Tuesday, July 7, 2009

A PAY FOR PERFORMANCE SYSTEM FOR HEALTH MANAGEMENT

1. CASH FOR HEALTH is a ROLL-UP to cooperatively convert independent medical 
practices into cash businesses.
2. CASH FOR HEALTH is a solution for employers to afford better health care for employees for less money.
3. CASH FOR HEALTH is a cash reward system for patients as an incentive to improve annual health scores.


THE CASH FOR HEALTH SYSTEM:
PAY-FOR-PERFORMANCE PREVENTION MANAGEMENT
$200 (min.) - $500 (max.) PER MONTH FOR ANYONE TO ENROLL

FOR PATIENTS: 
  • CASH FOR HEALTH MANAGES ALL YOUR HEALTH MAINTENANCE COSTS WITH YOUR CASH FOR HEALTH DEBIT CARD 
  • WIN CASH POINTS BACK BASED ON YOUR HEALTH PERFORMANCE OR WHEN YOU LOSE WEIGHT
CASH FOR HEALTH uses required annual personal health scores to create smart, managed care plans for H2O members and rewards members with cash points back when health scores improve or their catastrophic risk level is reduced. The CASH FOR HEALTH system motivates members to compete against themselves and members are supported by peers and CASH FOR HEALTH coaches to motivate individual success collectively.

I combined the best functioning parts of various systems (including those by Dr. Mehmet Oz, Dean Ornish and Safeway) and I added a special sauce; a cash reward system for members! That is the missing link and sets it apart from anything else on the table now. Another compelling feature, CASH FOR HEALTH separates catastrophic insurance from daily health management costs. As an CASH FOR HEALTH member based on your current health scores and risk level you can opt-in to purchase hospital care coverage from CASH FOR HEALTH insurance partners based on a dollar figure to cover anything from potential hospital visits ($100,000) or for cancer care ($1 million).

CASH FOR HEALTH DEBIT CARD INTERCHANGE REVENUE
iCASH FOR HEALTH financial services collects monthly payments from members, transfer payments (or government or employer subsidized transactional credit) onto individual member debit cards, that are coded for use only for health care services and products from CASH FOR HEALTH suppliers and merchants. 

 Interchange fees will support CASH FOR HEALTH health rewards programs. In other issuer models paying for rewards programs consumes 44% of the interchange costs, processing 13%, network branding 3%, and 35% covers cost of funds and profit margins. As franchisor CASH FOR HEALTH makes money from franchise fees, royalties, and CASH FOR HEALTH debit card interchange fees from suppliers.

TEST BEFORE NOT AFTER YOU'RE SICK. CASH FOR HEALTH TAKES THE GUESSWORK OUT OF HEALTH CARE

The dynamic CASH FOR HEALTH system is centered on empowering members to reduce health risk and win cash for health improvement and maintenance. The solution to smart health is to test before, not after, you are sick. We take the guesswork out of health care. Start with a health plan based on facts. Your facts. If the test determines a specific health issue, or if you have a wellness goal, we design a plan to solve the problem. 

CASH FOR HEALTH monthly plans cost between $200 minimum to $500 maximum (for chronic care patients). CASH FOR HEALTH transfers your monthly payment (from you, your employer, or government subsidy) onto your CASH FOR HEALTH member card (works like a debit card) that you use to redeem day-to-day health related services according to your plan; for medication, chiropractor visits, vitamins, yoga, gym memberships, CASH FOR HEALTH health coach visits, etc. CASH FOR HEALTH is able to provide maximum dollar value and best prices of services for our individual members by working together with vendors as a cooperative group.

Chronic care CASH FOR HEALTH members are managed by a team specifically engaged in care to reduce risk for hospitalization and to manage costs to be affordable for the long-term and to reverse disease. CASH FOR HEALTH membership also allows you to apply for catastrophic health insurance that makes sense. Based on your assessed health risk level determined by CASH FOR HEALTH tests, you can select insurance based on a dollar figure to cover anything from potential hospital visits ($100,000) or for cancer care ($1 million). The CASH FOR HEALTH system motivates members to compete against themselves and members are supported by peers and H2O coaches to motivate individual success collectively (CASH FOR HEALTH Member Circles). Peer support is what keeps people healthy over the long term. Outlined here.


