The Economic Win
Today, administrative overhead consumes a very large share of U.S. health spending—double‑digit percentages when all layers are counted. The HCC’s approach is to treat finance as settlement infrastructure, not a profit center.
Target admin take: 0.05–0.15% per cleared transaction for the infrastructure rail—roughly a 10× reduction vs. the multi‑layer status quo.
Capped Gain as Design
- Margin caps by class of service: dispensing, facility, and administrative margins are fixed and auditable.
- Corridor pricing: allowed prices float within transparent corridors (e.g., ±15% of reference), rewarding efficiency without enabling predation.
- Automatic rebates to people: captured surplus funds lower future contributions, erase debt, or finance community benefits (“dividends of wellness”).
The Human Win
Money is necessary but not sufficient; healing requires meaning. The HCC bakes in small, dignifying feedback loops that re‑humanize finance.
1) Thank‑You Economics
When a member chooses a cost‑saving alternative—biosimilar, home delivery, imaging center—the system sends a gratitude message (not points):
Because of your choice, our plan saved $312 this month—enough to fund a month of insulin for another member. Thank you for helping our community heal.
2) Voluntary Care Boards
Opt‑in spaces (no pressure, no shame) where members can share milestones or reflections; plans surface aggregated, anonymized “wins” as reminders that efficiency funds empathy.
3) Healing Infrastructure
UX copy and policy framing shift from “fight disease” to “live supported.” Utilization isn’t blamed—it fuels learning. Members never feel that seeking care “costs others”; the system shows how collective solvency protected them.
From Waste to Wellness (Flow)
[Wasteful Spend: Fragmented fees, spread pricing, rebate opacity]
│
▼
[HCC Clearing: Universal ledger + corridor pricing + capped gain]
│
▼
[Captured Surplus: Verified savings after fair margins]
│
├─► Member Dividends (lower premiums, debt relief)
├─► Community Benefits (grants, patient support, education)
└─► Better Rails (ethics research, FWA automation)
Two Lived Examples
Insulin Checkout (Retail)
- Node clears at net cost; coinsurance computed from net, not list.
- Member picks biosimilar → $312 plan‑level savings credited to dividends pool; member receives a gratitude note.
Outpatient MRI (Imaging Center vs. Hospital)
- Corridor publishes allowed range; center price sits inside the band, hospital outlier routes to arbitration.
- Adjudication is public; corridor updates next quarter incorporate the decision.
Practitioner Appendix: Technical Chops
A) What does 0.05–0.15% include?
- Identity & validity: verify parties, Node, and cost‑stack fields.
- Corridor computation: reference‑cost lookup + float validation.
- Settlement posting: member share (based on net), plan share, provider remittance; signed trace to public audit log.
- FWA sweeps: real‑time anomaly flags; outliers to arbitration queue.
B) Context: how that compares to common networks
| Network | Typical Fee | Notes |
|---|---|---|
| Credit card (interchange + assessment) | ~2–3% of volume | Varies by card type & merchant category; funds risk, rewards, and network ops. |
| ACH (bank‑to‑bank) | ~$0.10–$0.30 or low basis points | Batch settlement; limited metadata. |
| Legacy health admin stack | Multi‑layer, double‑digit % | Numerous actors monetize complexity (rebates, spread, consulting). |
| HCC clearing rail | 0.05–0.15% | Single rail verifies truth + corridor + settlement; margin caps outside the rail. |
Purpose of the comparison: to show order‑of‑magnitude economics—the HCC rail is engineered as a utility, not a revenue center.
C) Reinvestment Policy (Sketch)
- Surplus bucketization: X% to member dividends, Y% to community benefits, Z% to rails (ethics, FWA, R&D). Ratios are public and governable.
- Dividend mechanics: credits applied to next‑period contributions; hardship grants for arrears; automatic refunds when post‑adjudication lowers net cost.
- SLA & audit: reinvestment executed monthly; public ledger shows inflow/outflow by bucket.
Next — Spoke 5: Governance, Ethics & Why Innovation Thrives
Want to see the system’s mechanics? Revisit Spoke 3: The Blueprint, or return to the HCC Hub.