40 million seniors live with multiple chronic conditions. One condition worsens the next until the decline ends in hospitalization, amputation, or worse. We call that decline the cascade. Silver Health Plus is building the operating system for Accountable Cascade Management. We see the trajectory while it can still be changed, and change where it ends.
The top 5% of Medicare, roughly 3.4M people, absorb half of all Medicare spend. The trajectory is visible months before the acute event. A wound opens, vitals drift, fall risk climbs, and the path can still be changed. The loudest signal is a chronic or surgical wound, ~12M Medicare lives.
Composite patient profile. Illustrative cost trajectory drawn from public Medicare data and SHP analysis.
Payers (MA plans and ACOs). 25 to 30% of cascade-patient cost is potentially avoidable, but broad value-based care is structurally challenged to fund the intervention. Risk scores and Star ratings erode on top.
Health systems. These patients readmit at 1.8× the Medicare 30-day baseline, triggering HRRP penalties. Roughly 50% of an ACO’s cost variance traces back to the top 5%.
The cascade announces itself in several ways. A wound opens, vitals drift, medications stop working together, an acute event lands. Each is a door into the same underlying decline. The platform is being built to recognize them as one cascade surfacing in different places.
Figures from CMS public data, published post-acute and wound-care literature, and SHP analysis; illustrative and pre-diligence.
Nurse practitioners see patients at home. A virtual team behind them coordinates the home health agency, the primary care doctor, the specialists and the hospital. One care model runs underneath, built on published science.
Hospitals and health systems
Our software sits inside the hospital’s own medical record system, being built to flag the right patient at admission for the hospital to approve. A nurse practitioner is in the home within 24 hours of discharge. Between visits our virtual team runs the case. It tracks vitals and medications and resets the plan with the PCP, home health agency and specialists when something changes. We remain responsible for 30 to 60 days, longer when the risk holds. Inside wound centers, the software is being built to turn each routine visit into a readmission and cascade risk check, with evidence-backed recommendations that are defensible on medical necessity.
What the health system buys is capacity as much as savings. A complex chronic patient occupies an acute bed at the point where the acute setting adds least. The deterioration is continuous rather than an event, and it resumes on discharge. Run that same care in the home and the bed returns to the surgical and procedural work the hospital is built and staffed around. Shorter stays and fewer readmissions are how this shows up in the reporting. Case mix is why it gets bought, and it is a reason to buy that holds whether or not the system has taken on risk.
We are accountable for the care journey. That means the next needed encounter, the coordination around it, the measurement, and the longitudinal plan. Clinical decisions inside an encounter stay with the clinician delivering it.
Medicare Advantage plans and ACOs
We give the plan cascade-risk criteria to run against its membership, so members qualify as their risk changes. Every enrolled member gets one care navigator for the whole journey, starting with a full in-home assessment. The platform is being built to read that member continuously and put forward care-plan changes for a nurse practitioner to approve. The payer gets lower total cost of care, fewer admissions and readmissions, documentation that supports accurate risk capture, and a monthly view of who is deteriorating. The member gets more time at home.
Target clinical outcomes*
*Design targets, subject to prospective validation. Modeled from publicly available value-based-care program data and SHP internal analysis. Citations on request.
Broad value-based care takes accountability for a whole panel under one actuarial model; we take accountability for one cascade at a time, with its intensity priced in from the start. Health systems and payers are served on one infrastructure and one cost base. Every service is tailored to its population and personal to its patient, on one care model.
Broad value-based care serves the easier majority while the complex 5% keeps escalating, because economics built around a quarterly office visit are structurally challenged to fund what the cascade requires. That is weekly-plus contact, specialty judgment at the bedside, and care in the home, post-acute settings and wound centers. We take accountability for one cascade at a time, on shared infrastructure, with that intensity priced in from the start. A cascade is the interaction among a patient's conditions, not a single diagnosis.
Health systems buy episodes. Payers buy accountability. Both are served by the same nurses, protocols, network and software, so every revenue stream lands on one cost base. Density compounds three ways, in a market, in a customer, and at the patient, who can sit inside both models at once. The contract defines attribution and payment allocation where both apply.
One care model sits underneath every service, a versioned library of protocols and rules, built on published science and clinically owned. The factory configures it to each population's conditions, epidemiology and context. A guidance engine is being built to read each patient against it continuously and reshape the plan as they move. The fit narrows all the way from the population to the individual, at low marginal cost.
Rather than hiring a network, we take minority positions in mobile wound care practices and home health agencies already at these bedsides, billing today. The operator keeps the majority of the economics and keeps running the business. We hold clinical protocol authority, quality standards, technology and reporting, and payer contracting. Judgment inside each encounter stays with the treating clinician.
The affiliated network delivers the clinical encounters today. SHP is building the layer that identifies, sequences, documents and measures them.
The Accountable Care Service Factory runs three steps for every new population. Shape the service around it. Assemble the economics from reimbursement primitives that already exist. Then price the accountability for that slice, one cascade at a time rather than a whole panel. The design objective is for each service to launch at lower cost than the one before.
What accumulates is the clinical knowledge itself, not any one workflow. That is the asset the next service inherits. Attribution stays with the PCP or ACO; SHP supplies and scales the service instead of competing for it.
Design targets for the factory
Design targets for the engines under development, not results achieved.
You invest in Silver Health Holdings LLC (SHH), a Delaware limited liability company, where capital and exit governance sit. It places $10M of priced equity into the delivery network and $12M by SAFE into the Accountable Care Service Factory. Tranche 1 is open now at $6M, with pro rata rights in later tranches and round terms fixed at first close.
The sequencing matters. The affiliate base is designed to be cash-generative on its own, with value-based care the margin engine on top. The 2027 to 2028 step comes mostly from capacity contracted during 2027 and earning for a full year in 2028. Live affiliates double from five to ten. The third payer contract turns on. Enrolled members nearly triple. Platform operating cost rises about half while the revenue running through it quadruples. Roughly 70% of the EBITDA step is the platform.
What could slow this plan is known. Affiliate closing velocity and payer contracting cycles. The tranche structure is built around exactly those two risks. Each gate names the risk it retires and holds the next dollar until the proof lands, so capital follows evidence rather than projections.
Naming risks is the easy part. Each has been priced.
Basis. Projections are modeled, carried after risk adjustments and after the affiliate share owned by our operating partners. Revenue segments are drawn before intercompany eliminations and total slightly above the consolidated figure.
Terms. The delivery network is priced equity with a 1× non-participating liquidation preference. The platform entity is a post-money SAFE on the standard form, with a valuation cap and a discount to the next round. Both are set at Tranche 1 and hold for every first-round dollar.
Reg D 506(c) · Full teaser, financial model, and data room available under NDA.
