Plan & Care at Home — Redlands Health

The thesis

Risk aligns the money with health

Under fee-for-service we earn more when people are sicker. Under capitation / global risk we earn more when people are healthier — so prevention, RPM, wellness, and home-based care stop being cost centers and become the engine. This is the financial spine that makes every other pillar pay for itself.

Earn into the risk Don't start by chartering an insurer. Climb the ladder: shared-savings → partial cap → global risk → (eventually) a provider-sponsored plan under a CA DMHC Knox-Keene license. Each step builds the data, reserves, and infrastructure for the next. See Market Opportunity §4.

Care at home

RPM + Acute Hospital Care at Home

Remote Patient Monitoring Wearables & home devices (BP, glucose, weight, SpO₂, ECG) stream to the EMR. Care managers catch deterioration days early. Best ROI in CHF, COPD, diabetes, hypertension, post-discharge — exactly the admissions that crush an at-risk budget.

Acute Hospital Care at Home Deliver hospital-level acute care in the home for selected DRGs — lower cost, fewer infections, higher satisfaction. Under risk, the savings are ours. (Confirm the current CMS waiver/authority status & CA licensing before launch.)

Why it compounds RPM + Hospital-at-Home turn the home into a care site. Combined with the wellness center and primary care, we manage the whole patient continuously instead of in episodes — which is the only way prevention math actually works.

Community as strategy

The 1% community health investment

Commit 1% of plan/revenue to upstream determinants of health in Redlands — food access, housing, parks/movement, behavioral health, transportation. It's not charity; under risk, healthier social conditions lower our claims. We publish where it goes and what it moves.

Work with the City — co-invest on walkability, food deserts, parks, and a "healthiest city" agenda; align with the city's strategy refresh.
Food is medicine — produce prescriptions via regenerative-farm partnerships (ties to Wellness).
Transparency — a public community-health dashboard so residents see the return.

Sequencing

Phased build

Phase 1

Self-insure RCH + RPM

Pilot risk on our own 1,405 lives; launch RPM for chronic conditions; prove savings.

Phase 2

Shared savings

Value-based contracts with employers/payers; Hospital-at-Home stands up; 1% fund launches.

Phase 3

Global risk

Take partial→global cap on attributed lives; restricted Knox-Keene for downstream risk.

Phase 4

Own the plan

Full provider-sponsored plan under DMHC; sell coverage directly to the city & employers.

Metrics & risks

Measure & manage

Metrics

Medical loss ratio & PMPM trend
Admissions / 1,000 & 30-day readmits
RPM-enrolled chronic patients & days-at-home
1% fund deployed & population-health outcomes moved

Risks

Reserves & regulatory burden of bearing risk (DMHC)
Stop-loss / catastrophic claim exposure early on
Waiver/authority status for Hospital-at-Home
Actuarial discipline — need real expertise, not optimism

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