Do you want to start a medical case management business? If YES, here is a complete guide to starting a medical case management business with NO money and no experience. The medical industry is a broad one with great prospects in it. If you are lucky to have a combined experience in human resources and healthcare, then you are at a business advantage to start a medical case management firm.
Your services would always be in demand not only by small healthcare organizations, but also by big healthcare corporations, related businesses and even families. Medical case management firms are engaged in a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive general health needs via communication and every available resource to promote quality, and cost-effective outcome.
It is important to establish that medical case management is not concluded when a patient leaves the hospital or health facility. The process continues when insurance companies plan for ongoing medical needs, including further check-ups and when the bills are fully paid.
Just like most businesses, the medical case management services is open to as many people that are interested in the industry as long as they have the required experience and qualifications. Starting a medical case management firm is not too expensive except for the money required to rent and furnish an office space and purchase the applicable software apps.
Running this type of business requires that you should be trained as a consultant and it is indeed a very lucrative business in the united states, Canada, Australia and The United Kingdom because of the desire for continuous engagement between clients and key stake holders in the healthcare industry.
If you have decided to start a medical case management firm, then you must make sure that you carry out thorough feasibility studies and market survey. This will enable you correctly locate the business in a community or city with the right demography; a location that can readily accept your services.
So, if you have done the required feasibility studies and market research, then you might want to venture into this business.
18 Steps to Starting a Medical Case Management Firm
Table of Content
- 2. Conduct Market Research and Feasibility Studies
- 3. Decide Which Niche to Concentrate On
- 4. Know Your Major Competitors in the Industry
- 5. Decide Whether to Buy a Franchise or Start from Scratch
- 9. Discuss with an Agent to Know the Best Insurance Policies for You
- 10. Protect your Intellectual Property With Trademark, Copyrights, Patents
- 11. Get the Necessary Professional Certification
- 12. Get the Necessary Legal Documents You Need to Operate
- 13. Raise the Needed Startup Capital
- 14. Choose a Suitable Location for your Business
- 15. Hire Employees for your Technical and Manpower Needs
- 16. Write a Marketing Plan Packed with ideas & Strategies
- 17. Work Out a Reasonable Pricing for your Services & Products
- 18. Develop Strategies to Boost Brand Awareness and Create a Corporate Identity
1. Understand the Industry
Players in the medical case management services industry engage in the planning and coordination of healthcare services appropriate for medical rehabilitation. These services include care assessment and recommending treatment plans to ensure that appropriate medical care is made available to disabled, ill or injured individuals.
In recent time, the medical case management services industry has achieved steady growth as a result of expanded usage for primary medical care and workers’ compensation claims. So also, the industry has profited from improving corporate profit and US employment, which has increased the number of workers’ compensation claims.
The part case management services play in the healthcare sector has also shifted and expanded, hence you can find them engage in managing more injuries in offices and retail settings and fewer in traditional manufacturing settings, focusing on medical cost containment, employing nurse case managers and entering patient-centered medical homes and accountable care organizations et al.
The Medical Case Management Services Industry is indeed a large industry and pretty much active in countries such as United States of America, United Kingdom, France, Germany, Italy, Holland, Switzerland, Australia and Canada et al.
Statistics has it that in the United States of America alone, there are about 8,267 registered and licensed medical case management services firms scattered all across the United States responsible for employing about 38,940 and the industry rakes in a whooping sum of $7 billion annually. The industry is projected to grow at 2.7 percent annual growth between 2011 and 2016. It is important to state that GENEX Services has the largest available market share in the industry.
A recent report shows that in the five years to 2016, revenue for the Medical Case Management Services industry has grown steadily, rising at an average annual rate of 2.7 percent to $6.6 billion. The report also noted that operators in the industry plan and coordinate medical services with healthcare providers and patients to ensure appropriate and cost-effective treatment plans.
Industry operators are typically employed by insurance companies, employers, third-party administrators and hospitals; they are commonly used in cases of workplace injury to ensure that employees have access to timely and cost-effective care.
The fact that medical case management firms can easily be found in cities in the United States of America, does not in any way make the industry to be over saturated. The fact that there are people and organizations out there who would always need professional medical case management services cum healthcare consulting services from time to time to sort out healthcare related issue et al makes the business ever green.
