Health Plan Administration Business Plan


Health Plan Administration Business Plan


Southeast Health Plans, Inc. is a service company that will provide health plan administrative services to self-insured employers. The company will target employers with 50 to 500 employees. Many of these employers have current HMO, PPO, or major national insurance carrier health plans. While the majority of employers with 500 or more employees have at least some element of self-insurance incorporated into their health care programs, our target market is often ignored by the major national insurance companies. The majority of 500-plus employee-based companies are self-insured. However, Southeast Health Plans’ management discovered that less than 25% have plans.

Companies who are currently self insured and those with other types of insurance will have to transition to self-insurance. The availability of high-quality administrative and consultative services is an important factor in the transition from self-insurance to self. Southeast Health Plans, Inc., is managed by an experienced team. It has formed a strategic alliance and a subsidiary of Blue Cross/Blue Shield Pennsylvania, Blair Mill Administrator, to provide the best benefits management services to its target audience.

Southeast Health Plans, Inc. is expected to generate more than $5,000,000 in revenue over five years, with a net profit of $1.6 Million after taxes. After-tax earnings of $560 million will make the company profitable by year three. Margins as a marketing company and service provider will be high. Gross margins exceed 80% (less sales incentives costs) and close to 50% after operating expenses. Once market penetration has reached maturity, the company will turn profitable.

Southeast Plans, Inc.’s success lies in its ability to attract capital to market its services in the metropolitan Atlanta area and northern Georgia. Proper professional sales personnel is critical. The company will then need to expand its success in the Southeastern markets. The company must control costs, especially with respect to marketing programs and sales, in order to expand within the Southeastern markets. This will be possible by utilizing internal cash flow to fully fund expansion.

1.1 Objectives

The company has the following objectives:

  1. Co-operative marketing using Blair Mill advertising executions in the Atlanta metropolitan market
  2. To hire sales staff, both identified and unidentified, to implement a sales follow-up strategy.
  3. At least 4,800 employees total under management by year end.
  4. To reach break-even at the end of the second year by reducing the total loss to $100 000 in the second year and increasing market share.
  5. To shift to earnings by year three, and to accelerate gross margin contributions by building market maturity over infrastructure.
  6. To expand regionally using both sales and media personnel to penetrate new market segments while consolidating our service capabilities.
  7. To continue to achieve cost benefits through an expanding provider network, while maintaining quality patient care.
  8. To have more that 98,000 employees under management by year five.

1.2 Mission

Southeast Health Plans, Inc. provides small and medium-sized employers with a comprehensive benefits management program that allows them to manage their health benefits while giving employees access to high quality healthcare. Southeast will offer its clients, employees and employers, the best health care possible by combining self-insurance and stop-loss programs with efficient plan administration. Southeast will deliver a balance of quality care and freedom of choice at a fair price.

1.3 Keys to Success

These are your keys to success in the business.

  1. Marketing. Southeast Health Plans has the ability to sell directly through employers and independent insurance brokers and agents. Name recognition will be important among established programs. It is important to control media budgets and maintain closing ratios of 5% per annum for leads.
  2. High quality service. Services provided by Blair Mill administrators are among the best in small-employer services. Customers will be satisfied due to the value-added experience of the Southeast Health Plans, Inc. Management Team and their provider network.

It is important that clients feel satisfied with their service and plan cost in order to reduce client erosion as well as to fight competition. Renewals should be at least 85% of existing clients.

  • Controlled growth. Growth must include aggressive expansion to new markets, while also focusing on profitability. Each market that has been established must mature to ensure internal funding. Cash flow management must be done. Both market expansion as well media effectiveness must constantly be evaluated, and then re-evaluated or modified as needed.

    • Occupational Health Business Plan


    Occupational Health Business Plan


    Centroplex Health System (CHS), Workwell offers a top Occupational Medical Program. It helps to reduce healthcare costs, increase productivity, decrease absenteism as well as improve employee morale. Workwell also attracts and retains high-quality workers and provides a positive return. Workwell, Killeen’s first Industrial Occupational Medicine Program, will help area businesses become more productive while lowering overall costs.

    In their attempt to reduce health care costs, employers “want” occupational medicine clinics that provide them with the following components: accessibility, drug screening services, high quality staff, state-of-the-art care, and a wide scope of services. Workwell will help area employers fulfill their ‘#8220’ and #8220 ‘needs.

