The tiered structure — membership fee, copay, cash pool, mutual or major-medical insurance — is easy to draw and easy to explain in the abstract. It is a different exercise entirely to make it real: an actual rate, calibrated against actual costs, that people experienced in healthcare delivery, billing, insurance, and finance can test rather than simply admire.
What this actually requires: bring the people who understand the numbers into the room and run the model until its weak points become visible. Set the membership rate against what care genuinely costs to deliver well, not against what feels acceptable in a pitch. Walk through different patients, patterns of use, staffing levels, reimbursement assumptions, and high-cost events. Ask what happens when utilization is higher than expected, when enrollment grows more slowly, when a service costs more to provide than anticipated, or when the cash pool is drawn down faster than it can be replenished.
The model needs a clear answer for what the membership fee funds, what requires a copay, what fills the cash pool, and how that pool is restored. It must define what the mutual or major-medical insurance layer actually covers and where the line sits between that protection and the cash pool beneath it. Those boundaries should be tested through real scenarios, not left as labels on a diagram.
Test the entire structure at the scale actually being planned. Does it hold with one hundred members? Five hundred? One thousand? What changes as staffing, facilities, clinical demand, and risk change? A fee strategy that works only under the assumptions used to create it is not yet a strategy. Like the clinical model in Phase One, it must be challenged, revised, and run again until the numbers continue to hold when knowledgeable people try to break them.
Target Endpoint: a fully defined fee strategy, supported by documented cost and utilization assumptions and tested across multiple operating scenarios — precise enough that Phase Four’s anchor conversation can open with a real rate and a clear explanation of what that rate can reliably support.