Over and above, starting a medical case management firm requires professionalism and a good grasp of the healthcare industry. Besides, you would need to get the required certifications and license and also meet the standard for such business before you can be allowed to start a medical case management firm in the United States.
One good thing about the medical case management services industry is that there is a readily available market for their services because individuals and even organizations naturally would want to improve and effectively manage their healthcare concerns. So, if you are well positioned and you know how to deliver results as a medical case management consultant, you will always smile to the bank.
2. Conduct Market Research and Feasibility Studies
- Demographics and Psychographics
The demographic and psychographic composition of those who require the services of medical case management services firms cut across individuals, households, corporate organizations and businesses involved in healthcare fields such as hospitals, physicians, pharmaceutical companies, healthcare related organizations, health management organizations and healthcare insurance providers et al who need a third – party to help them handle medical case management services.
3. Decide Which Niche to Concentrate On
Most medical case management firms tend to operate general services that a standard medical case management firm is expected to offer. That is why it seems like there are no niche areas in the industry. But on the other hand, some medical case management firms may decide to major in key areas such as;
- Catastrophic case management
- Utilization management
- Vocational rehabilitation
The Level of Competition in the Industry
The competition that exists in the medical case management services line of business goes beyond competition amongst medical case management firms in your location; you are expected to compete with other healthcare consulting firms that have the capacity to offer medical case management to clients. Thus, it will be right to say the competition in the medical case management line of business is tough.
But no matter the level of competition in an industry, if you have done your due diligence and you brand and promote your services or business appropriately, you will always make headway in the industry. Just ensure you can effectively manage medical related cases for your clients, you can deliver excellent customer care services, get testimonials from your clients and you know how to attract and reach out to your target market.
There are several medical case management firms and healthcare services consulting firms that have the capacity to offer medical case management services to clients scattered all around the United States. So, if you choose to start your own medical case management services business in the United States, you will definitely meet stiff competition amongst these businesses. Besides, there are larger medical case management firms that determine the trends in the industry and you should be ready to compete with them for customers.
4. Know Your Major Competitors in the Industry
You will quite agree that in every industry, there are always brands that perform better or are better regarded by customers and the general public than others. Some of these brands are those that have been in the industry for a long time, while others are best known for how they conduct their businesses and the results they have achieved over the years.
These are some of the leading medical case management services firms in the United States of America and also in the globe;
- GENEX Services
- The Center for Case Management, Inc.
- Case & Associates Properties, Inc
- Professional Case Management Services of America, Inc
- ECG Management Consultants
- Health Care Network Associates
- Healthcare Management & Consulting Services
- Healthplex Associates
When it comes to starting a medical case management services firm, you just have to get your feasibility studies and market research right before venturing into the business. It is good to mention that the medical case management services business is not for rookies; it is for professionals who have successfully gathered the required experience to proffer medical case management services to people and organizations.
Starting this kind of business definitely entails that you acquire the required degree and profession certifications and also build good working relationship with stakeholders in the healthcare industry. If you are already a major player in the healthcare consulting services industry before venturing out to start your own medical case management services firm, this might not be an issue.
Depending on the scale at which you want to start from, you might require as much as multiple thousands of dollars to strike this off and at the same time you might need far less than that if you choose to start the business from your house, or a virtual office or shared office space.
5. Decide Whether to Buy a Franchise or Start from Scratch
When it comes to starting a business of this nature, it will pay you to buy the franchise of a successful medical case management services firm as against starting from the scratch. Even though it is relatively expensive and difficult buying the franchise of an established medical case management services firm, but it will definitely pay you in the long run.
But if you truly want to build your own brand after you must have proved your worth in the medical case management services industry, then you might just want to start your own medical case management services firm from the scratch.
The truth is that it will pay you in the long run to start your medical case management services firm from the scratch. Starting from the scratch will afford you the opportunity to conduct thorough market survey and feasibility studies before choosing a location to launch the business.
Please note that most of the big and successful medical case management services firms round started from the scratch and they were able to build a solid business brand. It takes dedication, hard work and determination to achieve business success.
6. Know the Possible Threats and Challenges You Will Face
If you decide to start your own medical case management services firm today, one of the major challenges you are likely going to face is the presence of well – established medical case management services firms and also other related healthcare consulting firms and advisory businesses who are offering same services that you intend offering. The only way to avoid this challenge is to create your own market.