    Workwell&#8217s existence is based upon two simple facts.

    1. Healthy employees are more productive than chronically ill employees.
    2. It costs less to prevent injuries than to treat them after they occur.

    Workwell helps employees make healthier choices and reduces company health care costs. It also increases worker productivity. The following factors will impact your health care spending: lower medical insurance premiums and absenteism, lower turnover rates, fewer worker’s compensation claims, fewer tardiness, shorter hospital stays, and lower medical insurance premiums.

    Centroplex Health System’s (CHS), relationship is a key advantage for Workwell. CHS is the choice provider for health services in its service region and has already supported the crucial structures that are required to establish a successful Occupational Med program, such Workwell. The structures include an Emergency Department and a free-standing walk-in facility (i.e. COMC), an MCO (currently developing), and a network with primary and special physicians. All four of these structures will form a loop, which acts as a catalyst to bring business into Workwell. Workwell then should refer back into these four structures. This completes the loop. The model proposed is to offer Occupational Medicine services&#8211, Workwell and primary care services in one setting, COMC. The service mix will offer a comprehensive alternative to traditional Occupational Health and Primary Care services for our clients employers. This will create a synergy which expands the market and establishes new relationships. It also reduces operating costs and generates new revenues.

    Workwell’s keys to success and critical factors for the next three years are:

    • Successful marketing strategies/plans for employers are developed and implemented.
    • Experienced medical and administrative talent are sought after.
    • Enter the Occupational medicine market and create a brand#8221 before the competition.
    • Commitment to continuously improve the quality of service.
    • Demonstrate a financial returns on investment
    • Senior Management’s commitment

    CHS can develop and implement an occupational medicine program based on the business plan. Market research indicates that there were 7,720 total worker compensation injuries last year. CHS treated 2,532. In addition, worker compensation injuries are projected to increase to a total of 9,446 in the next four years. This business plan has a five-year goal to position CHS so that it can treat 5,064 workers compensation injuries, and thus achieve 53 percent market share.

    Below is a chart that illustrates the overall highlights of the business plan for the next five-years. Total visits to COMC are projected to increase from 11,085 to 15,918 by Year 5. This will result in an increase in total revenues and net surplus.

    1.1 Objectives

    • Workwell’s key objective is to help ESTABLISH Centroplex Health System and make it the #8220ONE STOP SMOOKING&#8221 MEDICAL CENTER OF HEALTH CARE IN ITS SERVICE AREA.
    • Provide a full continuum of Industrial Occupational Medicine services that provides responsive, quality medical care to all injured employees.
    • By Year 1, you will provide Occupational medicine services to 10 Killeen employers with 50 employees and 20 small employers with 50 employees.
    • To expand the market and offer Occupational Medicine services, employers will need to be able to access these zip codes by Year 2.

  • Expand the target market to provide Occupational Medicine services to the Centroplex Health System Service Area (Bell, Lampasas and Coryell county) employers by the end of Year 3.
  • Become the Provider of Choice for Occupational Medicine in the service area.

    • 1.1.1 Observation & Recommendations

    OBSERVATIONOccupational health programs have been stepchildren in hospitals because they’ve historically not brought in much revenue. But they could become more lucrative if health systems develop the necessary competencies and sell them directly to employers. Providers have to be proactive as they look for new revenue streams, especially as the value of discounted managed care continues to shrink. Occupational healthcare services provides a way to create positive relationships and build trust with local employers.

    RECOMMENDATIONS

    The underlying factor in these recommendations is TIME IS OF THE ESSENCE FOR DEVELOPING WORKWELL.

    Following are the recommendations (options) being made:


    Hire a consultant to help you start your program.

    Two main reasons for this recommendation: First, expertise is required in developing an occupational medicine program. Second, why reinvent the wheel when we can learn from proven techniques. All the programs reviewed either hired an experienced occupational physician director or an outside consultant to help the program succeed. CHS does not have the expertise to support this effort and is considering hiring a consulting company.

    You can also use these reasons:

    CHS can now offer formal occupational medicine programs to both area employers and employees in as little as 30 days. You can use the personnel ($$$) needed to develop this program to hire experts to execute their proven techniques. Senior leaders will feel renewed commitment to the program’s success by spending money on consultants.

