Creating a new category in healthcare

A major Turkish premium hospital group earned the most per visit from the patients who came the least often. Self-pay patients paid full price every visit and visited the group rarely; insured patients came in at heavy discounts and visited several times a year. The cohort the group treated as its most valuable was generating less annual revenue than the cohort it discounted hardest, and competitors were eroding it further.

Turkey’s private healthcare market segments around two insurance tiers: complementary (TSS) for cost-conscious cover, comprehensive (OSS) for full cover. Between them sits a band of affluent customers who want premium care without a full insurance product, and nothing in the market fit. Entering TSS would dilute the brand; losing the band above kept eroding revenue.

Underneath the retention problem was a positioning one. As insurance ate the cash-pay segment from below, where did the group want to stand? Competing harder inside the existing product set would not change the underlying erosion. Entering the low-cost TSS market would contradict the premium brand. The strategic answer was to design a new segment between TSS and OSS that the market had not yet built. That work covered segment design, product build, actuarial pricing, and taking the new business through to live.

Proposal preparation was the engagement’s first phase. By the time the proposal went in, the answer was already in hand — a subscription product sitting between TSS and OSS, anchored in value-based-care economics, with the diagnosis of why self-pay patients were not the value cohort the group had assumed they were. The proposal carried the answer, not a plan to find one. The engagement that followed built it into a live business.

The product is an annual subscription for outpatient care, priced between TSS and OSS. The hospital distributes it directly; insurers can also distribute it as a co-branded offering. The subscription locks the self-pay margin onto a frequency the group already saw work commercially in its insured base — paid for as deferred revenue from day one, with a meaningful share of those visits converting to inpatient cases where the group’s existing economics carry the conversion.

The engagement carried every layer the new business needed: strategic positioning, product family and brand, customer journeys, operating model, actuarial backbone, commercial pricing built on advanced machine learning models, and the board-level business case. End-to-end was a structural choice, not scope creep. The actuarial assumptions had to be testable against the positioning that created them, the pricing had to survive both the board case and the launch, and the brand had to read as premium to a customer comparing it against OSS rather than against TSS.

A subscription product in healthcare carries a structural risk: payer pays for care, provider profits from delivering care, and the two have opposing incentives. The product’s design removes that tension by making the hospital group its own payer for subscribers. An avoided complication is a cost saving and a quality outcome at the same time, falling on the same balance sheet either way. Preventive care and proactive specialist monitoring are built into the subscription: customers are monitored continuously rather than reactively, so problems are addressed before they become acute. Value-based care is the operating model, not a slogan; the subscription’s economics depend on it being honest.

Across the product family, revenue per patient ran up to 350% above prior self-pay activity from the same cohort. Customer churn, defined as a customer making no visit to the group in twelve months, ran at roughly 80% across the self-pay base; under the subscription it is projected to fall to 15%. The 350% lift comes from frequency and from outpatient-to-inpatient conversion, not from charging each subscriber more for a given visit. The 15% churn projection rests on the subscription contract itself: an annual arrangement resets the customer relationship from per-episode shopping into a year-long commitment, and the preventive-monitoring layer surfaces value continuously rather than at the moment of acute need.

Nine months from kickoff to a live business unit. The group operates the new business day-to-day. Governance stood up in parallel: actuarial review on a fixed cadence inside the group, pricing controls with the new commercial team, clinical protocols with medical leadership. The handover was the close.