24A – Venture Concept No. 1

Community Outreach for Healthcare Access
Venture Concept Write-Up

Opportunity

Every person needs access to good medical care. Community Outreach for Healthcare Access (COHA) sees a significant opportunity addressing the needs of consumers who are uninsured or under-insured, and Medicare beneficiaries.

The major obstacle to accessing healthcare is cost. The uninsured and under-insured have difficulty getting affordable and effective healthcare mainly due to economic reasons. Many who are uninsured are not provided employer-based coverage because the employer does not offer any healthcare benefits, or the employer offers benefits to select groups of employees. The Patient Protection and Affordable Care Act (PPACA) provides subsidies to those who qualify to help pay for healthcare premiums. Those who have Medicare are responsible for 20% of the costs that Medicare does not cover. They need information about insurance products that assist them with their cost-sharing responsibility.

Demographically, the basic categories of our target market are those under 65 and those who are approaching 65 and above. Those under 65 would include individuals and families, ages 18-64 and have incomes between 100-400% of Federal Poverty Level. In the U.S., the total number of people who are uninsured is approximately 27.9 million. Those who have Medicare (parts A & B) are may be younger than 65, but generally are not. According to CMS, the number of Medicare beneficiaries exceeds 62 million. Individuals who have employer-based coverage are not our current target market.

The need for healthcare is universal. Sickness or chronic conditions are major drivers for those who seek medical attention. Pregnant women and children frequently require checkups, vaccinations and dental services. The elderly and disabled deal with chronic conditions that require monitoring and prescription drugs. COHA has many potential customers within these demographics.

Our target market is localized to the state of Florida, and specifically the Central Florida region consisting of seven counties (Orange, Osceola, Seminole, Volusia, Polk, Brevard and Lake). This area has approximately 442,000 uninsured. The number of Medicare beneficiaries represented by the region is 901,425. Currently, by definition, the uninsured are not for the most part receiving necessary care. Medicare beneficiaries usually have coverage through a Medicare supplement or Medicare Advantage plan. Those with supplements are concerned primarily about price and are not likely to choose another carrier. Medicare Advantage members change plans more frequently, and the special populations demographic can switch plans throughout the year.

PPACA has stipulated that in order to meet Minimum Essential Coverage Standards, major medical and qualified health plans (QHPs) must have:

1.)    An “Actuarial” value of 60% or more

2.)    Cover 10 essential health benefits.

The ten essential healthcare benefits that must be covered are:

·         Laboratory Services

·         Emergency Services

·         Prescription Drugs

·         Mental Health and Substance Abuse Services

·         Maternity and Newborn Care

·         Pediatric Services, including Oral and Vision Care

·         Rehabilitative and Habilitative Services & Devices

·         Ambulatory Patient Services

·         Preventive and Wellness Services and Chronic Disease Management

·         Hospitalization

The ability to reach at large market of 1.3 million who could use our services within a 50-mile radius. Our window of opportunity is wide because healthcare a constant need. Health insurance products are in a constant state of flux and change constantly. Providers close panels and discontinue acceptance of certain insurance carriers. Consumers need continuous information about the options available.

Innovation

COHA is at the core a marketing company. We market to our target audience and consumers request more information. We then can forward the request to our partners who compensate us. We also operate as an affiliate for companies that sell health related products which consumers can purchase through us directly or directly through a company we represent.

However, COHA seeks to aggregate information in a way that is easy for consumer to understand. It’s not just about running a health insurance quote or selling products. We seek to understand what exactly our customer’s needs are and match the consumer with a resource that is available in their local community. It may be a specific healthcare provider or specialty, or a program that is available which they had no knowledge of previously which would improve their circumstances. We are positioned to make recommendations because we develop relationships with community healthcare providers, insurance companies and governmental agencies to develop a broader frame of reference in relation to healthcare delivery.  

Venture Concept

COHA will use its resources and contacts to better connect consumers with healthcare options that are available in an easy to understand manner. Matching consumers with resources for those who do not currently have insurance or healthcare coverage, and assisting those who do maximize benefits it key to our differentiation from our competitors. Most of our competitors in the healthcare marketing space are concerned mainly with sales. Providing the consumer with unheralded but effective options is not their priority. Providing consumers with actionable information is our priority. This is our competitive advantage, our “unfair advantage”.

We obtain real-time information about consumer needs and preferences. Using predictive analytics, in the future we can anticipate future needs of consumers. Our partners can have a clearer picture of what type of products and services interest consumers. Information concerning price points would be especially useful. Leveraging data collected without violating privacy rights is key.

The next market opportunity COHA will target is probably the Medicare Supplement market. Medicare Supplements and Medicare Advantage plans are not the same. In fact, it is illegal to have both at the same time. The Supplement market involves reaching consumers in higher income brackets who already have access to more options than others. Developing a value proposition to this market is a little more involved but very achievable.

Within 5 to 10 years, COHA could be a trusted resource when it comes to getting the best information concerning healthcare access on a local level. We would then look at going to a statewide level and beyond. As an entrepreneur, my vision is that every person know that they can participate in their healthcare and that they take concrete steps to do so.