Distributed Healthcare's mental model is Medicare plus Medigap, for all ages. The universal essential floor is comprehensive across categories — hospital, emergency, primary, specialty, maternity and newborn, mental health and SUD, AHQB-formulary prescriptions, preventive care at $0 cost sharing, basic dental prevention and emergency extraction, emergency vision exams, hearing screening — with cost sharing set by AHQB evidence. The regulated supplemental (standardized tiers, guaranteed issue, community-rated, AHQB-supervised) is a financial and convenience layer on the same clinical floor, and the AHQB one-way ratchet migrates supplemental benefits into the floor as unit costs fall. Payment is set centrally by AHQB.
Distributed Healthcare runs on two independent dimensions: who delivers care, and how care reaches Americans. The architecture deliberately avoids enumerating tiers — public, non-profit, and private organizations all participate, and capabilities like telehealth, mobile health, and Centers of Excellence cut across all of them.
A single delivery model cannot meet a continental population's needs. VHA — expanded — is the structural backbone, but VHA alone cannot reach every rural tract, cannot offer every clinical specialty, cannot serve as the only telehealth provider. The two-dimensional design lets several provider types operate in parallel on AHQB-set rates and standards, while delivery mechanisms (telehealth, mobile, in-person, Centers of Excellence, pandemic surge, forensic traceback) are offered across all of them. The architectural test: a patient should not be able to tell, from the quality of care or the absence of out-of-pocket surprise, which provider type or delivery mechanism they were routed through.
Provider types — who delivers care.
VHA — expanded. Public, salaried, integrated. Existing VHA infrastructure scales nationally to all Americans. Primary public provider. Staff buildout and physical-site expansion are the rate-limiters; the rollout schedule addresses both.
Kaiser-style regional integrated systems. Multi-specialty integrated systems contracted at Distributed Healthcare rates, with a service-area enrollment obligation: the contractor must serve the full population in its geographic catchment, not select the healthier subset. Capitated payment structures align incentives toward population health. Public, non-profit, and private all qualify. AHQB monitoring on quality, access, and population-health metrics prevents under-treatment.
Medicare-style community-based providers. Independent hospitals, clinics, FQHCs, and physician practices delivering care under AHQB fee schedules. The Medicare payment infrastructure is the rail; community organizations across public, non-profit, and private status all participate on equal AHQB-set terms.
Private supplemental. Voluntary above-floor coverage on community-rated guaranteed-issue terms — single-room stays, concierge access, faster elective scheduling, premium prosthetics, AHQB-excluded interventions. Carries no payroll tax bundle.
Delivery mechanisms — how care reaches Americans, cut across all provider types.
In-person clinic and hospital care. The baseline of medical delivery; every provider type carries this.
Telehealth. Video, async-message, and phone consultation. Anchored physically at every Post Office 2.0 telehealth booth — every ZIP code has access. Cross-state licensure reform removes the jurisdictional bottleneck.
Mobile health. Mobile clinic units serving rural catchments, COMPASS-identified deserts, and disaster response. Staged from Post Office 2.0 sites; deployable by any qualifying provider type.
Centers of Excellence. High-complexity referral care: transplants, advanced oncology, rare-disease referral, complex pediatric surgery. Volume-concentrated for clinical competence. Reference-priced (120% of international basket). CoE designation by outcomes against AHQB evidence thresholds — public, non-profit, or private organization status is not the discriminator.
Pandemic preparedness. Surge capability funded as standing capacity, distributed across provider types so no single category is a single point of failure.
Drug-overdose forensic chemistry traceback. Every overdose case sampled at point of medical contact contributes to a national chemical-signature database tracing synthesis routes to manufacturers and distributors. Each overdose response becomes intelligence against the supply network.
Cross-mechanism coordination. Patient records flow through the FedCard-anchored health record; routing across mechanisms (telehealth escalating to in-person, mobile referring to a Center of Excellence, etc.) is part of the care plan, not separate administrative encounters.
- Universal essential floor
- Provider types and delivery mechanisms are how the floor is delivered. Coverage scope is set in the floor; provider types and mechanisms are the operational axes.
- Payment design — capacity vs. fee-for-service
- Kaiser-style integrated systems and capacity-supported VHA segments use capitation / capacity payment; Medicare-style community providers use fee-for-service on AHQB schedules.
- Post Office 2.0
- Physical anchor for telehealth (booth) and mobile health (staging).
- COMPASS shortage indicators
- Mobile-health deployment and capacity-payment trauma siting both ride on the maternity-care, trauma-access, and primary-care HPSA overlays.