Some other threats that you are likely going to face as a medical case management services firm operating in the United States are unfavorable government policies, the arrival of a competitor within your location of operation and global economic downturn which may affect businesses such as medical case management services firm and other healthcare consulting firms. There is hardly anything you can do as regards these threats other than to be optimistic that things will continue to work for your good.
7. Choose the Most Suitable Legal Entity (LLC, C Corp, S Corp)
Generally, you have the option of either choosing a general partnership, or limited liability company for a medical case management services firm. Ordinarily, general partnership should have been the ideal business structure for a small – scale medical case management services firm especially if you are just starting out with a moderate start – up capital.
But if your intention is to grow the business and have clients both corporate and individual from all across the United States of America and other countries of the world, then choosing general partnership is not an option for you. Limited Liability Company, LLC will cut it for you.
For example, Setting up an LLC protects you from personal liability. If anything goes wrong in the business, it is only the money that you invested into the limited liability company that will be at risk. It is not so for general partnerships. Limited liability companies are simpler and more flexible to operate and you don’t need a board of directors, shareholders meetings and other managerial formalities.
These are some of the factors you should consider before choosing a legal entity for your medical case management services firm; limitation of personal liability, ease of transferability, admission of new owners, investors’ expectation and of course taxes.
If you take your time to critically study the various legal entities to use for your medical case management services firm, you will agree that limited liability company; an LLC is most suitable. You can start this type of business as limited liability company (LLC) and in future convert it to a ‘C’ corporation or an ‘S’ corporation especially when you have the plans of going public.
8. Choose a Catchy Business Name
Generally, when it comes to choosing a name for a business, it is expected that you should be creative because whatever name you choose for your business will go a long way to create a perception of what the business represents. Usually it is the norm for people to follow the trend in the industry they intend operating from when naming their business.
If you are considering starting your own medical case management services firm, here are some catchy names that you can choose from;
- Job Culberson & Co® Medical Case Management Firm, LLC
- Spiff Henderson® Medical Case Management Services, LLC
- Jason Pharaoh® Medical Case Management Firm, LLP
- Clarkson McFarlane® Medical Case Management Services, LLP
- Innocent Famous© Medical Case Management Services Company, Inc.
- Hanks Smiths & Associates® Medical Case Management Services, LLP
- Silver House® Medical Case Management Services Group
- West Coast® Medical Case Management Services, LLC
- Golden Fritz & Co Medical Case Management Services, LLP
- Cletus Buckingham® Medical Case Management Services, Inc.
- Sharon Dell® Medical Case Management Services, Inc.
- Emmanuel Rosa – Park® Medical Case Management Services, LLP
9. Discuss with an Agent to Know the Best Insurance Policies for You
In the United States of America and in most countries of the world, you can’t operate a business without having some of the basic insurance policy covers that are required by the industry you want to operate from. So, it is imperative to create a budget for insurance policy cover and perhaps consult an insurance broker to guide you in choosing the best and most appropriate insurance policies for your medical case management services firm.
Here are some of the basic insurance policy covers that you should consider purchasing if you want to start your own medical case management services firm in the United States of America;
- General insurance
- Risk Insurance
- Financial reinsurance
- Health insurance
- Liability insurance
- Workers Compensation
- Overhead expense disability insurance
- Business owner’s policy group insurance
- Payment protection insurance
10. Protect your Intellectual Property With Trademark, Copyrights, Patents
If you are considering starting your own medical case management services firm, usually you are required to file for intellectual property protection/trademark. This is so because the nature of the business makes it possible for you to challenge organizations and individuals in court for illegally making use of your company’s intellectual properties.
So also, if you want to protect your company’s logo and other documents or software that are unique to you or even jingles and media production concepts, then you can go ahead to file for intellectual property protection. If you want to register your trademark, you are expected to begin the process by filing an application with the USPTO. The final approval of your trademark is subjected to the review of attorneys as required by USPTO.
11. Get the Necessary Professional Certification
Aside from the results you produce as it relates to timely medical case management services for your clients, professional certification is one of the main reasons why some medical case management services firms stand out. If you want to make an impact in the medical case management services firm services industry, you should work towards acquiring all the needed certifications in your area of specialization.
