# Vitable Health Financial Model

Affordable primary & urgent care health coverage for SMB living-wage employees, delivered via telehealth and at-home nurse practitioner visits.

- Canonical: https://finamodel.com/startups/vitable-health
- Excel download: https://finamodel.com/startup-models/vitable-health.xlsx
- Category: InsurTech
- Model type: SaaS ARR / Valuation
- Funding round: Seed
- Funding: $6M
- Founded: 2020
- Geography: Philadelphia area initial market [DECK slide 6]; U.S. addressable market cited [DECK slide 7].
- Customer: B2B2C

## About the company

Vitable Health offers affordable primary and urgent care for living-wage employees through telehealth and at-home nurse-practitioner visits. It bundles care with catastrophic coverage to create a lower-cost employer health benefit.

The product is priced at $50 per member per month and distributed through brokers, with future routes through self-insured employers, gig workers, and HR platforms. Its care model is designed to avoid the cost of facility-heavy alternatives.

The model is PMPM healthcare revenue. Members, employer groups, price, enrollment, utilization, clinician capacity, care cost, and retention build revenue and margin. Broker productivity, medical quality, and home-visit economics determine scale.

## 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

- "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%.

## Market

- 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.

## Revenue model

- 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.

## Traction & metrics

- 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.

## Unit economics

- 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.

## Competition / moat

- 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.

## Team & funding ask / use of funds

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

## Recommended financial model

- **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)

## Frequently asked questions

### Is the Vitable Health financial model free?

Yes. The Vitable 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.