This document summarizes the business plan and strategy for a proposed new health maintenance organization (HMO) in Nigeria. It recommends acquiring an existing HMO to obtain the required operational license. Key strategies include aggressive marketing, robust provider networks, world-class customer service, and efficient claims processing. Financial projections estimate breaking even within the first year with sales of 400 million Nigerian naira and profit targets growing to 200 million naira by year five. Board members and top management are responsible for driving early sales and profit goals.

1. Aesculapius Healthcare Consultants

2. TeamSTEPPS Patient Safety
Strategies Trainers, Certified by
the US. Department of Defense
and Agency for Healthcare
Research and Quality (AHRQ).
Certified Project Managers
(PMI),Quality Management
& Process Improvement
Experts (ASQ).
Competencies include Patient
Safety Initiatives, Healthcare
Project Management, Business
Development, Idea Generation,
Financial Management and
Healthcare Quality Management.
Managing minimum of 2
HMOs from Start-up

3.  Need for Continued ROI for Investors.
 Investing in a sector with minimum of annual 5%-
12% Growth Rate
 Increased Value for present Health Customers
 Lack of Health Insurance offer outside present
Portfolio
 Integration as Strategy

4. NHIS Operational License is
required -3 types namely:
* National License –
Covers whole of the
Nigerian territorial space.
*Regional License – Covers
a stated geographical
region within the Nigerian
territorial space.
* State License –Covers a
definite state within the
country.
NHIS Required
Share Capital
Breakdown
Capital Assets
(Buildings, Land
etc)
200,000,000
Liquid
Capital(Account
Balance &
Operational
Assets)
200,000,000
Total Share
Capital
400,000,000

5. Buy Existing HMO
Values Challenge-VISION, Cost, Integrity/Liability,
Responsibility, Innovation, Customer Focus,
Excellence
HMO Start-up
Longer period to achieve Market Leader, deferred ROI,
Huge Learning Curve
Buy & Merge HMOs
Migrating to Same Platform, Values Challenge, Merging
2 different cultures.
Benefits: Ready-Made Customers & Shorter Learning
Curve.

6. Current Market Performance
Previous Return on
Investment
Types of Assets
Level of Revenue &
Liabilities
Level of Pay-out-Fee for
Service or Capitation
Customer Acquisition Costs
Claim Management Costs
Other Pay-outs
Provider Engagement Costs
Assess HMOs to reduce Your Risk

7. Design Service Bundles and Offering
Design Organizational Processes costs
regarding payouts and other administrative
overheads?
Develop Critical-To-Quality(CTQ) processes for
cost-efficient Service
Identify new opportunities to establish Beach-
head in the Market

8. Provider Hospitals
Provider Hospital
Engagement
Provider Credentialing
Case Management
Provider hospital
Administration: Service
approvals, Claims
Processing & Claims
Verification.
Operations/IT
Administration/Database
Management
Enrollee Registration
Production of Enrollee
Identification Cards
Maintenance of the
Company Database
Procurement of IT
Hardware

9. Utilize the widespread
disaffection by Provider
Hospitals in Service
Delivery.
Viable Alternative to the
present Market Leaders
Coverage and Benefits-
Robust Health Plans with
‘WOW’ Benefits
Provider Choice: Robust
Provider choice for
enrolees
Claims Processing-
efficient Claims
Processing
World-Class Customer
Service as Strategic
Objective
Fast and Efficient
Approval Processes
Making Service Providers
the first line of Marketing

10. Utilize the widespread
disaffection by provider
hospitals in service delivery.
Position as Viable alternative
to the present market leaders.
Provider Choice: Robust
provider choice for enrollees.
Build efficiency into key
operational processes like
Claims Processing
World –class customer
service as strategic
objective.
Fast and efficient approval
processes.
Making service providers
the first line of marketing
through efficient
Prompt payment of claims
and capitation.

11.  Design Services like
Wellness Programs;
Evidence Based
Preventive Health
Programs,
 Continuous Enrollee
Education &
Engagement
Executive Concierge
Services
HMO-Enrollee Team
Building
‘1-enrollee HMO’
HMO-Provider Team
Building

12. Huge business potential exists in the Nigerian Health Insurance Sector.
This can be achieved with Aggressive marketing, Strategic Direction &
well designed Processes and Systems.
Overarching Target is Breakeven of N400,000,000 in Yr. 1
We suggest:
Responsibility Target
Board Members with wide network & influence
in the corporate Environment
Committed
80%(320,000,000)
Top Management Team & other staff 20% (80,000,000)

13. JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
10
20
30
50
80
100
120
150
180
200
250
300
350
400M
40
SALES
PROFIT
Actual
Net Profit
(40M)

14. 400M
800M
1.2B
1.6B
2.0B
2016 2017 2018 2019 2020
SALES
0
PROFIT
Profit
@ (10%)
(40M) (80M) (120M) (160M) (200M)

15. We Thank You For Reviewing Our Presentation.
It is imperative to state that complete acquisition or total
buy out of existing HMO is key to acquiring LICENCE for
Health Insurance Operations.
Existing Liabilities will be net off the acquisition Cost
Infusion of Passion & Efficiency with proper Cost
Management of Operating Systems and Processes is
paramount to Success.
THANK YOU