Faresay
Therapy, matched.

Market Research Synthesis

Confidential Faresay Ltd·25 June 2026

Source: deep-research run (28 sources fetched, 40 claims extracted, 25 adversarially verified → 15 confirmed / 10 killed). Confidence tags below reflect that verification. Magnitudes from market-sizing reports are directional only — several specific $-figures were refuted as inconsistent across sources, so treat ranges, not point values, as reliable. Verify any number before putting it in front of investors. Last updated: [PLACEHOLDER: date]

⚠️ Strategic reframing (canonical sequencing). The expansion path is now UK first → English-speaking expatriates worldwide → broader markets (incl. the US) later — not "UK → US". The US sections below remain valuable context but should be read as the large-but-most-competitive later option, not the next move: US demand is concentrating around insurance (high CAC, in-network migration), which makes it attractive in size yet crowded and structurally harder for a cash-pay entrant. The next beachhead after the UK is the globally mobile English-speaking professional segment (see new §2.5 / §7) — underserved, naturally cash-pay, concentrated and referral-rich. This segment has no sourced figures yet; it is written qualitatively with explicit [RESEARCH NEEDED] markers and must not be assigned a TAM/SAM until primary research lands.

Confidence legend

0. Primary-source firmed numbers (research pass 2 — higher confidence)

These were pulled directly from official / primary sources and supersede the softer figures below. | Figure | Value | Source | Conf. | |--------|-------|--------|-------| | US adults who received mental-health treatment, past year (2023) | 59.2M (23.0% of adults), +3.4M YoY | SAMHSA NSDUH 2023 | 🟢 official | | Behavioral-health workforce gap | demand +49% by 2033 vs supply +11%; 40% (137M people) live in a Mental Health HPSA | HRSA Bureau of Health Workforce 2025 | 🟢 official | | US behavioral-health spend | ~$280B (2020); MH+SUD treatment spend $139.6B (2021), of which MH $126.5B | NJAMHAA; Health Affairs 2025 | 🟢 | | Medicare CY2025 conversion factor | $32.35 (−2.83% YoY) | CMS CY2025 PFS Final Rule | 🟢 official | | Medicare therapy rate (national, approx.) | 90837 (60-min) ≈ $117 (3.63 RVU); 90834 (45-min) ≈ $79 (2.45 RVU) × CF, pre-locality | CMS RVUs × CF | 🟢 derived | | Cash-pay therapy price | $100–200 typical ($65–300+ range; online often $60–100; psychologists $150–250) | multiple consistent 2025 sources | 🟢 | | BetterHelp pricing | $260–400/mo (~$65–100/wk); adding insurance in 30+ states (2026) | BetterHelp / comparisons | 🟡→🟢 | | Talkspace pricing | $69–109/wk out-of-pocket; insurance copays ~$0–10 | Talkspace | 🟡→🟢 | | Grow Therapy take rate | % of insurance payout, not publicly disclosed (so "20–30%" is an estimate only) | Grow / provider guides | 🟡 |

Strategic signal reinforced: both major cash-pay players (BetterHelp and Talkspace) are now bolting on insurance — independent confirmation that US demand is migrating in-network. And the macro provider shortage (HRSA) coexists with platforms being client-demand- constrained: clinicians are scarce nationally, but the scaling bottleneck for a marketplace is still acquiring paying clients, not signing therapists.

Confidence legend (original pass-1 findings below)

1. Market size & growth (US — large but most-competitive later option)

Sequencing note: the US figures below describe the biggest prize and the most crowded, insurance-gravitating arena. Under the canonical sequencing they justify why the US is a deliberate later phase, not the immediate target — read them as "size of the eventual opportunity", not "size of the next move".

2. Competitive landscape & models

Three distinct models — important for positioning:

A. Cash-pay / D2C (Faresay's chosen lane) - BetterHelp (Teladoc) & Talkspace — subscription/cash-pay, heavy paid-marketing CAC. - 🟢 Talkspace is actively pivoting OUT of pure cash-pay into insurance/payer + employer: total revenue +25% YoY, unique active payer members +29% YoY (Q3 2025), EAP/employer line growing, gross margin declining sequentially. Signal: the public cash-pay leader is moving toward insurance — a strategic tell. (Talkspace Q3 2025 investor release — primary.)

B. Insurance-enablement marketplace (the current growth story) - 🟢 Headway — insurance-enablement: credentials providers with major payers, handles claims/ billing/payments; three-sided (patients/providers/insurers); ~$2.3B valuation. Free for providers to join; monetises on the reimbursement flow. - 🟢 Alma — membership-based insurance-enablement; $130M Series D (Thoma Bravo, + Cigna Ventures & Optum Ventures), ~$800M valuation. Insurer venture arms investing is itself a signal. - 🟡 Grow Therapy — similar insurance-enablement; reportedly takes a ~20–30% cut (directional).

C. Employer / EAP - Lyra Health (~$4.6B val) & Spring Health — sell to employers; not a direct comp for a D2C marketplace but relevant for a future B2B line.