Certification validates your competency and shows that you are highly skilled, committed to your career, and up-to-date in the competitive market. These are some of the certifications you can work towards achieving if you want to run your own medical case management services firm;
- Certified Healthcare Business Consultant (CHBC)
- ACHC Certified Consultants
- Degree in Management and Healthcare Related Courses
Please note that you cannot successfully run a medical case management services firm in the United States and in most countries of the world without necessarily acquiring professional certifications and business license even if you have adequate experience cum background in the medical case management services industry.
12. Get the Necessary Legal Documents You Need to Operate
The essence of having the necessary documentation in place before launching a business in the United States of America cannot be overemphasized. It is a fact that you cannot successfully run any business in the United States without the proper documentations. If you do, it won’t be too long before the long hand of the law catches up with you.
These are some of the basic legal documents you are expected to have in place if you want to legally run your own medical case management services firm in the United States of America;
- Certificate of Incorporation
- Federal Tax Payer’s ID
- State Permit
- Business License and Certification
- Business Plan
- Non – disclosure Agreement
- Employment Agreement (offer letters)
- Operating Agreement for LLCs
- Insurance Policy
- Consulting contract documents
- Apostille (for those who intend operating beyond the United States of America)
- Company Bylaws
- Insurance Policy
- Memorandum of Understanding (MoU)
13. Raise the Needed Startup Capital
Apart from the required certifications and hands-on experience, starting a medical case management services firm can be cost effective. Securing a standard office in a good business district, equipping the office and paying your employees are part of what will consume a large chunk of your start – up capital.
No doubt when it comes to financing a business, one of the first things you should consider is to write a good business plan. If you have a good and workable business plan document in place, you may not have to labor yourself before convincing your bank, investors and your friends to invest in your business or to partner with you.
Here are some of the options you can explore when sourcing for start – up capital for your medical case management services firm;
- Raising money from personal savings and sale of personal stocks and properties
- Raising money from investors and business partners
- Sell of shares to interested investors
- Applying for Loan from your Bank
- Pitching your business idea and applying for business grants and seed funding from donor organizations and angel investors
- Source for soft loans from your family members and your friends
14. Choose a Suitable Location for your Business
Medical case management services firm and most consulting services based type of businesses require that you see physically with your clients hence it must be located in good location; a location that is prone to both human and vehicular traffic and a location that is at the epicenter of a healthcare – related business district if indeed you want to attend to loads of clients and maximize profits from the business.
The fact that you can operate your medical case management services firm from any part of the world does not mean that location has little influence on the success of a medical case management services firm. If you have taken your time to study medical case management services industry, you will realize that medical case management services firms and related businesses are willing to pay expensive rents in order to stay in a busy business district; a place where business activities and healthcare activities are at its peak.
Most importantly, before choosing a location for your medical case management services firm, ensure that you first conduct a thorough feasibility studies and market survey. The possibility of you coming across similar business that just closed shop in the location you want to open yours can’t be ruled out. This is why it is very important to gather as much facts and figures before choosing a location to set – up your own medical case management services firm.
These are some of the key factors that you should consider before choosing a location for your medical case management services firm;
- The demography of the location
- The demand for the services of medical case management services in the location
- Accessibility of the location
- The number of medical case management services firms and related healthcare consulting services businesses that in the location
- The local laws and regulations in the community/state
- Traffic, parking and security
15. Hire Employees for your Technical and Manpower Needs
On the average, there are no special technologies or equipment needed to run this type of business except for customized medical case management software and other related software apps and social media management software applications. So also, you will definitely need computers, internet facility, telephone, fax machine and office furniture (chairs, tables, and shelves).
When it comes to choosing between renting and leasing an office space, the size of the medical case management services firm you want to build, and your entire budget for the business should influence your choice. If you have enough capital to run a standard medical case management services firm, then you should consider the option of leasing a facility for your office; when you lease, you will be able to work with long – term planning, structuring and expansion.
As regards the number of employees that you are expected to kick start the business with, you would need to consider your finance before making the decision. Averagely, you would need a Chief Executive Officer, Medical Case Management Officer, Admin and HR Manager, Business Developer, Accountant, Customer Service Executive/Front Desk Officer.
Over and above, you would need a minimum of 5 to 10 key staff to effectively run a medium scale but standard medical case management services firm. Please note that there will be times when you are expected to go out of your way to hire experts to help you handle some high – profile clients especially from big corporations.
The Service Delivery Process of the Business
On the average, the way medical case management services firms work varies from one agency to another, but ideally, a medical case management services firm is expected to first and foremost build a robust company profile before sourcing for clients.
