VH

Vitable Health Financial Model

• "Kaiser for primary and urgent care" for living-wage workers.
• Independent contractor nurse practitioners (NPs) supported by on-call physicians.
• Care delivery: telehealth + at-home visits (broader scope than telehealth alone, still cheaper than on-site facility).
• Bundled with third-party high-deductible catastrophic insurance to create ACA-compliant plan at lower total cost to employer and employee.
• Value to employer: avoids ACA penalty ($2,320/employee for 50+ employee firms) and offers competitive benefit to attract/retain workers.
• Value to employee: replaces unaffordable traditional plan ($250/month) or uninsured status; prevents costly ER visits.
• Care mix addressed: Urgent Care 45%, Preventative Care 29%, Non-urgent Acute Care 16%, Chronic Care 10%.

• 65M U.S. employees earning under $15/hr (42.4% of working Americans).
• TAM: $39B - calculated as $600/yr × 65M living-wage U.S. workers.
• SAM (Philadelphia area): ~$1B.

• Price: $50/month per member (PMPM).
• Annualized revenue per member: $600/yr.
• Channel: Bundled into third-party high-deductible catastrophic insurance plans; sold via insurance brokers (pilot with "largest insurance broker in Philadelphia").
• Future channels: self-insured employers, on-demand/gig workers, HR/payroll platforms.
• Revenue recognition: subscription (PMPM); B2B2C - employer or broker relationship, member is end consumer.
• Cost of delivery: NP contractors + on-call physician oversight; no facility overhead.

• Insurance broker pilot: Partnership with "largest insurance broker in Philadelphia" in trial.
• Founder background: Family-run home healthcare company; <15% employee enrollment in $250/month plan due to cost.
• No revenue, member count, growth rate, or retention figures disclosed in deck.

• Revenue per member: $600/yr.
• Traditional employer health insurance: $6,000/yr premium, employer pays ~50% ($3,000/yr/employee).
• Employee cost under legacy plan: ~$250/month ($3,000/yr).
• Vitable price: $50/month ($600/yr) - ~80% cheaper for employee vs. legacy plan.

• Implicit competitive positioning: Traditional group health insurance (expensive, low enrollment) and uninsured status.
• Moat claims: IC NP model keeps delivery cost low; at-home visits extend telehealth scope without facility cost; ACA-compliant bundled product is a structural distribution advantage.
• Network effects / data moat: Not discussed.

• Founder: Healthcare small-business background (family home healthcare company), Penn State, Microsoft, Vitable.

• Archetype + why: Healthcare subscription / PMPM model (similar to digital health or direct primary care). Revenue is purely member-count × $50/month. Cost structure is utilization-driven (NP contractor hours per visit × visit rate per member). This is not SaaS (no software seat), not insurance (no risk pool / loss ratio), and not marketplace - it's a subscription care delivery business sold B2B2C through brokers and employers.

• Forecast horizon & granularity: 3 years monthly (months 1–36). Monthly needed to model broker pipeline ramp, employer cohort onboarding, and NP staffing cadence.

• Key drivers & assumptions:

*Demand / member growth*

• Month 1 employer accounts: 2–3 SMB accounts from Philadelphia broker pilot; each account ~30–75 employees eligible
• Member enrollment rate per employer: 40–60% (higher than legacy 15% due to lower price point; sensitivity driver)
• New employer accounts/month: 3–5/month in Y1 ramping via broker channel; accelerating in Y2–Y3 as channels expand
• Average employer size (employees): 50 employees (ACA mandate threshold; SMB focus implied)

*Revenue*

• PMPM: $50
• Annual revenue per member: $600
• Revenue recognition: monthly, per active enrolled member

*Cost of care delivery*

• NP contractor cost per visit: $35–$60/visit (IC NP market rate for telehealth; sensitivity driver)
• At-home visit premium: 2× telehealth rate (~$80–$120/visit)
• Visit mix: ~70% telehealth / 30% at-home
• Utilization rate: 1.5–2.5 visits/member/month (primary + urgent care focus; key margin driver)
• Physician on-call cost: flat monthly retainer per NP or per 100 members
• Care mix (for utilization modeling): Urgent 45%, Preventative 29%, Acute 16%, Chronic 10%

*Gross margin*

• Target 40–60% gross margin at scale; heavily dependent on utilization rate and visit mix

*Opex*

• Sales/broker commissions: 10–15% of premium (standard health broker commission)
• G&A: lean team; 2–3 FTE in Y1, scaling with member base
• Technology / platform: modest build cost; NP scheduling and telehealth infrastructure

• Scenarios (Base / Bull / Bear - which variables flex):
• Bear: Low employer enrollment rate (25%), high utilization (3 visits/month/member), NP cost at high end → margin squeeze
• Base: 45% enrollment rate, 2 visits/month/member, blended NP cost $50/visit, 3 new accounts/month
• Bull: 60% enrollment rate, 1.5 visits/month/member, broker channel scales to 10+ accounts/month by Y2; HR/payroll platform partnership adds volume

• Required sheets / outputs:

1. Assumptions - all PMPM, visit rate, cost, and growth levers
2. Member Roll - employer accounts × enrollment rate × churn; active member count by month
3. Revenue - active members × $50 PMPM
4. Cost of Care - visits × blended NP rate; physician retainer
5. Gross Profit & Gross Margin %
6. Opex - broker commissions, headcount, G&A, tech
7. EBITDA / Net Income
8. Cash & Runway (given early stage)
9. Unit Economics summary - revenue/member, cost/member, contribution margin/member, LTV (assumed churn), CAC
10. Scenario toggle (Base / Bull / Bear)