Financial Model
A profit-and-loss view: revenue, then every cost, then the profit and margin that remains. A single clinic plus a treatment van runs at a healthy profit at steady state, and that profit grows as we add sites.
The centerpiece is the steady-state profit-and-loss in section 3. Revenue is Medicaid and Medicare billing; costs cover every staff member, all software, the facility, the van, supplies, medication, and insurance. Grants don't replace this profit — they fund the build and reimburse several cost lines, making the profit larger and the early ramp safer. Tables are the source of truth; charts illustrate them. Reimbursement rates are verified against the CMS and Illinois Medicaid (HFS SUPR) fee schedules, dated 2026-06-25.
1 · What one patient is worth
Every patient enters through medication for opioid use disorder ("the medication," or MOUD) — the front door. Most then opt in to behavioral health — therapy, psychiatric care, collaborative care, case management, and peer support — which roughly doubles annual value and keeps them in care longer.
| Per patient | Medication only | Medication + behavioral health |
|---|---|---|
| Annual revenue / patient | ~$2,590 | ~$6,640 |
| Annual multiplier | 1.0× | ~2.6× |
| Median time in care | ~1.3 yrs | ~2.5 yrs |
| Lifetime value / patient | ~$3,370 | ~$16,600 |
Figures are blended across billable patients (~71% Illinois Medicaid, 29% Medicare) over roughly nine billable months a year, verified against the CMS and Illinois Medicaid fee schedules.
Per-patient value — medication only vs. medication + behavioral health
Behavioral health lifts annual revenue per patient from ~$2,590 to ~$6,640 (~2.6×) and lifetime value from ~$3,370 to ~$16,600 (~4.9×). Getting patients to opt in at intake is the single highest-leverage move the business makes.
2 · The representative operating unit
We model one established clinic plus one buprenorphine outreach van. The clinic treats patients in office and by telehealth; the van extends reach into the community and feeds new patients in.
| Assumption | Value | Why |
|---|---|---|
| Active patients at steady state | ~340 | An established office-based clinic commonly carries 300–500 buprenorphine patients; the van adds reach. |
| Behavioral-health opt-in rate | ~70% | Warm hand-off from the medication visit to therapy and collaborative care at intake. |
| Blended revenue / patient / yr | ~$5,425 | 70% at $6,640 (medication + behavioral health) + 30% at $2,590 (medication only). |
| Payer blend (billable patients) | ~71% Medicaid · ~29% Medicare | About 25% of patients are uninsured and billed $0; grants cover their care. |
| Breakeven census | ~248 patients | Below this the unit runs at a loss; grants bridge the early ramp. |
The medication bills mainly through the Medicare monthly office-based bundle (G2086 first month, ~$491; G2087 each later month, ~$443) and, in Illinois Medicaid, through office visits plus substance-use counseling. Behavioral health adds psychiatric evaluation and medication management, individual and group therapy, collaborative care (G0568, ~$162/month), case management, and peer support. Behavioral-health telehealth is paid at the in-person rate, with parity permanent in both Medicare and Illinois Medicaid. Full code-level detail is in the appendix and verified-rates note.
3 · Profit-and-loss at steady state centerpiece
Revenue, then every cost, then profit and margin — for one clinic plus one van at a steady ~340 patients. The right-hand column notes which grant, if any, can cover each line; grant-covered lines are upside on top of this profit, not a substitute for it.
| Line item | Monthly | Annual | Grant that can cover it |
|---|---|---|---|
| Revenue (Medicaid + Medicare billing, ~340 patients) | $153,700 | $1,844,500 | Billing (revenue-funded) |
| Clinical staff | |||
| Physician / prescriber (0.5 FTE addiction MD) | $11,667 | $140,000 | Revenue-funded |
| Nurse practitioner prescriber (1.0 FTE) | $10,583 | $127,000 | Revenue-funded |
| Registered nurse (1.0 FTE) | $7,333 | $88,000 | Revenue-funded |
| Counselor / licensed clinical social worker (1.0 FTE) | $7,083 | $85,000 | Revenue-funded |
| Counselor, associate (1.0 FTE) | $4,583 | $55,000 | SOR / county |
| Peer recovery specialist (1.0 FTE) | $3,333 | $40,000 | SOR / county |
| Admin staff | |||
| Chief Technology Officer (1.0 FTE) | $16,667 | $200,000 | Revenue-funded |
| Office coordinator (1.0 FTE) | $4,583 | $55,000 | Revenue-funded |
| Billing / revenue-cycle specialist (1.0 FTE) | $5,000 | $60,000 | Revenue-funded |
| Payroll taxes & benefits (~22% of salaries) | $15,583 | $187,000 | Revenue-funded |
| Software & technology | |||
| Electronic health record (EHR) | $2,000 | $24,000 | Revenue-funded |
| Billing / clearinghouse | $1,000 | $12,000 | Revenue-funded |
| Telehealth platform | $750 | $9,000 | Revenue-funded |
| Data & analytics tools | $1,250 | $15,000 | RCORP / stackable |
| Facilities & vehicle | |||
| Facilities / clinic rent & utilities | $5,000 | $60,000 | Revenue-funded |
| Vehicle fuel | $1,000 | $12,000 | RCORP / SOR |
| Vehicle insurance | $750 | $9,000 | RCORP / SOR |
| Vehicle maintenance & registration | $750 | $9,000 | RCORP / SOR |
| Supplies, medication & insurance | |||
| Medical supplies | $1,500 | $18,000 | Revenue-funded |
| Medication (net of reimbursement) | $3,750 | $45,000 | MMHU / SOR |
| Malpractice / liability insurance | $3,333 | $40,000 | Revenue-funded |
| Other operating costs | |||
| Marketing, outreach & referral development | $1,500 | $18,000 | RCORP / SOR |
| Professional fees (legal, accounting, credentialing) | $2,000 | $24,000 | Revenue-funded |
| Office, telecom & miscellaneous | $1,250 | $15,000 | Revenue-funded |
| Total operating cost | $112,250 | $1,347,000 | — |
| PROFIT (revenue − all costs) | $41,450 | $497,500 | — |
| Profit margin | ~27% | ~27% | — |
One clinic plus one van earns about $497,500 in profit a year — a 27% margin — on billing alone, after every staff member (including the CTO), all software, the facility, the van, supplies, medication, and insurance. All-in operating cost is about $112,250 a month.
