UK to US healthcare expansion readiness scorecard

How to use this scorecard

Score each dimension Red, Amber or Green.

• Green

  Evidenced, owned, and specific enough to spend against.

• Amber

  Directionally right, but still assumption-heavy or unowned.

• Red

  Missing, contradicted by how US healthcare actually works, or resting on hope.

A plan with two or more Reds is not ready for a full capital commitment. Fix or sequence around them first. This is commercial and operational judgement, not legal, tax or regulatory advice — confirm those with qualified US advisers.

Having led operations across a national US behavioural health network of 236 clinics and telehealth services serving patients in all 50 states, these are the dimensions I pressure-test first.

The eight dimensions

1. 01

   Route to revenue

   Have you named one primary route for phase one — payer, employer or benefits, or cash-pay — with the operational burden of that route made explicit?

   Green:

   Single route chosen; claims, coding and denials or acquisition cost modelled; alternatives parked for later.

   Amber:

   You prefer a route but are keeping two or three “open”.

   Red:

   “We'll see what works”, or national multi-channel from day one.

2. 02

   Buyer and budget-holder

   Can you name who experiences the problem, who holds the budget, who signs and who can veto — and are those the same person?

   Green:

   Buying unit mapped; procurement cycle estimated; the evidence each member needs is listed.

   Amber:

   The category of buyer is known (for example “payers”) without named roles.

   Red:

   The customer is “the US market” or “health systems”, with no buying unit behind it.

3. 03

   State sequencing

   Is the plan built on a state cluster, with licensure, credentialling and payer enrolment timelines as the spine rather than a national average?

   Green:

   First cluster chosen on addressable population against incremental operating cost; further states treated as a playbook.

   Amber:

   Priority states listed, with no owner for the timelines.

   Red:

   “Launch nationally”, or fifty-state ambition in year one.

4. 04

   Clinical workforce and licensure

   Is care for US patients delivered by clinicians licensed in the patient's state — and is recruitment and credentialling on the critical path with realistic lead times?

   Green:

   Workforce model matches the delivery model; licensure path owned; supervision and pay bands costed.

   Amber:

   Licensure is understood but treated as HR admin to handle after launch.

   Red:

   The plan assumes UK clinicians, or remote delivery, without a tested model and proper advice.

5. 05

   Operating model redesign

   Have you budgeted the time and money to rebuild intake, triage, scheduling, documentation and coverage for US expectations, rather than translate the UK model?

   Green:

   Explicit rebuild workstreams; a US-hours access and scheduling plan; a decision on what must be US-based and when.

   Amber:

   “We'll adapt as we go.”

   Red:

   Copy-paste UK standard operating procedures with a US entity on top.

6. 06

   Patient access readiness

   Can you convert US demand into booked, attended care — response standards, multi-attempt contact, booking rules, no-show recovery — before volume arrives?

   Green:

   Access pathway designed; owners and metrics named; capacity matching rules defined.

   Amber:

   A marketing plan exists; access is treated as administration.

   Red:

   Growth spend released without a front door that can hold US-hours demand.

   The reasoning behind this dimension is set out in patient access is a growth function.

7. 07

   Unit economics in dollars

   Have you built bottom-up unit economics including acquisition, clinical pay, billing and denials where the route is payer-contracted, insurance and legal overhead, and non-attendance — rather than UK margin plus a price uplift?

   Green:

   A dollar model with sensitivities; denials and no-shows included where relevant.

   Amber:

   A headline price comparison only.

   Red:

   “US prices are higher, so margins will be.”

8. 08

   Decision gates and capital discipline

   Are there explicit conditions that must be true before the next tranche of spend is released — with a genuine willingness to stop or narrow?

   Green:

   Staged capital; go/no-go tests; a pilot definition that counts as commercial evidence.

   Amber:

   Soft milestones without stop rights.

   Red:

   A single large bet with no gates.

How to read your score

• Mostly Green, one Amber

  Ready to pressure-test with an operator and sequence execution.

• A mix of Amber with one Red

  Fix the Red before scaling spend. It is most often state sequencing, workforce or access.

• Two or more Reds

  Pause capital. The size of the market is not the constraint — the operating case is.

If the constraint turns out to be licences, credentialled clinicians or an existing referral base, compare routes rather than assuming a build: build vs buy for UK and US expansion. For the assumptions this scorecard is designed to replace, see 10 assumptions that break in the American market. For how Clarendum runs this work with leadership teams and investors, see US healthcare market entry.

Frequently asked questions

Is this a substitute for legal or regulatory advice?

No. The scorecard is a commercial and operational self-assessment. Licensure, corporate structure, tax and regulatory specifics should always be confirmed with qualified US advisers.

Should cash-pay score higher than a payer route?

Not automatically. Cash-pay is faster to validate and gives pricing freedom, but acquisition cost sits entirely with you and the addressable market is narrower. Score the route you have actually chosen for phase one, on the evidence you hold for that route.

What is a good first use of the scorecard?

Score your live board pack with the leadership team in one sitting. The arguments that surface while scoring — where two people give the same dimension different colours — are usually the real risks in the plan.