The insurance company was noted for selling life insurance products in the country and now wanted to introduce a new health insurance product to their existing large group clientele. The company recruited me to develop a Health Maintenance Organization (HMO) which would be the first of its kind in the English-speaking Caribbean. At that time only the traditional indemnity (i.e. 80/20) health plans were offered by the company and its competition.
Insisting that research be presented, I recommended that an in depth feasibility study be conducted to examine the critical strengths, weaknesses and threats (S.W.O.T.) from a financial, operational and marketing perspectives within the targeted environment.
The leadership of the firm decided to create separate company (joint venture) in partnership with select influential persons from the legal, medical and dental communities. Since none of these individuals were knowledgeable about HMO’s I had to educate them via board presentations on the basic concepts of managed care (e.g. capitation, physician networks, gate keepers, etc.)
Directed the planning, design, and implementation of the first IPA group model HMO
Developed of the initial concept proposal and project budget of $1 million
Identified and selected the corporate investor for joint venture
Recruited and trained all professional and administrative support staff
The feasibility study phase included meetings and interviews held with key individuals in the medical and business communities as well as an analysis of claims data from the insurance company. Various HMO models were examined to determine which one would best fit this environment.
The HMO was successfully launched with more than 500 network physicians and 20,000 members and still exists after 30 years of operation.