in the year ended december 31 , 2019 , our clients completed a total of 1.1 million visits on the amwell platform , while in the year ended december 31 , 2020 , clients significantly expanded their use of the amwell platform with 5.9 million completed visits . during the covid-19 crisis , utilization of the platform achieved levels not seen before , evident by a larger number of clients ' own providers using the amwell platform . amg providers accounted for 27 % of total visits performed versus 66 % of total visits performed on the amwell platform during the years ended december 31 , 2020 and 2019 , respectively . 57 new use patterns and functionality looking past covid-19 , we can see that some effects of the current period may be felt beyond the immediate crisis . in particular , we are seeing the growing awareness among consumers of the availability and efficacy of telehealth for many healthcare needs and we are seeing more widespread hands-on experience among providers in delivering care via telehealth . it remains unclear the extent to which the currently more relaxed regulatory environment , favorable reimbursement policies , and leniency with respect to cross-state provider licensure will become normative . however , we believe that the current experience is more likely to be favorable to telehealth and amwell 's business than otherwise over the longer term . new client acquisition we believe our ability to add net new health system and health plan clients is a key indicator of our increasing market adoption and future revenue potential . we maintain dedicated direct sales teams for both health systems and health plans focused on selling solutions that meet each of their respective needs . our direct sales teams sell our full suite of technology , services and carepoints . channel partners also play an important role in marketing and selling our products to our customer base , primarily focusing on the amwell platform and carepoints . channel partners reduce our sales cycle and lower customer acquisition costs . for example , through our ehr channel partners we are able to natively embed our technology into existing health system technology infrastructure which , as a competitive differentiator , may lead to a higher win rate . in addition , because of the technology integration , an ehr partner sale may accelerate our ability to launch the technology and ultimately recognize revenue . carepoint channel partners primarily consist of value-added resellers that have established relationships with health systems and health plans . we typically generate lower revenues in connection with sales obtained through these channel partner agreements . client expansion and retention health system contracts are initially priced based on the size of the system and their projected visit activity . the contract value is typically expected to grow as the health system increases the number of providers on the platform and the number of consultations performed through the platform or adds the ability to deliver new use cases across their enterprise whether by the health system 's own providers or through amg . when a client chooses to adopt a new use case , amwell configures a module for its amwell platform instance . a module represents a unique patient or provider workflow , documentation requirement , or technology integration and associated services . our platform modules currently support over 100 active use cases with new modules continually being developed as virtual care continues to expand into new areas . we expand business with health plans when they expand the number of members who have access to our amwell platform and amg services or through offering new clinical programs to eligible plan members . in many cases health plans pay amwell incremental subscription fees for adding new members to the amwell platform , and for each clinical program that is deployed , which over time increases the annual contract value per health plan , a key indicator of the growth of our business . we believe our ability to grow subscription revenue in our existing health plan client base is an indicator of the long-term value of our customer relationships . active providers an important indicator of the value of our amwell platform to our clients is the number of non-amg providers that are active on the amwell platform . we define “ active providers ” as providers that have delivered a visit on the amwell platform at least once in the last 12 months . active providers demonstrate the prevalence of telehealth within our clients in both home and hospital environments . we believe active providers is a measure of our success in delivering on our mission of enabling access to care . we expect that the number of active providers will increase over time as a result of several factors : the number of modules and use cases deployed within health systems the adoption of telehealth by providers across the spectrum of care the number of programs offered through health plans the continued improvement in the regulatory environment for telehealth , including reimbursement for telehealth services 