the relationship and they only process it, you are paying a marketplace price for plumbing.
This is why a take rate is invisible. There is no invoice. Nothing leaves your account. The money simply never arrives. I have never once watched $3,060 leave a bank statement. A cost you never see leave is the hardest one to manage, and the easiest to keep paying for years.
Go deeper: three things a school would add
- Take rates are defended by bundling — routing, payments, compliance, support. Price each component separately and you usually find one part worth paying for and three that are not.
- The exit test reveals ownership: if you left tomorrow, who would follow you and who would be re-routed? That answer, not the contract, is the truth of the relationship.
- Marketplaces raise take rates as switching costs rise. Your rate is a starting position, and the moment to negotiate it is before your dependence is obvious.
Work the case
Two decisions. Choose before you read the reasoning. The wrong answer is the one worth understanding.
An intermediary takes 25% and calls itself your marketing department. It brought you 40 customers last year; 34 of them came back on their own this year.
Choose one — the reasoning opens after you commit.
You are offered a lower take rate in exchange for a two-year exclusivity clause.
Choose one — the reasoning opens after you commit.
Somebody said: join the platform and you have marketing. Look at the board instead. The plan allows 150 for the visit, not what the platform shows you; what the plan pays.
The platform pays you 105. The 45 they keep isn't a fee you pay once.
It's a take: a share of every visit, for as long as you're there.
The calendar isn't the number either. Eighty booked, sixty-eight showed and paid, 85%, and they pay on completed. Sixty-eight is the number.
68 × 105 = 7,140 landed. 68 × 45 = 3,060 walked out the door as the take. This month. Every month.
Schools call this a take rate, and the company running it a two-sided market: they sit between the plan and you and keep a piece of each transaction.
Fine. So what does the piece buy?
You've been asking "is the cut fair?" The question is "what does the cut buy, and what happens the day I leave?" If you were credentialed under their group contract, your in-network status ran through their contract, not yours.
If the patient found you in their directory, that was their listing.
The day you leave, read the agreement: are you still in-network with that plan? Can you contact those patients? Don't guess. Read it.
That's the switching cost, and the switching cost is the business model.
Put the two columns side by side. What the 3,060 bought this month: credentialing under their contract, real. Claims filed, paid on completed, real.
A listing in their directory, real. What marketing is: impressions you can count, inquiries you can count, booked · showed · came back, a funnel you own with a number in every box.
Nothing on the left is on the right.
Now price the alternative honestly. Direct, composite: credential yourself (90–150 days of waiting), collect 93% of allowed because the denials are now yours, a biller at 7%, your own listing at $30 a month.
Same 68 visits: 8,792 versus 7,140. The gap is 1,652 a month, and it assumes the same 68 patients found you without their directory, which is the whole question.
1,652 a month is a real price for not waiting four months, not doing the admin, and not eating the denials.
Should you pay it? Some of you should. Pay it on purpose. Don't call it marketing.
The question, as it actually gets asked
Composite questions — blended from the operator rooms, never one person's words.Read these for the method, not the answer. The next question you have will not be on this list — the point is that the concept above answers it anyway.
Which concept this really isA take rate is a price for a bundle. The comparison isn't platform-versus-direct, it's which parts of the bundle you'd otherwise buy, and what the cut costs once patients start returning on their own.
How you work it outSplit the bundle: acquisition, credentialing, billing, scheduling, support. Price each separately, then multiply the per-visit cut by a year of visits. A composite $45 a visit at 68 visits a month is $36,720 a year. Set that against what the same services cost bought separately.
The mental model that makes it hardTreating the cut as a marketing department. It's an acquisition price that keeps being charged after acquisition has already happened.
The Monday rule, what do you actually run this week?
A take rate is a share of every visit. Ask what it buys, and who owns the patient when you leave.
Connected lessons
- show-rate The funnel you own — booked × showed × collected — is this page’s right-hand column.
- four-gates "Credential yourself" is gate 3. This is what the four months buy their way past.
- the-split Same question one layer down: what does the cut buy?
This is one of eleven lessons, free to read. One arrives by email each week, on composite numbers you can check.