4 min read
2026-06-11
Therapy marketplaces run W2 plus 1099 networks at scale, and ACH cost adds up fast. Here is the payout architecture that holds at 10k providers without breaking your reconciliation.
The Friday Problem
A therapy marketplace at scale runs the same operation every Friday: pay 10,000 providers. Some are W2 employees who need direct deposit. Most are 1099 contractors who get paid for the sessions they billed that week. Both expect their money by 5 PM local time.
At one bank that charges $0.25 per ACH and a $5 monthly maintenance per provider, 10,000 payouts a week is $130,000 of avoidable per-transaction cost a year, plus the back-office work of tracking which provider got paid for what. Most platforms run this on a Friday-morning script that breaks at least once a quarter.
The Payout Architecture That Holds
Three components.
Free ACH at scale. The whole economics of a therapy marketplace falls apart if every Friday batch costs $0.25 per provider. Healthcare-native banks that charge $0 per ACH eliminate the line item entirely.
Per-provider routing identifiers. Each provider has a stable payout account on file. Reconciling who got paid for what session means matching at the payment level, not at the platform level. Virtual accounts (or just well-architected ACH metadata) handle this without per-provider account openings.
A working capital reserve. Claims revenue from insurance lands on its own cadence. Provider payouts happen on yours. A reserve smooths the gap, and sweeps from claims accounts top it up as remits clear.
What Changes for the Operations Team
Two things, immediately.
Friday becomes boring. The payout batch runs automatically against the week's billable sessions. Provider-level reconciliation runs the same morning. Exceptions are flagged for the ops team in a queue, not in a panic.
The financial close gets cleaner. Each provider's payout ties to a specific revenue line. Per-state taxes, per-modality cost-of-revenue, and per-provider gross margin all become accessible because the banking layer already tags them.
The Number You Should Be Tracking
Cost per provider payout. Pull your last 12 months: total banking spend on payouts (ACH fees, maintenance, exception handling) divided by total payouts processed.
Healthy at scale is under $0.05 per payout. Most therapy marketplaces we benchmark are at $0.15 to $0.40 because they're paying per-item ACH at a generalist bank. Cutting that number to under a nickel is mostly a banking choice, not an operations choice.
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