58 the ongoing consumerization of healthcare invest in growth we expect to continue to focus on long-term revenue growth through investments in technology development and sales and marketing efforts . in addition , we believe additional investments in platform modules and clinical programs will allow us to continue to penetrate our products and services further in to our existing client relationships . accordingly , in the short term we expect these activities to increase our net losses , but in the long term we anticipate that these investments will positively impact our results of operations . regulatory environment our operations are subject to comprehensive united states federal , state and local and international regulation in the jurisdictions in which we do business . story_separator_special_tag 64 consolidated results of operations the following table sets forth our summarized consolidated statement of operations data for the years ended december 31 , 2020 , 2019 and 2018 and the dollar and percentage change between the respective periods : replace_table_token_8_th revenue for the year ended december 31 , 2020 , the increase in revenue was substantially driven by an increase in visit revenue volume ( $ 76.5 million increase ) . visit revenue has increased due to the impact of the covid-19 crisis . revenue increase was also attributable to new clients using our platform and existing clients adding additional modules to their platform subscriptions , such as our covid-19 module . we believe that the strength of our technology platform will continue to serve as the foundation for our revenue growth . subscription revenue from health systems was $ 49.8 million for the year ended december 31 , 2020 , compared to $ 38.8 million during december 31 , 2019 , an increase of $ 11.0 million , or 28 % . revenue earned from amg patient visits increased by $ 76.5 million , or 188 % , from $ 40.7 million for the year ended december 31 , 2019 to $ 117.2 million in the december 31 , 2020. the increase was primarily driven by increased utilization across our health system and health plan clients primarily from the covid-19 pandemic as well as overall increased acceptance of telemedicine . amg visits constituted 27 % of the total visits for the year ended december 31 , 2020 , compared to 66 % for the year ended december 31 , 2019. revenue earned from services and carepoints was $ 29.7 million for the year ended december 31 , 2020 , compared to $ 24.5 million during december 31 , 2019 , an increase of $ 5.2 million , or 21 % . the increase in services and carepoints revenue was largely due to the overall increased volume of carepoints sales and partially the result of timing with respect to the performance of services and the timing of delivery of carepoints . for the year ended december 31 , 2019 , the increase in revenue was predominately the result of new clients using the platform as the average number of health system and health plan clients on our platform increased by 50 , to 194 as of december 31 , 2019 from 144 as of december 31 , 2018 , a 35 % increase . we believe that the strength of our technology platform will continue to serve as the foundation for our revenue growth . subscription revenue from health system clients was $ 38.8 million for the year ended december 31 , 2019 , compared to $ 27.3 million during the year ended december 31 , 2018 , an increase of $ 11.5 million , or 42 % . this increase was substantially driven by a 50 % increase in the average number of subscription clients increasing from 92 to 138. subscription revenue from health plan clients was $ 30.6 million for the year ended december 31 , 2019 , compared to $ 23.6 million during the year ended december 31 , 2018 , an increase of $ 7.0 million , or 30 % . this increase was driven by an 8 % increase in the average number of subscription clients , increasing from 52 to 56 , and increases in the health plan client average contract value increasing 21 % . the total number of paid amg patient visits increased 38 % , by 208,000 , from 551,000 in the year ended december 31 , 2018 to 759,000 in the year ended december 31 , 2019. this increase was primarily driven by increased utilization across our health system and health plan clients . amg visits constituted 66 % of the total visits for the year ended december 31 , 2019 , compared to 73 % for the year ended december 31 , 2018 . 