Basically, when clients hire your services, they expect you to effectively handle everything as it relates to managing their medical cases and related concerns. Depending on the agreement reached by both parties, you are expected to come up with measurable indices that will show that the professional services you are offering is indeed producing results.
It is important to state that a medical case management services firm may decide to improvise or adopt any business process and structure that will guarantee them good return on investment (ROI) efficiency and flexibility; the above stated medical case management services process is not cast on stone.
16. Write a Marketing Plan Packed with ideas & Strategies
As a medical case management services firm owner, you would have to prove your worth over and over again before attracting corporate organizations and individuals to hire your services. So, if you have plans to start your own medical case management services firm, it will pay you to first build a successful career in the management and healthcare services industry.
People and organizations will only hire your services if they know that they are going to get good returns on their investment or solve their business – related challenges.
So, when you are drafting your marketing plans and strategies for your medical case management services firm, make sure that you create a compelling personal and company profile. Aside from your qualifications and experience, it is important to clearly state in practical terms what you have been able to achieve in time past as it relates to the medical case management services industry and the organizations you have worked for. This will help boost your chances in the market place when sourcing for clients/investors.
Please note that in most cases, when sourcing for clients from corporate organizations and other institutions, you will be called upon to defend your proposal, so you must be pretty good with presentations. Here are some of the platforms you can utilize to market your medical case management services firm;
- Introduce your business by sending introductory letters alongside your brochure to residents, corporate organizations and all businesses involved in healthcare fields such as hospitals, physicians, healthcare related organizations, and healthcare insurance providers et al within and outside the city you are operating in who have the capacity to pay for your services
- Advertise your business in relevant healthcare magazines, radio and TV stations (make yourself available for medical case management services related talk shows and interactive sessions on TV and Radio)
- List your business on local directories/yellow pages
- Attend international healthcare expos, seminars, and business fairs et al
- Create different packages for different category of clients in order to consult for them
- Leverage on the internet to promote your business
- Join local chambers of commerce and industries around you with the main aim of networking and marketing your services; you are likely going to get referrals from such networks
- Engage the services of marketing executives and business developers to carry out direct marketing
17. Work Out a Reasonable Pricing for your Services & Products
One key factor that will help you offer your medical case management services at a price that is highly attractive is to ensure that you source your working capital from sources that won’t put pressure on you or give you high interest rate.
Another strategy that will help you offer your medical case management services at the right price is to ensure that you cut operational cost to the barest minimum, and channel your efforts towards marketing and promoting your brand name. Aside from the fact that this strategy will help you save cost, it will also help you get the right pricing for your products and services.
You can also try as much as possible to work with independent contractors and marketers; it will help you save cost for paying sales and marketing executives.
18. Develop Strategies to Boost Brand Awareness and Create a Corporate Identity
If your intention of starting a medical case management services firm is to grow the business beyond the city where you are going to be operating from to become a national and international brand, then you must be ready to spend money on the promotion and advertisement of your brand.
In promoting your brand and corporate identity, you should leverage on both print and electronic media and also social media (the internet). As a matter of fact, it is cost effective to use the internet and social media platforms to promote your brand, besides it is pretty much effective and wide reaching.
Another strategy is to sponsor relevant community based programs, TV and radio programs, advertise your business in relevant magazines and newspapers. Below are the platforms you can leverage on to boost your brand and promote and advertise your medical case management services firm;
- Place adverts on healthcare related magazines and newspapers, radio and TV stations
- Encourage the use of word of mouth publicity from your loyal customers
- Leverage on the internet and social media platforms like YouTube, Instagram, Facebook, Twitter, LinkedIn, Snapchat, Google+ and other platforms to promote your business
- Ensure that you position your banners and billboards in strategic positions all around your city
- Distribute your fliers and handbills in target areas in and around our neighborhood
- Contact residents, corporate organizations and all businesses involved in healthcare fields, such as hospitals, physicians, healthcare related organizations, and healthcare insurance providers et al within and outside the city you are operating in who have the capacity to pay for your services by calling them up and informing them of your organization and the services you offer
- Advertise your business in your official website and employ strategies that will help you pull traffic to the site
- Brand all your official cars and ensure that all your staff members and management staff wear your branded shirt or cap at regular intervals.