Belong Health Financial Model

Belong Health provides a "full-stack health plan operating platform" - a bundled set of services, technology, and owned care delivery assets that a regional health plan partner plugs in to run a D-SNP. The four pillars:

1. Health Plan Infrastructure - provider network, MSO, IPA management, sales & brokerage, statutory capital support.
2. Clinical Management - care coordination, care management, transitions of care, social determinants, behavioral health.
3. Care Delivery Assets - in-home care, extensivists, owned primary care clinics.
4. Analytics & Technology - data lake, analytics platform, AI/ML-driven care management workflow, member/provider portals.

The value prop to the health plan partner: Belong supplies what they lack (D-SNP operating expertise, tech, clinical assets) while the partner supplies what Belong lacks (health plan license, statutory capital, claims infrastructure, existing member base).

• Medicare Advantage: $320B market, 5.6% CAGR forecast through 2030 (Congressional Budget Office).
• Dual Eligible segment: $330B spend, 11M individuals, 7.3% growth rate.
• Dual Enrolled (currently in a coordinated plan): $90B, 3M individuals, 2.5% growth.
• Medicare total: $800B, 60M individuals, 6.7% growth.
• Medicaid total: $621B, 74M individuals, 3.9% growth.
• National Healthcare Expenditure 2019: $3.8T, forecast 5.4%/yr growth.
• Market growth signal: Age-ins add $1B in new annual premium every 10 days (assumes 10,000 age-ins/day × $800 PMPM).
• SNP eligibility growth materially outpacing MA enrollment.
• Addressable partner universe: 104 regional health plans + 20 independent BCBS licensees + 4 multi-state BCBS licensees + 161 Medicaid MCOs with 5,000+ lives but no MA offering + 21 regional provider systems with no insurance offering = ~310 prospective partner targets.
• Competitive context: Innovative MA insurers (Oscar, Devoted, Clover, Alignment, Bright) collectively serve <250K lives vs. 26.4M MA enrollees and 62.7M Medicare-eligible. Market penetration by next-gen models is <1%.

Not explicitly disclosed in deck. Based on the business model described:

• Belong is a platform + services provider to health plan partners, not itself a licensed insurer (the partner holds the license and statutory capital).
• Revenue is most likely structured as: (a) a PMPM management fee paid by the partner plan for each enrolled dual-eligible member, and/or (b) a percentage of the premium revenue the plan earns from CMS/state Medicaid agencies, plus (c) potential shared savings participation on medical cost reduction.
• The anchor contract with MVP Health Care has a disclosed "estimated total contract value" - but the dollar amount is redacted in the deck image (slide 5 shows the phrase but the number is blank/redacted).
• Channels: Direct B2B sales to health plan partners; pipeline includes regional health plans, BCBS licensees, Medicaid MCOs, and provider systems.

• Anchor partner signed: MVP Health Care, definitive operating agreement August 23, 2021.
• Launch date: January 1, 2022, upstate New York (Hudson Valley + Capital District).
• Estimated total contract value with MVP: REDACTED in deck image.
• Pipeline: Active pipeline with prospects at "Early Conversation," "Moving Towards LOI," and "LOI Near Completion" stages; specific names and counts redacted.
• Financial Forecast section (slides 27+): Entire section redacted.

• Revenue per partner is likely large (multi-year contract, PMPM × member count × 12 months).
• Medical Loss Ratio (MLR) risk: If Belong bears any insurance risk on medical costs, MLR is the dominant margin driver. If pure fee-for-service/PMPM management model, MLR risk stays with the health plan partner.
• Dual-eligible PMPM premiums are high (~$800/month implied by slide 9 footnote), but medical costs for this population are also very high.

• Competitive landscape (next-gen MA insurers): Oscar (3K lives), Devoted (39K), Bright + Brand New Day (63K), Clover (66K), Alignment Healthcare (77K) - all direct insurers, not platform/partner model.
• Advanced practice provider models: Village MD (600K), ChenMed (200K), Landmark (150K), Oak Street (109K), Iora (30K) - these are provider-side, not health plan enablement.
• Belong's moat claim: No direct competitor identified in deck for the "full-stack D-SNP operating partner" model for regional health plans. Moat relies on: (1) first-mover with anchor partner; (2) proprietary tech stack; (3) experienced leadership team with deep D-SNP / MA operational backgrounds; (4) network effects as more partners join the platform.
• Leadership backgrounds (moat evidence): CEO managed 9th largest MA+D-SNP plan at Cigna-HealthSpring ($1.5B premium) and a 5-star MA plan at Essence Healthcare.