65 costs of revenue , excluding depreciation and amortization of intangible assets for the year ended december 31 , 2020 , the increase in cost of revenue was primarily due to an increase of $ 50.8 million in provider related costs , with some portion of these provider costs due to increased visit volumes . some portion of these provider costs were above typical levels due to the covid-19 emergency rapid expansion of active providers . the increase in visit volume also resulted in the need to utilize a significantly higher level of non-clinical contractor resources to properly service visit demand . the company experienced a $ 14.1 million increase in employee-related expense ( primarily in the form of variable compensation and stock compensation expense ) . hardware costs increased $ 6.0 million related to the increase in sale of devices . there was also an increase of $ 5.5 million in third party software . as a percentage of revenue , cost of revenues has increased as a result of the shift in revenue mix . the impact of covid-19 has increased our visit revenue , which generates a lower gross margin contribution . for the year ended december 31 , 2019 , the increase in cost of revenue was primarily due to an increase of $ 4.6 million in employee-related expense ( inclusive of stock compensation expense ) and a $ 16.8 million increase in other costs , primarily provider related costs , combined with implementation and hosting related expenses . with respect to employee-related expense , our total administrative employee headcount dedicated to servicing amg increased to 158 on december 31 , 2019 , as compared to 145 on december 31 , 2018. as a percentage of revenue , cost of revenues have remained relatively consistent year over year . research and development expenses research and development expenses increased for the year ended december 31 , 2020 , compared the year ended december 31 , 2019 , which was primarily driven

cash used in operating activities for the year ended december 31 , 2020 , cash used in operating activities was $ 112.5 million . the primary driver of this use of cash was our net loss of $ 228.6 million . the net loss for the year was reflective of the investments made back into the company ( from both a personnel and technology perspective ) , partially offset by the overall growth of our business including an increase in new clients and expansion of business with existing clients . the net loss was partially offset by non-cash expenses of $ 134.6 million ( primarily stock-based compensation of $ 118.4 million and depreciation and amortization of $ 10.2 million ) . for the year ended december 31 , 2019 , cash used in operating activities was $ 81.9 million . the primary driver of this use of cash was our net loss of $ 88.4 million . the net loss for the year was reflective of the investments made back into the company ( from both a personnel and technology perspective ) , partially offset by the overall growth of our business including an increase in new clients and expansion of business with existing clients . the net loss was partially offset by non-cash expenses of $ 21.0 million ( primarily stock-based compensation of $ 12.1 million and depreciation and amortization of $ 7.8 million ) . for the year ended december 31 , 2018 , cash used in operating activities was $ 74.0 million . the primary driver of this use of cash was our net loss of $ 52.3 million . the cash used for operating activities was primarily driven by the overall growth of our business including an increase in new clients ( through organic growth and the avizia acquisition ) and expansion of business by existing clients . the net loss was partially offset by non-cash charges totaling $ 15.1 million , which was primarily comprised of stock-based compensation of $ 7.7 million and depreciation and amortization expense of $ 5.3 million .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```cash used in operating activities for the year ended december 31 , 2020 , cash used in operating activities was $ 112.5 million . the primary driver of this use of cash was our net loss of $ 228.6 million . the net loss for the year was reflective of the investments made back into the company ( from both a personnel and technology perspective ) , partially offset by the overall growth of our business including an increase in new clients and expansion of business with existing clients . the net loss was partially offset by non-cash expenses of $ 134.6 million ( primarily stock-based compensation of $ 118.4 million and depreciation and amortization of $ 10.2 million ) . for the year ended december 31 , 2019 , cash used in operating activities was $ 81.9 million . the primary driver of this use of cash was our net loss of $ 88.4 million . the net loss for the year was reflective of the investments made back into the company ( from both a personnel and technology perspective ) , partially offset by the overall growth of our business including an increase in new clients and expansion of business with existing clients . the net loss was partially offset by non-cash expenses of $ 21.0 million ( primarily stock-based compensation of $ 12.1 million and depreciation and amortization of $ 7.8 million ) . for the year ended december 31 , 2018 , cash used in operating activities was $ 74.0 million . the primary driver of this use of cash was our net loss of $ 52.3 million . the cash used for operating activities was primarily driven by the overall growth of our business including an increase in new clients ( through organic growth and the avizia acquisition ) and expansion of business by existing clients . the net loss was partially offset by non-cash charges totaling $ 15.1 million , which was primarily comprised of stock-based compensation of $ 7.7 million and depreciation and amortization expense of $ 5.3 million .
