1The at-risk health plan (covered lives)
Three payer segments — edit lives, per-member-per-month (PMPM) premium, and medical loss ratio (MLR) for each.
Commercial
Medicare Advantage
Medi-Cal (managed)
Plan contribution = premium − care cost (MLR) − admin. Year-1 plan revenue: · contribution:
2Service lines (ancillary & cash revenue)
Each line: volume × unit economics × contribution margin. This is where labs, RPM, personal medicine, surgery, retail and gyms drive the model.
Outpatient surgery center
Remote Patient Monitoring (RPM)
Personal / precision medicine (cash-pay biohacking)
In-house lab
Supplements & retail (B12, methylation-driven, etc.)
Wellness gym network
Year-1 service revenue: · service contribution:
3Fixed cost & org overlay
The human-capital + infrastructure base (ties to the FTE ranges on Definitions).
Year-1 fixed overhead:
4Year-1 summary
55-year projection
Plan lives and service volumes grow at the annual growth rate; fixed overhead held flat (edit it per year mentally, or raise the growth driver). The J-curve from start-up loss to operating leverage is the story to watch.
| Year | Covered lives | Plan rev | Service rev | Total rev | Total cost | Operating income | Margin |
|---|
All figures illustrative and fully editable. Not actuarial, accounting, or investment advice — pressure-test with a healthcare actuary and CFO before any decision.