    CHS is at risk of being ‘canned’ and could be subject to legal action, but it is clear that the positives far outweigh any negatives. Three consulting firms have submitted their bids towards this project. These are Concentra Health Services Florida Hospital, and Occupational Health Research. This information has been included in my presentation.

    In-house occupational medicine program

    Positives:

    Save money.

    Programming customized.

    Negatives:

    Time frame

    Inadequacy of expertise.

    Senior leadership is not committed.

    Decision to remain status quo:

    If you choose this option, the program will continue to operate as usual.

    Positives:

    None.

    Negatives:

    Continue to lose revenue

    Potential to lose market share

    You don’t have the opportunity to network effectively with employers in your area.

    Don’t miss your chance to become a #8220one-stop shop#8221 for health care services.

    CHS employees will continue to be injured.

    Divestiture by COMC

    This option involves placing COMC on a marketplace for sale.

    Positives:

    There is a lot of money.

    You can invest the $$$ to develop or expand new programs.

    Leaders can spend more time on issues closer to “home”.

    CHS should improve its bottom line, at least in the near term.

    Negatives:

    Lose new revenue stream.

    Gain market share.

    Loss or relocation of prime real estate.

    It is possible for a competitor to establish itself in the same setting.

    You can lose your identity in the market.

    1.2 Mission

    Workwell, a premier program in industrial occupational medicine, is customer-focused. The team approach aims to deliver quality occupational health, safety, and rehabilitation services. This includes addressing a person’s overall health (body, mind, and spirit) while building and maintaining partnerships with local businesses.

    1.3 Keys to Success

    Workwell’s key to success is:

    • Development and implementation of a successful marketing strategy/plan to employers.
    • Experienced medical and administrative talent are sought after.
    • Building a career in Occupational Medicine and entering the market

    Brand name before the competition

  • An ongoing commitment to improving the quality of service.
  • Demonstrate a financial profit on your investment.
  • Senior Management Commitment

    • Spa Health Club Business Plan


    Spa Health Club Business Plan


    Visions (VS), is a socially and ecologically conscious health club. It is not only concerned about physical beauty, but also with mental well-being. It’s a club that is socially and environmentally conscious. All products used are safe for plants and free from cruelty. VS believes that treating our clients well leads to better health and well-being for the wider society. Therefore, we offer a variety of health services, including yoga, meditation, and exercise.

    Our company’s goals are to become financially successful and establish a product line by name recognition. The immediate goal is to launch a new product line in the beauty market. Long-term, the goal is to go public with several fitness clubs and an active product line.

    1.1 Keys to Success

    • Create an environment for people to feel good about themselves, both physically and mentally.
    • Provide natural healing methods for patients suffering from illness or injury.
    • Service to the financial and emotional needs of women who live in shelters.
    • Special activities are available for different holidays.

    1.2 Objectives

    • Break even by year two
    • Each quarter, increase your number of new clients.
    • Include the company’s involvement in the community in local media.
    • Increased profits can be donated to charities.

    1.3 Mission

    Our company’s goal is to improve the lives of both men and women through providing an environment that encourages relaxation and offers health-conscious alternatives.


    Health Club Business Plan


    Health Club Business Plan


    Corporate Fitness will serve Seattle-area businesses, helping them to become more productive, while lowering their overall costs.

    Two simple facts define our business model:

    1. The productivity of healthy employees is higher than that of chronically ill workers.
    2. It costs less than to prevent injury or illness, and more to treat them afterwards.

    Corporate Fitness links worker productivity directly with the health care issue. We believe traditional approaches to solving the current health crisis are misdirected. These traditional efforts have been called reactive. This means that they wait until the worker becomes ill or has suffered an injury to pay for the necessary treatment. Our approach emphasizes prevention and promotion of good health. It is far more proactive.

    By helping employees change their behavior patterns and choose more healthy lifestyles, Corporate Fitness will lower companies’ health care expenditures, while raising worker productivity. Health care expenditures will decrease due to reduced medical insurance premiums, reduced absenteeism, reduced turnover rates, reduced worker’s compensation claims, reduced tardiness, shorter hospital stays, etc.

    The current crisis in America’s healthcare system and changes in the American population could not only make it worse, but could also cause further declines in worker productivity. These market factors combined with the current competitive situation indicate a favorable market. Corporate Fitness seems to be the right time.