THE CASH FOR HEALTH KEY TO BALANCING PATIENT DEMAND WITH APPOINTMENT SUPPLY

Doctors who see more patients and work more hours, make more money. But there is a fine balance between patient demand and appointment supply to maintain quality care. The ideal practice has 1800-2000 patients per doctor, works 240 days of the year, sees 24 patients per day, 3 times per year. Using that formula doctors can't afford to stay in business due to badly negotiated third party payor relationships with insurers who pay doctors $24 per patient visit. Some patients only come once per year, if at all, and some come too much. Too many uncontrollable variables to manage.

So it occurred to me for doctors to make a profit, we need to control it from the other end! Control the patient! Patient flow and care has to be systemized, and this "control" is "sold" to patients as "wellness care" and prevention attention!

On average 60% of medical practice income goes to salaries, staff benefits, supplies, malpractice insurance, 15% to debt service, 2-5% to state and local government taxes. 

Based on this research 50%-75% primary care visits can be handled by a nurse or healthcare practitioner. Using a nurse managed clinic network healthcare for 10,000 patients costs $800,000 vs. $3-$5 million to operate a traditional model.

CASH FOR HEALTH Volunteer Coaches receive free CASH FOR HEALTH health services. Every 5,000 CASH FOR HEALTH members is managed by one doctor, five practitioners, and 5 volunteers. 

CASH FOR HEALTH : 
5000 MEMBERS PER DOCTOR'S OFFICE CASE EXAMPLE

$21,000,000 Average Annual Doctor Member Revenue 
(5000 Patient Members @ $350 per month x 12 months = $21,000,000)

$1,680,000 Financial Management Fee 8%
$500,000 Doctor Salary $100 per member/per year
$750,000 Practitioner Salaries ($150,000 per year x 5 practitioners per 5000 members)
$500,000 Operations (Rent, Supplies, Equipment Lease, Insurance)
$16,500,000  CASH FOR HEALTH Member Maintenance Actual Cost for 5000 Members
$19,930,000 Total CASH FOR HEALTH Doctor Member Costs
$1,070,000 Profit

CASH FOR HEALTH Member who pays $350 per month = $4200 per year
Actual Annual Per Member Costs = $3,300
$1000 Diagnostic Tests
$250 Plan Analysis
$250 EMR
$400 Exercise Program (Gym, Yoga, etc.)
$100 Doctor Visit (1)
$300 Practitioner Visits (4 @$75 each)
$1000 Medication, Supplements

Saturday, July 4, 2009

FAQs ABOUT CASH FOR HEALTH SYSTEM


HOW WILL THE OBAMA PLAN IMPACT THE STRATEGY?
The missing link in the Obama plan is testing for individual health facts to rationally reallocate money from "Cadillac" plans for people who don't use benefits to people who need them. Health is not static. We need to financially reward health improvements because it saves the government money! Then there is plenty to go around and the medicare problem would organically be solved in the process. Obama would like to start from scratch but can't because employers are health insurance company customers...not you or me...and employers have no other alternative right now. What insurance firms actually sell to large employers, which account for the largest segment of the entire health care market, is administrative services, not actual insurance. And even worse, ask any person on the street and they will tell you their health insurance is FREE! Employees have no idea their employers pay $10,000 - $15,000 per year on health insurance for them. And at these prices employers and doctors are jumping ship. CASH FOR HEALTH is the rescue boat. Employers will "buy" from whomever provides the best care for the least cost to keep their employees in their cubicles. CASH FOR HEALTH goes one step further for $6,000 per employee rather than $10,000. H2O pro-active plans will actually make people healthy, happy, and more productive! An employer will choose CASH FOR HEALTH over any government plan simply because it will be perceived as higher quality in the eyes of their employees. And even better, it really is.


WILL DOCTORS ACCEPT THE CASH FOR HEALTH DEBIT CARD?
Only CASH FOR HEALTH doctors (franchisees) and CASH FOR HEALTH suppliers (participating gyms, pharmacies, food stores) will accept the CASH FOR HEALTH card. The CASH FOR HEALTH system is designed to give member patients a customized list of CASH FOR HEALTH practitioners and suppliers for their personalized health care, so patients never have to worry about a doctor not accepting the CASH FOR HEALTH card. Members of course can pay cash for services outside the network.