```    
 Suspicious Activity Report : in the year ended december 31 , 2019 , our clients completed a total of 1.1 million visits on the amwell platform , while in the year ended december 31 , 2020 , clients significantly expanded their use of the amwell platform with 5.9 million completed visits . during the covid-19 crisis , utilization of the platform achieved levels not seen before , evident by a larger number of clients ' own providers using the amwell platform . amg providers accounted for 27 % of total visits performed versus 66 % of total visits performed on the amwell platform during the years ended december 31 , 2020 and 2019 , respectively . 57 new use patterns and functionality looking past covid-19 , we can see that some effects of the current period may be felt beyond the immediate crisis . in particular , we are seeing the growing awareness among consumers of the availability and efficacy of telehealth for many healthcare needs and we are seeing more widespread hands-on experience among providers in delivering care via telehealth . it remains unclear the extent to which the currently more relaxed regulatory environment , favorable reimbursement policies , and leniency with respect to cross-state provider licensure will become normative . however , we believe that the current experience is more likely to be favorable to telehealth and amwell 's business than otherwise over the longer term . new client acquisition we believe our ability to add net new health system and health plan clients is a key indicator of our increasing market adoption and future revenue potential . we maintain dedicated direct sales teams for both health systems and health plans focused on selling solutions that meet each of their respective needs . our direct sales teams sell our full suite of technology , services and carepoints . channel partners also play an important role in marketing and selling our products to our customer base , primarily focusing on the amwell platform and carepoints . channel partners reduce our sales cycle and lower customer acquisition costs . for example , through our ehr channel partners we are able to natively embed our technology into existing health system technology infrastructure which , as a competitive differentiator , may lead to a higher win rate . in addition , because of the technology integration , an ehr partner sale may accelerate our ability to launch the technology and ultimately recognize revenue . carepoint channel partners primarily consist of value-added resellers that have established relationships with health systems and health plans . we typically generate lower revenues in connection with sales obtained through these channel partner agreements . client expansion and retention health system contracts are initially priced based on the size of the system and their projected visit activity . the contract value is typically expected to grow as the health system increases the number of providers on the platform and the number of consultations performed through the platform or adds the ability to deliver new use cases across their enterprise whether by the health system 's own providers or through amg . when a client chooses to adopt a new use case , amwell configures a module for its amwell platform instance . a module represents a unique patient or provider workflow , documentation requirement , or technology integration and associated services . our platform modules currently support over 100 active use cases with new modules continually being developed as virtual care continues to expand into new areas . we expand business with health plans when they expand the number of members who have access to our amwell platform and amg services or through offering new clinical programs to eligible plan members . in many cases health plans pay amwell incremental subscription fees for adding new members to the amwell platform , and for each clinical program that is deployed , which over time increases the annual contract value per health plan , a key indicator of the growth of our business . we believe our ability to grow subscription revenue in our existing health plan client base is an indicator of the long-term value of our customer relationships . active providers an important indicator of the value of our amwell platform to our clients is the number of non-amg providers that are active on the amwell platform . we define “ active providers ” as providers that have delivered a visit on the amwell platform at least once in the last 12 months . active providers demonstrate the prevalence of telehealth within our clients in both home and hospital environments . we believe active providers is a measure of our success in delivering on our mission of enabling access to care . we expect that the number of active providers will increase over time as a result of several factors : the number of modules and use cases deployed within health systems the adoption of telehealth by providers across the spectrum of care the number of programs offered through health plans the continued improvement in the regulatory environment for telehealth , including reimbursement for telehealth services 58 the ongoing consumerization of healthcare invest in growth we expect to continue to focus on long-term revenue growth through investments in technology development and sales and marketing efforts . in addition , we believe additional investments in platform modules and clinical programs will allow us to continue to penetrate our products and services further in to our existing client relationships . accordingly , in the short term we expect these activities to increase our net losses , but in the long term we anticipate that these investments will positively impact our results of