Revenue vs. cost vs. profit (annual)
Where the money goes (annual cost breakdown)
4 · How grants improve the profit
Grants fund the one-time build — the van and clinic fit-out — so the business doesn't borrow to start, and they reimburse several recurring cost lines instead of billing. Every cost a grant covers drops straight to the bottom line.
| Grant (plain name) | What it can cover | Speed / status |
|---|---|---|
| County settlement direct-share | Van purchase, uninsured-patient care, peer and case-management staff, van operating costs | Fastest — 60–120 days |
| Federal rural opioid program (RCORP) | Van operating costs, outreach, data & analytics tools | Open; applications due July 8, 2026; up to $750K/yr × 4 yrs; for-profits eligible |
| State federal opioid-response grant (SOR) | Peer and case-management staff, medication, uninsured-patient care, outreach | ~$36M/yr to Illinois; accessed as a state (IDHS/SUPR) subrecipient |
| State mobile-unit grant (MMHU) | Van purchase, all three FDA-approved OUD medications, staff | Up to $700K/unit — currently closed |
| Stackable HRSA & foundation grants | Data tools, outreach, capacity-building | Added funding/upside on top of the above |
| Profit view | Annual profit | Margin |
|---|---|---|
| Profit on billing alone | ~$497,500 | ~27% |
| Grant-covered cost lines (peer/case mgmt, van opex, medication, outreach, data, uninsured care) | +~$173,000 | — |
| Net profit with grant offsets | ~$670,500 | ~36% |
Grants lift steady-state margin from ~27% to ~36%. During the early ramp — before the ~248-patient breakeven — grant draw-down covers the gap, so the unit funds its own build and early losses rather than relying on outside capital. See Fundraising & Capital.
5 · From launch to steady state
A clinic doesn't open at full census. Patients are added month by month from referral pipelines — emergency departments, jails, courts, shelters — with the van accelerating intake. Until the unit passes breakeven at ~248 patients, grant draw-down bridges the gap.
| Stage | Active patients | Annual revenue | Annual cost | Profit | Margin |
|---|---|---|---|---|---|
| Early ramp | ~180 | ~$976,500 | ~$1,347,000 | ~−$370,500 | loss (grant-bridged) |
| Breakeven | ~248 | ~$1,345,000 | ~$1,347,000 | ~$0 | 0% |
| Steady state | ~340 | ~$1,844,500 | ~$1,347,000 | ~$497,500 | ~27% |
Revenue, cost, and profit as the unit ramps
The base mix is ~50% Medicaid, 20% Medicare, 5% commercial, 25% uninsured. Among billable patients that blends to ~71% Medicaid / 29% Medicare; the uninsured are billed $0 and grant-funded. A Medicare-heavier mix lifts revenue; a more uninsured mix leans harder on grants — so screening every patient for eligibility at intake is a core operating discipline.
Payer mix
6 · How the model scales
Profit grows faster than cost as sites are added, because the CTO and data/analytics team are a fixed network cost (~$244,000/yr including benefits). The first clinic carries it in full — hence its ~27% margin — while each additional clinic shares the same team, lifting margin toward ~38%.
| Network size | Revenue | Cost | Profit | Margin |
|---|---|---|---|---|
| 1 clinic + van (1 county) | ~$1.84M | ~$1.35M | ~$0.50M | ~27% |
| 3 clinics + vans (multi-site) | ~$5.53M | ~$3.55M | ~$1.98M | ~36% |
| 6 clinics + vans (multi-county) | ~$11.07M | ~$6.86M | ~$4.21M | ~38% |
Profit and margin grow as the network scales
Medicaid and Medicare billing is recurring revenue that scales per patient, per county. Adding sites raises profit and margin together via the shared technology and data team, while grants fund each new build and cushion each new ramp — a durable, profitable network, not a one-time number. See the full Year 1 · 2 · 5+ roadmap.