1The bottom line
37,000
jobs in the city of Redlands (EDD)
~22,000
capturable covered lives (modeled midpoint, non-Kaiser)
82
insured employers in-city we can see & name
1,405
lives on RCH's plan today (the baseline)
Essence
The ceiling is ~36,000 commercially-covered lives tied to Redlands employers. But ~40% sit with Kaiser — a closed network you can't capture. The realistic prize is the other ~60% (~22,000 lives) on open PPO networks or self-funded plans. The highest-value, lowest-friction wedge is the 12 self-funded employers in town (64 across the wider roster): they bear their own claims risk and can direct-contract with RCH now — no health-plan license required.
The one thing that shapes everything
Optum / Beaver Medical Group is Redlands' #4 employer (~1,000 staff) and the dominant primary-care & specialty group — and it is owned by UnitedHealth Group, a payer. Any RCH network must solve physician capacity in a market where the largest medical group is owned by a competitor.
2Sizing the lives
We can't read covered lives directly (Form 5500 counts are company-wide; small employers don't file). This is a transparent top-down model anchored on city employment, every assumption exposed.
37,000 — jobs in the city (EDD, via City ACFR)
~36,000 — covered lives via Redlands employers (≈55% take coverage × ≈1.8 lives each)
~22,000 — capturable: open-network + self-funded (excludes ~40% Kaiser-locked)
~3,000–5,000 — near-term direct-contract wedge (self-funded + anchor employers)
Sensitivity
Capturable lives = 37,000 × take-up × 1.8 lives/enrollee × (1 − Kaiser share).
| Kaiser share ↓ / take-up → | 45% | 55% | 65% |
|---|---|---|---|
| Kaiser 35% | ~19,500 | ~23,800 | ~28,100 |
| Kaiser 40% | ~18,000 | ~22,000 | ~26,000 |
| Kaiser 45% | ~16,500 | ~20,100 | ~23,800 |
Read Even conservatively the capturable pool is 15–28k lives — roughly 11–20× the 1,405 lives on RCH's plan today. The constraint is execution, not market size.
3Who insures Redlands today
Among the 82 insured employers physically located in Redlands on public record (DOL Form 5500 / Schedule A). Employers can offer more than one carrier, so bars show carrier presence.
Closed (hard to capture)Open PPO/HMO (capturable)Self-funded (direct-contract)Other
Kaiser = the wall ~40% presence. Members are steered to Kaiser facilities; an RCH network can't readily serve them. Out of scope, not a conversion target.
Where the openings are ~40 employer relationships on open networks (Anthem/UHC/Blue Shield/Aetna/Cigna/Health Net) whose members can use community providers, plus 12 self-funded plans that pick their own network.
4How to build it — a risk ladder
Lowest commitment / fastest at top. You start at the top and earn your way down.
| Model | What it is | Best target | Lift | License |
|---|---|---|---|---|
| 1. Direct-to-employer | Bundled/case rates, COEs, on/near-site clinic. | Self-funded (12 local / 64 wider) | Low | None |
| 2. Narrow / tiered network | RCH-centered network rented to a carrier/TPA. | PPO employers; TPAs | Med | None |
| 3. Clinically-integrated network / ACO | Align independent MDs + RCH for value-based contracts. | Independent MDs; payers; Medicare | Med-High | ACO rules |
| 4. Provider-sponsored plan | RCH bears insurance risk, sells coverage directly. | The whole market | High | DMHC Knox-Keene |
Regulatory reality (CA) Full risk = a Knox-Keene license from the Dept. of Managed Health Care (reserves, TPA, network-adequacy filings) — or a restricted license for downstream risk-sharing. Tiers 1–3 build lives and physician alignment without that burden first. (Confirm current requirements — dmhc.ca.gov.)
5Phased geography
| Phase | Market | County | Note |
|---|---|---|---|
| 1 | Redlands | San Bernardino | Home market; RCH is the anchor hospital. |
| 2 | Calimesa / Yucaipa | Riverside / SB | Adjacent, fast residential growth; already in RCH's draw. |
| 3 | Beaumont / Banning | Riverside | San Gorgonio Pass — booming housing, under-served for specialty care. |
Data note Phases 2–3 are largely Riverside County. Re-run this exact pull on each city's business roster + Form 5500 cross-match so each phase gets its own carrier map and lives model.
6Methodology & caveats
- Business roster — City of Redlands business-license database (HdL), 7,264 active licenses. → ../redlands_business_licenses.csv
- Health plans & carriers — DOL Form 5500 + Schedule A, 2023–2024 (EFAST2). → ../health_plan_carriers_by_employer.csv
- Employment & top employers — City of Redlands ACFR FY2025; total city employment 37,000 (EDD). → ../redlands_top_employers.md
- Life counts are modeled — take-up (~55%) and lives/enrollee (~1.8) are industry rules of thumb; the sensitivity table shows the swing. Planning figures, not actuarial.
- Form 5500 only captures 100+ participant plans, so small employers are invisible; the true small-group pool is larger and more fragmented.
- Internal market-sizing to guide strategy — not legal, actuarial, or financial advice.