# Belong Health Financial Model Tech-enabled full-stack operating partner for regional health plans launching Dual-Eligible Special Needs Plans (D-SNPs) for Medicare + Medicaid dual-eligible beneficiaries. - Canonical: https://finamodel.com/startups/belong-health - Excel download: https://finamodel.com/startup-models/belong-health.xlsx - Category: Health-tech - Model type: SaaS ARR / Valuation - Funding round: Series A - Funding: $40M - Founded: 2021 - Geography: Launch market - upstate New York (Hudson Valley and Capital District) [DECK, slide 5]. Target market is national (regional health plans, Blues licensees, Medicaid MCOs across the US). - Customer: B2B2C ## About the company Belong Health is a technology-enabled operating partner for regional health plans launching D-SNPs for Medicare and Medicaid dual-eligible members. It provides platform and operating expertise while its plan partners retain the insurance licence and statutory capital. Its revenue is expected to be a management fee per enrolled member, with potential shared-savings upside. Partner-plan growth and beneficiary enrolment therefore matter more than conventional software seats. The model should forecast plan partners, enrolled members per partner, PMPM fees, implementation, and shared-savings assumptions. Care operations, partner concentration, enrolment ramp, and any insurance-risk exposure should be kept separate from the platform fee. ## What's included - 5-year monthly revenue build with stage-appropriate growth assumptions - Full P&L, headcount plan, and operating-expense schedule - Cash-flow statement, runway, and burn-rate tracking - Valuation via exit multiple with a DCF cross-check - Returns analysis with MOIC and IRR - Unit economics including CAC, LTV, payback, and cohort retention ## Product & value proposition 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). ## Market - 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%. ## Revenue model 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. ## Traction & metrics - 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. ## Unit economics - 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. ## Competition / moat - **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 & funding ask / use of funds **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. --- ## Recommended financial model **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. ## Frequently asked questions ### Is the Belong Health financial model free? Yes. The Belong Health model is a free Excel download with live formulas. ### Can I change the assumptions? Yes. The workbook is editable and its live formulas recalculate when assumptions change.