Funding Your Own Healthcare

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More folks including both individual adults and families are on their own to provide funding for healthcare. There is a growing trend of being your own freelance business owner, being a contract employee or being employed by a business that does not offer a health insurance benefit. Many people make the mistake of buying price instead of value in a healthcare funding plan. This article provides an overview of options for funding healthcare with both advantages and disadvantages of each strategy.

How Much does Healthcare Cost?

Understanding what healthcare costs is important to deciding the best strategy for funding your own healthcare needs. Buying based only on price and not value (price vs. benefits) is a common and very grave mistake. Some examples of what healthcare can cost will help illuminate the importance of value and risk transfer (insurance) in funding your own healthcare.

Routine Care: Having an ongoing relationship with a medical doctor is important value and can help you avoid much more costly illness and improve your overall health outcome. I am an example of the benefits of routine medical care with the goals of avoiding cardiovascular disease, diabetes and managing my sinus allergies. My recent doctor visit including blood test = $248 Well Baby Check (price from local pediatrician) = $160 Annual Physical = $500? Cost depends on how elaborate a physical you get.

Rx Drug: Prescription drugs are approximately 10% of total healthcare spending [1]. Prescription drugs can be a large component of treating a major or chronic illness. These are drugs that I take with the list prices from my local drug store. OTC Claratin (equivalent house brand) = $10 / month Crestor = $137.99 / month Astelin = $115.99 / month An example of a more expensive medicine that my wife takes regularly for her chronic migraines: Topamax (generic equivalent) = $566.99 / month

Diagnostic Tests: Diagnostic tests are an important part of most disease identification, management and treatment and are a large component of healthcare costs. My recent blood test (three panels) = $152 X-Rays = $100+ Mammogram = $150+ MRI = $1000+; a complex MRI can cost several thousand dollars

Emergency Care: ER Visit = $1000+; this is based on my experience – I have never had an ER visit that was less than a $1000 in billed costs

Hospital Admission About 30% of healthcare costs are for in-patient hospitalization. The average length of a hospital stay is five days [2] with costs highly dependent on treatment. Heart Arrhythmia (irregular heartbeat) – Example from one of my clients = $45,000 including an ER admission and then three days in the hospital

Major Illness: Cancer (Lymphoma) – My brother over two years of treatment = $500,000+; It is hard to tell the actual total but when I called to see if my brother was close to exceeding his $1 million lifetime limit the expectation was at least $500,000 in paid benefits to complete his cancer treatment.

Chronic Illness: A chronic illness is defined by a medical condition lasting a year or more that requires ongoing treatment. Examples are Diabetes, Asthma, hypertension and Depression. Approximately half of all Americans have some kind of chronic aliment [2]. Type 2 Diabetes – Average Annual Cost = $5949 [3] Asthma – Average Annual Cost = $3192 [4]

Put all of this in a gigantic pile and the average cost of healthcare in Texas according to the Texas Department of Insurance in 2006 was $7110 per person. That is $593 per month per person. Admittedly that includes a lot of unhealthy and high healthcare uses but it provides some perspective on what healthcare costs. If you have not had a close relative, family or friend with a serious illness or injury, it is hard to imagine the high cost of healthcare. Value in funding healthcare is more than helping with the cost of routine care. Value to me means grappling with the risk of a major illness or injury.

Choices for Funding Healthcare

Cash – Just buy it when you need it and pay what it costs out-of-pocket. The big disadvantage of the “Cash” or what I call the “If we are Lucky Plan…” is that you have no protection of the risk for a major illness or injury. We have over 24% of Texans uninsured for healthcare with a fourth of the uninsured on the “Cash” plan by choice — about 6% of the entire population.

Advantages:

No Monthly Premium / Fees
Ask for Cash discount from healthcare providers

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Healthcare Executive Recruiting – Bet on the Horse or the Jockey?

Experience breeds intuition when it comes to healthcare executive recruiting. Does it work for horse racing too? I will not attempt to prove whether experience improves your outcome at the track. However, healthcare venture capitalists often use horse racing analogies when discussing ideal investments. These venture capitalists prefer to bet on the jockey versus the horse. Their logic, it’s the people that drive the business.