DOCTORS ARE NOT BUSINESS PEOPLE.
That is why CASH FOR HEALTH is perfect for doctors. H20 handles the business systems and doctors get to practice medicine and care for patients. CASH FOR HEALTH doctors are current medical practices who have converted to the CASH FOR HEALTH system. Today many doctors can't afford to accept insurance because they are abused financially by Medicare and insurance companies and are without leverage to negotiate changes to payor agreements, fees, and schedules. Doctors get paid on average $24 per patient/per visit and 50% of that goes to their admin staff to manage the paperwork. CASH FOR HEALTH by comparison pays them $75 per patient/per visit by controlling patient flow with mandatory scheduled visits. Doctors will trust a system that pays them cash.  CASH FOR HEALTHs Chairman will be a branded doctor (like a Dr. Oz or Dr. Roizen) and doctor franchisees will trust another doctor.


PEOPLE ARE CUTTING BACK ON DISCRETIONARY AND PREVENTION SPENDING
CASH FOR HEALTH proposes not spending extra; simply reallocating what you are already spending (you or your employer) and saving you money in the process as well as getting more benefits.

PEOPLE HAVE BEEN TRYING TO FIX HEALTH CARE FOR 60 YEARS BUT THERE IS NO COORDINATED THRUST TO LOWER COSTS AND BUILD EFFICIENCY INTO THE SYSTEM

Many of the relics who built this system can no longer make an impact. People's wages have not increased while corporate profits have. So change is coming simply because employers can't afford the current system now.

Health Insurance was created after WW2 as an low cost incentive so employers could entice employees to work in exchange for low wages. Wages were kept static. Software came along and companies became more efficient and profitable. Then banks offered CEOs incentives to invest profits with them instead of increasing wages. As cost of living increased and wages stayed the same people could no longer pay their bills and had to send mom out to work. Families took this as a personal problem. Not an employer problem. With mom as the emotional glue of the family, now out of the house, more stress, more fast food, more fighting over bills contributed to our current chaos.


HOW LONG DOES IT TAKE A FRANCHISEE TO GET 5000 PARTICIPANTS
Current medical practices already have 2,000 - 10,000 patients. CASH FOR HEALTH simply converts these practices to the CASH FOR HEALTH system and inherits their current patients as CASH FOR HEALTH members. CASH FOR HEALTH will simultaneously sell employers in the local area as a "group" and push these new members to each new CASH FOR HEALTH practice. Every new CASH FOR HEALTH franchisee will start with 5000 members minimum and will be recruited that way.


HOW MUCH WILL THE FRANCHISE HAVE TO INVEST TO GET 5000 PARTICIPANTS
Since the CASH FOR HEALTH strategy is to convert current medical practices already in operation so start-up costs are minimal. Many doctors have long term leases and even own their practice location because it is their only profit center now. Once CASH FOR HEALTH eliminates the need for the doctor to continue badly leveraged third party agreements, cash is automatically freed up, and can be applied to the initial franchise fee. We are basically converting them to the H2O system at no cost just by finding them money!


THE 5% PROFIT NUMBER IS VERY LOW TO JUSTIFY A LARGE UPFRONT INVESTMENT.  THIS IS WHY THE COSTS LOOK ATTRACTIVE.
Most doctors right now are breaking even or barely making $100,000 in salary per year and no profit. Based on a patient list (panel size) of 5000 CASH FOR HEALTH offers doctors a $500,000 salary and a $1 million profit/bonus.


Non-medical franchise or retail businesses or with one location is essentially just buying themselves a $50,000 to $100,000 per year job. You generally only break-even. In any franchise system you have to own at last five locations to make it to millionaire status.


CASH FOR HEALTH is dynamically designed to give CASH FOR HEALTH doctors an incentive to live off their CASH FOR HEALTH pay increase earning $500,000 per year and to reinvest their $1 million profit in buying new CASH FOR HEALTH locations over 5 years.


H2O AS FRANCHISOR MAKES MONEY FROM THREE REVENUE STREAMS
1. Initial franchise fee...$500,000 (financing options are available)
2. 8% royalties per location.
3. 30% profit from CASH FOR HEALTH debit/credit card interchange fees. (In other issuer models paying for reward programs consumes 44% of the interchange costs, processing 13%, network branding 3%, and 35% covers cost of fund and profit margins.)