    1.1 Objectives

    1. Offer wellness programs/strategies to businesses in downtown Seattle.
    2. By the end year one, you will have established working relationships with 20 businesses.
    3. Expand Corporate Fitness to Portland by the end year 2.

    Success Keys 1.2

    Keys to corporate fitness&#8217’s success are:

    • Marketing services for individuals and companies.
    • Experienced managerial talent is sought after
    • The founders’ dedication and hard work.
    • Raising productivity.
    • Lowering your overall costs.

    1.3 Mission

    Corporate Fitness is a health service that helps businesses and individual workers attain one of the greatest gifts of all–that of good health. Employer and employee both will reap the benefits of self-esteem and motivation, as well as measurable advantages.


    Home Health Care Services Business Plan


    Home Health Care Services Business Plan


    Opportunity

    Problem

    We see a large need in this area for quality home and social care services. We believe that by employing skilled and educated staff, and providing them with an organized and responsive management system, we can be the top home and social service agency in Southeastern Kansas.

    Solution

    Wheatland Health Services offers unique home health care as well as community-based social service to Southeastern Kansas.

    Market

    The consumer base for Wheatland Health Services (Home Health Care Services) will be patients referred by physicians, health care facilities and other health care professionals. A majority of these patients are covered by Medicare. Kansas Medicaid or private insurance will cover a smaller percentage.

    Competition

    Consumers and referring professionals should trust the professionalism, reliability, and quality of the services offered by the home healthcare Agency.

    Why Us?

    Wheatland Health Services is committed to providing affordable and high quality home care services and social services in the community to residents and their families in Southeastern Kansas.

    Expectations

    Forecast

    We are projecting growth and total annual sales very conservatively, with high projected expenses. Our cost of selling is very low because we are a service agency. Payroll is the main expense involved in providing these services. The costs of sales reflects the cost of mileage reimbursement to employees, because the services we provide are home- and community-based and require travel to and from service locations.

    Financial Highlights Year-by-Year

    Finance required

    We will borrow $50,000 from Elizabeth Patzer for a five-year loan, and then receive $20,000 cash directly from Elizabeth Patzer.


    Health Spa Business Plan


    Health Spa Business Plan


    SoulSpace aims to be the premier spa/salon in the Raleigh, NC area. Through a unique combination of offered services and products, they will quickly gain market share. SoulSpace offers customers a relaxing and rejuvenating environment that can cater to all of their needs. The business will be a partnership, with Steve Long and Debby Long owning equal parts of it. Linda Hill-Chinn will also own a portion.


    Products and Services

    SoulSpace offers a wide variety of mind and body healing services and products. Male and females will be able to get all types of hair styling services from the salon. The spa provides holistic massages, bodywork, and energy work. All this is done in tranquil, relaxing surroundings.


    Location

    SoulSpace has chosen Raleigh, NC as their city for the business venture. Raleigh has consistently over the last few years been voted the best place to work and live in the USA, frequently making the top five and ten lists of Forbes, Money, and Inc. magazines. Raleigh is home to one of the highest educated communities in America. This correlates with earning potential or indicates that there is a higher average household income. In addition, downtown Raleigh has been remodeled recently and is a hot spot for new businesses.


    Competitive Edge

    SoulSpace’s competitive advantage is their unique combination service, location, customer-centric focus. Both the extraordinary services and location has been detailed previously. SoulSpace has set out since its inception to provide quality, dependable services. SoulSpace is a pioneer in training, properly training employees so that they can provide unparalleled customer service. SoulSpace customers will feel satisfied that they received a service that was beyond their expectations and better than any other. This customer-centric business model goes beyond mere rhetoric. It also includes financial incentives that allow employees to offer exceptional levels of service. SoulSpace can achieve its ambitious goal of 90% return customers by using this system.


    Financials

    SoulSpace forecasts significant sales revenues for year two. SoulSpace expects to reach profitability in year two and earn a healthy profit prior to taxes. When SoulSpace begins their fundraising efforts they will consider options such as LLC status to replace the partnership business formation that they have currently adopted.

    SoulSpace is an exciting business that provides a combination of sought after services that are not currently offered by a direct competitor. SoulSpace is a peaceful, tranquil environment that will allow you to enjoy a wide range of mind and body revitalizion services.