A healthcare venture capital firm’s success is dependent on their ability to recruit and retain a high-performing Jockey, a.k.a. “the CEO.” If it was only so easy to win The Kentucky Derby or deliver a ten-bagger return. My healthcare executive recruiting experience working with healthcare venture capital firms provides intuition in defining the firm’s CEO need. Once understood, identifying and recruiting the CEO and building a solid support team for the CEO requires experience, extensive networks, new and real-time research and a thorough process. The intent of this article is to offer outcome-driven insights for the healthcare venture capital firm that chooses to search internally for a portfolio CEO versus retaining a healthcare executive recruiting firm.

Recent quarters show an increased level of new capital investment from healthcare venture capital firms. The Health Care M&A Monthly reported in March 2008 that healthcare services deal volume in February 2008 totaled thirty completed deals. Looking back to 2007, total funding for healthcare venture capital deals was more than $9 billion across more than 480 deals. Healthcare venture capital investment increases the demand for these firms to conduct a thorough and accurate executive search process in order to identify, recruit and retain the CEO. While a healthcare venture capital firm often retains a healthcare executive recruiting firm to assist in CEO recruiting efforts, healthcare venture capital firms can mimic the search process of the top healthcare executive recruiting firms.

Insights from healthcare executive recruiting firm processes will lead to an improved exit:

1. Healthcare venture capital firms are committed to recruiting a proven CEO for the portfolio business and may occasionally be inclined to conduct an in-house CEO search process. The approach is to put a CEO in place that is known by the healthcare venture capital firm from previous experiences and business dealings. However, many times these healthcare venture capital firms will admit they “don’t know what they don’t know” about the business, the segment, or the pool of available CEO talent. However, if there was any doubt at the onset, it quickly becomes clear they need to bet on the jockey to run an unfamiliar race. It is at this point the firm should consider duplicating the search methodology that healthcare executive recruiting firms utilize for CEO assignments.

Healthcare executive recruiting firms are engaged to identify and recruit leading CEOs for high-growth, venture backed businesses. To reduce the risk of making a hiring mistake, a healthcare venture capital firm’s internal search process should assess those executives the firm knows and trusts in parallel with proven executives who are newly introduced to the healthcare venture capital firm. Ultimately the CEO may be selected from the firm’s personal rolodex. However, the value of benchmarking known CEOs against a broader CEO talent-pool will prove valuable.

2. CEO contingency and succession planning belongs early in the healthcare venture capital firm’s investment. Recruiting strategies to recruit key CEOs, senior leaders and board members are at the foundation for a portfolio company’s success. Common practice is for the healthcare venture capital firm to identify and recruit a seasoned and industry-experienced board member, one capable of leading the business if the current CEO cannot finish the race. The immediate need is fiduciary but both succession and contingency planning should be considered too. While some individuals believe that succession planning should be below the CEO, healthcare venture capital firms are interested in developing concepts and financial carry more so than developing future leadership talent. Therefore, succession and contingency planning belong in the board room for two reasons: one, if the CEO in place is successful the new board member can maintain his or her fiduciary duties. However, if the CEO loses control of the business or the market, this board member is engaged and able to step in immediately. This hedge strategy can be effective to dramatically reduce downside risk.

If the CEO loses control of the business or the market and the healthcare venture capital firm did not plan appropriately, there will be many sleepless nights. It’s during those sleepless nights when the unprepared healthcare venture capital firm will incorrectly pursue one of these three options:

o Retain a healthcare executive recruiting firm. However, the search is often initiated on quick sand as the healthcare venture capital firm needs to recruit a savior. Conversely, the venture capitalist may decide to avoid retaining a healthcare executive recruiting firm as it is perceived to be too cumbersome of a process during this time of panic. Neither scenario leads to a high-multiple exit.

o Turn to someone the healthcare venture capital firm knows from previous dealings. This option is not focused on growth but rather on building a floor to minimize investment loss.

o The healthcare venture capitalist will take over the business and act as CEO. My experiences say that poor planning and a subsequent reactionary jerk will not deliver a positive cash outcome.

The success of a risk-taking healthcare venture capital firm is based on hiring and recruiting the right Jockey for the business. While healthcare executive recruiting firms are often critical resources to venture firms, there are occasions when a healthcare venture capital firm chooses to conduct their CEO search internally. In those occasions, healthcare venture capital firms should mimic the proven search process of the top healthcare executive recruiting firms. Healthcare venture capital firms will benefit by conducting an unbiased and thorough executive search process tied to board level contingency and succession plans. This will deve

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