A growing shortage of medical doctors and nurses, globally, coupled with increasing life expectancy, is generating greater cost pressures on health care, in the U.S. and globally. In this respect, telehealth can help alleviate these pressures, as well as extend medical services to under-served or unserved areas. However its relatively slow adoption in the U.S., as well as in other markets, suggests the presence of barriers and challenges. The use of a Business Model framework helps identifies the value-proposition of telehealth as well as these challenges, which include identifying the right revenue model, organizational structure and, perhaps more importantly the stakeholders in the telehealth eco-system. Successfully and cost effective deployment of telehealth require a re-definition of the eco-system, a comprehensive review of all benefits and beneficiaries of such a system, hence a re-thinking of all the stakeholders that benefit from such a system, beyond the traditional patient-health provider-insurer model, and thus “who should pay ”for such a system, and the driving efforts of a “keystone” player in developing this initiative.