The Health Delta Bonus
Doctors get paid when patients get healthier — not when they come back sicker.
Your doctor earns a bonus when you get healthier — not when you come back sicker.
Today, doctors get paid per visit, so the system quietly profits from sickness. Under this plan, family doctors are paid a flat amount for each patient plus a bonus tied to real improvement — like helping a patient bring their diabetes under control. Suddenly the sickest patients go from being avoided to being the ones doctors most want to help.
Fee-for-service rewards volume, not health
The legacy model pays per visit and per procedure, incentivizing short, frequent visits and over-prescription. Worse, it produces 'Lemon Dropping': complex, chronically ill patients are financially toxic, so practices quietly avoid them.
Capitation + Delta: efficacy is the profit center
Tier 1 pays a Risk-Adjusted Capitation fee per assigned patient, plus a Delta Bonus: Bonus = (Metric t₁ − Metric t₀) × Complexity Factor. The algorithm compares biometrics at the start and end of each year.
Want to dig deeper?
The key numbers, at a glance
Tier 1 physicians earn Risk-Adjusted Capitation plus a Delta Bonus computed from year-over-year biometric improvement. Sick patients become the most financially desirable assets in the system.
Base Payment
Capitation
Risk-adjusted, per assigned patient
Bonus Formula
Δ × Complexity
(Metric t₁ − t₀) × Complexity Factor
Budget
$1,000/capita
Based on Direct Primary Care market rates
Incentive Flip
Sick = valuable
Reverses Lemon Dropping
What exactly is broken today?
- Revenue scales with visits, not outcomes.
- Chronic disease management is a cost center, so it's neglected.
- The sickest patients struggle hardest to find a doctor.
How the fix works, point by point
- Healthy 25-year-old: standard capitation, negligible bonus (delta ≈ 0).
- Uncontrolled diabetic managed from A1C 9.0 → 7.0: a massive Delta payout.
- Lemon Dropping reverses — doctors compete to take on complex cases.
Why capitation alone isn't enough
Pure capitation invites under-treatment — collect the fee, minimize the visits. The Delta Bonus closes that hole: neglect shows up as deteriorating biometrics, which directly destroys the practice's bonus pool. Improvement is the only profitable strategy.
What Would Your Raise Be?
See the Compensation Preservation Protocol (CPP) work for your own paycheck
The US average employer contribution is ≈ $15,000/year for family coverage — money you earn but never see in your paycheck.
Today
$50,000
+ $15,000 hidden premium
Your New Cash Wage
$65,000
an immediate $15,000 raise
Year 0 — Total Comp Freeze: the OTV certifies your Total Compensation Load at $65,000.
Year 1 — Mandatory Conversion: private premiums are abolished; the Fair Labor Standards Act makes the certified baseline your new minimum cash salary. Your employer’s costs don’t change a penny: $0 net.
The Wage Clawback Clause: an employer who pockets your $15,000 instead faces the Unjust Enrichment Tax — 100% of retained savings plus a 20% punitive surcharge, a $33,000 penalty. It is mathematically more expensive to steal the savings than to pay you.
More from the Healthcare Trust
- The Bifurcation Model
A private family doctor with no paperwork — and honest, posted price tags on everything else.
- Cryptographic Defenses
One plastic card replaces the paperwork — and makes the most common kinds of fraud impossible.
- The Solvency Voucher Program
No separate 'poor people's clinics' — those who need help get money to buy the same insurance as everyone else.