Care Model 101

The foundation of a care model all starts with the business model. Is it a fee-for-service model? Direct-to-consumer subscriptions? Or is it a value based care arrangement? Is there a clear and established easy button route to get paid via insurance? Is it a new concept that also requires a new way to get paid by payors? Or is it some combination of the above?

Next, we have to understand if it’s a general service like Virtual Primary Care that needs to support the management of thousands of conditions. Or is it hyper-focused on managing just one condition? Or is it focused on just a few conditions within a specialty?

Then, is it a 1:1 model like 1:1 therapy? Or is it a team-based model that requires primary care, specialists, clinical admins, care navigators, etc? If it’s a team, which role is the primary contact patients are working with the most?

When we begin working together, these are the kinds of questions that absolutely must be answered. These considerations inform the foundational architecture of the tech platform, the financial operating model, everything. A subset of other questions that will be considering when defining the foundation are:

• What forms of online communication will we enable and nudge toward?
• Is there a physical component to the care model? If so, are physical visits ad hoc or scheduled?
• What are the non-provider roles needed to power the model?
• What do we believe is our Intellectual Property?
• What are licensing requirements for each role?
• What is the policy if a patient loses access to our service due to employment termination or cancellation for any number of reasons?
• What is the relationship between our service and a patient’s personal PCP?
• What are the company’s objectives and drivers as it relates to the Product? How do we weigh each?