Team (co-founders + key hires):

• J. Patrick Foley - Co-Founder + CEO. Cigna-HealthSpring ($1.5B premium MA+D-SNP), Essence Healthcare (5-star MA plan).
• Dr. Jennie Byrne - Co-Founder + Chief Patient Officer. Chief Behavioral Health Officer at CareMore.
• Tahasin Alam - Co-Founder + CTO. Co-founder of Centivo (tech-led employer insurance platform).
• Gen Gillespie - Co-Founder + CRO. National sales responsibility at Lumeris.
• Lewis Biggers - Co-Founder + Chief Provider Officer. Accountable care at Stanford Health Care.
• Alon Krashinsky - Co-Founder. 15+ years launching built-for-purpose companies.
• Brian Lovett - Co-Founder. 5+ years launching built-for-purpose companies.
• Maura McGinn - SVP People + Ops. Led people/recruitment at Bright Health.
• Natasha VanWright - VP Care Management. 20 years health plan leadership.
• Julie Berez - VP Partner Operations. RubiconMD and Bain.

Funding ask: Series A - amount not disclosed in deck (redacted or not stated).

Use of funds: Implied from exec summary: (1) fund the MVP Health Care D-SNP launch (Jan 2022); (2) build out tech-enabled clinical model; (3) expand team (care management, growth, provider engagement, analytics, health IT); (4) pursue pipeline of additional health plan partners.

Archetype + why: Managed Care Enablement / PMPM Partner Revenue model - specifically a multi-partner PMPM-based P&L with insurance economics layered in. This is closest to a B2B SaaS-meets-managed-care hybrid. The core mechanics: number of partners × enrolled members per partner × PMPM fee = revenue. Optionally add shared savings upside. On the cost side: clinical delivery costs (CHW, NP, RNCM, behavioral health), technology OpEx, G&A, and sales/BD. If Belong carries any capitation or risk corridor, an MLR/medical expense line is required. Given the redacted financial section, the model must be built from structural assumptions.

Forecast horizon & granularity:

• 5-year annual model (2022–2026), with 2022 monthly build for the first year (MVP launch ramp).
• Quarterly suffices for years 2–5.

Key drivers & assumptions:

*Partner/enrollment funnel:*

• Partners live (Year 1): 1; subsequent years.
• Members per partner (Year 1, MVP):.
• Member growth per partner per year:.
• Churn/attrition of members:.

*Revenue:*

• PMPM management fee to Belong:.
• Shared savings upside:.
• Contract duration:.

*Cost structure:*

• Clinical staffing (CHW, RNCM, NP, behavioral health, social work):.
• Technology platform (build/maintain):.
• G&A and corporate overhead:.
• Sales & BD (partner acquisition):].

*Insurance/MLR economics (if risk-bearing):*

• Medical Loss Ratio:.
• If fee-for-service/PMPM management only: MLR stays with health plan partner; Belong's P&L is a services business with ~40–60% gross margins.

*Capital & funding:*

• Series A raise:.
• Pre-revenue through end of 2021.
• Cash burn pre-revenue:.

Scenarios (Base / Bull / Bear - which variables flex):

• Base: 1 partner live in 2022 (MVP, ~1,000 members), 1 additional signed in 2023, 2 in 2024; PMPM fee $150; clinical costs scale efficiently with volume.
• Bull: 2 additional partners LOI to signed in 2022 (consistent with pipeline stage disclosed); members per partner grow faster (200% YoY); shared savings upside materializes; PMPM fee negotiated higher as value demonstrated.
• Bear: MVP launch delayed or enrollment misses ramp; no new partners signed until 2024; regulatory / CMS compliance costs higher than expected; clinical costs don't scale (high per-member cost for complex population).

Required sheets / outputs:

1. Assumptions - all drivers with Base/Bull/Bear toggles.
2. Partner & Member Ramp - partners signed × go-live date × member enrollment curve per partner.
3. Revenue Build - members × PMPM fee × months live; shared savings upside (optional toggle).
4. Clinical & Operational Cost Build - headcount by role × cost per FTE, scaling with member count; non-headcount clinical OpEx (home visits, labs, etc.).
5. Technology & G&A - platform build costs (capex), hosting, corporate overhead.
6. Income Statement - revenue, gross profit (if fee-based), EBITDA, net income; or medical expense / MLR if risk-bearing.
7. Cash Flow & Runway - burn rate, Series A proceeds, months of runway.
8. Sensitivity Table - PMPM fee vs. members per partner; MLR vs. gross margin.
9. Dashboard - KPIs: partners live, total members, revenue, burn, runway.