    1.1 Objectives

    Below are the objectives of SoulSpace:

    1. Substantial sales revenue by end of second year.
    2. Profit before taxes at the end of the second year.
    3. At least 90% clientele return rate by end-of-first year
    4. End of the first calendar year, establish yourself as a destination for community members.

    1.2 Mission

    SoulSpace will provide a comforting, yet stimulating, atmosphere in which customers will be able to relax both their body and mind, reconnecting their daily lives to their true purpose through a wide range of holistic methods including massage, body works, energy works, and hair styling. SoulSpace will establish itself as a dependable destination to which they can always come to escape the stresses of life, and rejuvenate their energies, their souls, and their lives.

    Success Keys 1.3

    1. Highly skilled and qualified employees, who are well-versed in energy work and are attuned to a calm spiritual disposition.
    2. You can build trust with your community by ensuring that every customer is taken care of at all times.
    3. It is easily accessible.
    4. Effective advertising.


    Psychological Health Center Business Plan


    Psychological Health Center Business Plan


    Amesbury Psychological Center is a multi-disciplinary behavioral health care facility that offers substance abuse and mental health services to the Merrimack Valley. Our goal is to offer quality, cost-effective treatment. Our mission is to establish, promote, sustain and improve customer relationships with clients, Anna Jaques Hospital and payors as well our staff, associates, employees, and community.

    The market for behavioral health services is healthy, as will be shown by the growth the existing Center has experienced during the past two and a half years. Massachusetts recently passed legislation regarding mental health parity, which will go into effect in month 1. This bill requires that insurance companies offer benefits for biologically-based behavioral health disorders in the same way as for other health disorders. This will ensure that the expected growth is sustained. Currently, approximately four calls per day are made to the Outpatient Psychiatric Center by patients wishing to be referred to other providers.

    The key to success for this turnkey project includes:

    1. Ability to transfer existing hospital behavioral healthcare contracts to the Center
    2. Rapid credentialing of clinicians
    3. Obtaining initial working capital.
    4. You can contract with your clinicians for reasonable rates.
    5. Developing and implementing a successful billing and collection system.
    6. Listening to your customers and meeting their needs.
    7. Obtaining a medicaid provider number.

    The business plan gives us a road map to sustain growth, improve revenue collections, and increase our bottom line to generate a profit.

    1.1 Objectives


    Goal 1: To develop, strengthen, improve, and continue to improve the services provided by this Center.

    1. Strengthen the current payer mix by creating and maintaining strategic alliances at five top behavioral health managed healthcare companies.
    2. Find and form strategic alliances to support three community-based addiction and human service agencies.
    3. Find and foster strategic alliances or networks with eight community health group practices.
    4. Two months prior the date of your start date, transfer or hire 80% of your staff.
    5. Two months prior to the start date, identify and implement a billing process.
    6. Increase the expected receipts rate 40% over the last year
    7. Increase in all services provided by the Center by 80%, compared with the previous year.
    8. Organise working capital for the initial phase.


    Goal 2 is to strengthen the Center’s commitment and excellence.

    1. Three in-service trainings are offered to improve customer service. They focus on client satisfaction, accessibility, treatment, and staff-client interactions.
    2. Continuously evaluate the satisfaction of your referral base using a satisfaction survey.
    3. Continuously evaluate client satisfaction in three dimensions: accessibility, environmental, and treatment-related.

    1.2 Mission

    The Merrimack Valley community’s well-being is promoted by providing access to quality mental health care and substance abuse/addiction support for children, adolescents and adults. This service system emphasizes trust, respect, confidentiality and compassion. We are committed providing quality mental health care, in collaboration with the consumers’ overall health strategies and a range of medical services. We also believe in the principle of being there for the client/customer.

    1.3 Keys for Success

    • By the start of your project, you can secure working capital.
    • Be profitable on an forward basis by the seventh of the first fiscal Year.
    • Be cash flow positive by the seventh month of operation.
    • Being associated with a respected community acute-care hospital.
    • Managed Care friendliness by cooperation, accessibility and clinical focus.
    • Center services can be made known to the community.
    • Establish a medicaid provider # and create an interim plan for operation during the application phase.
    • Staff commitment to excellence as evidenced by the Center’s growth and customer satisfaction.
    • Accessibility and responsiveness of the Center to the needs.

  • Being flexible, responsive, open to change, and able to adapt to the ever-changing needs of the behavioral industry.