I am not familiar with SkyMD but I participate with a competitor's product.
The teledermatology service we use charges an upfront fee to be on their platform (I am unfortunately not privy to that information but I do know it was a rather hefty sum)
Similar services in our area will charge ~$50 to $100 per online visit.
Employees (docs/midlevels) get a % of that, the rest goes towards the partners in an attempt to recoup the upfront fee. It has been a financial disaster thus far (as far as I can tell)
The right physician with the right patient population (younger patients, tech savvy patients, college-aged / pediatric patients, busy professionals) can do very well and clear up in-office time for more lucrative procedures
Our group deals with a primarily older patient population thereby likely making our telederm platform a sunk cost.