operations . regulatory environment our operations are subject to comprehensive united states federal , state and local and international regulation in the jurisdictions in which we do business . story_separator_special_tag 64 consolidated results of operations the following table sets forth our summarized consolidated statement of operations data for the years ended december 31 , 2020 , 2019 and 2018 and the dollar and percentage change between the respective periods : replace_table_token_8_th revenue for the year ended december 31 , 2020 , the increase in revenue was substantially driven by an increase in visit revenue volume ( $ 76.5 million increase ) . visit revenue has increased due to the impact of the covid-19 crisis . revenue increase was also attributable to new clients using our platform and existing clients adding additional modules to their platform subscriptions , such as our covid-19 module . we believe that the strength of our technology platform will continue to serve as the foundation for our revenue growth . subscription revenue from health systems was $ 49.8 million for the year ended december 31 , 2020 , compared to $ 38.8 million during december 31 , 2019 , an increase of $ 11.0 million , or 28 % . revenue earned from amg patient visits increased by $ 76.5 million , or 188 % , from $ 40.7 million for the year ended december 31 , 2019 to $ 117.2 million in the december 31 , 2020. the increase was primarily driven by increased utilization across our health system and health plan clients primarily from the covid-19 pandemic as well as overall increased acceptance of telemedicine . amg visits constituted 27 % of the total visits for the year ended december 31 , 2020 , compared to 66 % for the year ended december 31 , 2019. revenue earned from services and carepoints was $ 29.7 million for the year ended december 31 , 2020 , compared to $ 24.5 million during december 31 , 2019 , an increase of $ 5.2 million , or 21 % . the increase in services and carepoints revenue was largely due to the overall increased volume of carepoints sales and partially the result of timing with respect to the performance of services and the timing of delivery of carepoints . for the year ended december 31 , 2019 , the increase in revenue was predominately the result of new clients using the platform as the average number of health system and health plan clients on our platform increased by 50 , to 194 as of december 31 , 2019 from 144 as of december 31 , 2018 , a 35 % increase . we believe that the strength of our technology platform will continue to serve as the foundation for our revenue growth . subscription revenue from health system clients was $ 38.8 million for the year ended december 31 , 2019 , compared to $ 27.3 million during the year ended december 31 , 2018 , an increase of $ 11.5 million , or 42 % . this increase was substantially driven by a 50 % increase in the average number of subscription clients increasing from 92 to 138. subscription revenue from health plan clients was $ 30.6 million for the year ended december 31 , 2019 , compared to $ 23.6 million during the year ended december 31 , 2018 , an increase of $ 7.0 million , or 30 % . this increase was driven by an 8 % increase in the average number of subscription clients , increasing from 52 to 56 , and increases in the health plan client average contract value increasing 21 % . the total number of paid amg patient visits increased 38 % , by 208,000 , from 551,000 in the year ended december 31 , 2018 to 759,000 in the year ended december 31 , 2019. this increase was primarily driven by increased utilization across our health system and health plan clients . amg visits constituted 66 % of the total visits for the year ended december 31 , 2019 , compared to 73 % for the year ended december 31 , 2018 . 65 costs of revenue , excluding depreciation and amortization of intangible assets for the year ended december 31 , 2020 , the increase in cost of revenue was primarily due to an increase of $ 50.8 million in provider related costs , with some portion of these provider costs due to increased visit volumes . some portion of these provider costs were above typical levels due to the covid-19 emergency rapid expansion of active providers . the increase in visit volume also resulted in the need to utilize a significantly higher level of non-clinical contractor resources to properly service visit demand . the company experienced a $ 14.1 million increase in employee-related expense ( primarily in the form of variable compensation and stock compensation expense ) . hardware costs increased $ 6.0 million related to the increase in sale of devices . there was also an increase of $ 5.5 million in third party software . as a percentage of revenue , cost of revenues has increased as a result of the shift in revenue mix . the impact of covid-19 has increased our visit revenue , which generates a lower gross margin contribution . for the year ended december 31 , 2019 , the increase in cost of revenue was primarily due to an increase of $ 4.6 million in employee-related expense ( inclusive of stock compensation expense ) and a $ 16.8 million increase in other costs , primarily provider related costs , combined with implementation and hosting related expenses . with respect to employee-related expense , our total administrative employee headcount dedicated to servicing amg increased to 158 on december 31 , 2019 , as compared to 145 on december 31 , 2018. as a percentage of revenue , cost of revenues have remained relatively consistent year over year . research and development expenses research and development expenses increased for the year ended december 31 , 2020 , compared the year ended december 31 , 2019 , which was primarily driven