Competitor gap relevant to the new beachhead: the incumbents above are overwhelmingly US-insurance-bound (Headway / Alma / Grow monetise the US reimbursement flow) or US-employer- bound (Lyra / Spring). None is structured to serve English-speaking professionals living outside their home country, who typically sit outside local insurance and outside US payer networks. The current alternative for that population is fragmented local directories and word-of-mouth — i.e. no dominant cross-border, culturally-matched, English-language player. See §2.5.

2.5 New beachhead — globally mobile English-speaking professionals (qualitative)

Confidence: none sourced yet. This entire section is qualitative and reasoned, not measured. Every quantitative claim is deliberately left as a [RESEARCH NEEDED] marker. Do not invent a TAM/SAM, population count, or willingness-to-pay figure for this segment until primary research lands. This is the post-UK target and the reason the US is reframed as a later phase.

Who they are. Internationally mobile English-speaking professionals and their families — expats, "global nomads", posted employees, and returnees — concentrated in hubs such as Japan, Singapore, Hong Kong, the UAE, Thailand, Vietnam, and across Europe. Culturally and linguistically oriented toward English-language therapy, often with a UK/Western frame of reference that maps onto Faresay's existing UK supply.

Why underserved. - Local mental-health systems are usually delivered in the local language and clinical culture; culturally-compatible English-language therapy is thin on the ground per corridor. - Expats frequently fall outside local public-health and insurance entitlement, and outside US payer networks — so the insurance-enablement incumbents simply do not address them. - The standing alternative is fragmented local directories, embassy lists, and word-of-mouth — high-friction discovery, inconsistent quality signalling. - [RESEARCH NEEDED: per-corridor expat population + share lacking culturally/linguistically matched provision — primary/official sources (e.g. national statistics offices, chamber-of-commerce and expat-association data)]

Why naturally cash-pay. - Often ineligible for local insurance or holding international policies that don't cleanly cover outpatient talk-therapy → they are already paying out of pocket by default, which fits Faresay's cash-pay model without the payer-contracting burden that makes the US hard. - This sidesteps the very dynamic (in-network migration) that makes the US a crowded, later play. - [RESEARCH NEEDED: private-pay willingness + typical out-of-pocket session price per corridor — primary sources / direct pricing surveys]

Why CAC-favourable. - Expat communities are concentrated and bounded (specific neighbourhoods, employers, schools, associations, online groups) → reachable channels rather than broad, expensive paid search. - They are referral-rich and high-trust internally — strong word-of-mouth within tight networks lowers blended acquisition cost relative to US cash-pay's paid-marketing CAC (see §3, §6). - [RESEARCH NEEDED: realistic CAC + organic/referral share per corridor — pilot data, not assumption]

Competitor gap. - Incumbents are US-insurance-bound (Headway, Alma, Grow) or fragmented local directories; no dominant cross-border, English-language, culturally-matched marketplace serves this population today. This is the differentiation thesis for the segment. - [RESEARCH NEEDED: competitor density + positioning per corridor — primary scan of local English- language therapy directories, expat-focused platforms, and any cross-border entrants]

Key dependency — cross-border licensure / jurisdiction (research + legal). - Therapy delivered to a client physically located in another country raises per-corridor questions about where the clinician must be licensed, which jurisdiction's standards and consumer-protection rules apply, data-protection regime, and tax/establishment exposure. Unlike the US compacts (PSYPACT etc. — see §5), there is no single multi-country framework; each corridor must be assessed individually. - This is a gating dependency of the expat strategy, not a footnote: corridor viability depends on it. - [RESEARCH NEEDED + LEGAL: per-corridor cross-border licensure, regulated-activity scope, data- protection (e.g. GDPR vs local), and tax/establishment analysis — qualified local counsel per target corridor]

3. Pricing & unit economics (treat as ranges to validate)

4. Insurance vs cash-pay dynamics

5. Regulatory tailwinds/headwinds

6. Go-to-market & defensibility

7. Sequencing summary (canonical)

  1. UK first — home market, existing supply, single jurisdiction.
  2. English-speaking expatriates worldwide (§2.5) — the next beachhead: underserved, naturally cash-pay, concentrated/referral-rich, less crowded than the US, and a natural extension of UK-aligned supply. Qualitative only so far — gated on [RESEARCH NEEDED] (population, private-pay willingness, competitor density, CAC) and on per-corridor cross-border licensure/jurisdiction clearance.
  3. Broader markets incl. the US — later, optional (§1, §4) — the largest but most-competitive arena, with demand concentrating around insurance. Attractive in size, entered last and deliberately.

⚠️ Discipline reminder: §2.5 and the expat parts of §6/§7 carry no sourced figures. They are intentionally written without TAM/SAM or statistics. Resolve every [RESEARCH NEEDED] marker with primary sources before any of it goes in front of investors.

Sources (with verification context)

Net: enough to write credible market/competitive/strategy sections with ranges and direction for the UK and US context. The expat beachhead (§2.5) is not yet sourced — it is reasoned qualitatively and must be backed by primary corridor research (population, private-pay willingness, competitor density, CAC) plus per-corridor legal review before use. Before any investor-facing use, refresh the hard US/UK numbers (market size, CMS rates, competitor take rates) from primary/official sources and resolve the expat [RESEARCH NEEDED] markers.