Silver Health PlusThree in four seniors carry multiple chronic conditions that compound. Encounters are infrequent and specialties work in silos. No standard exists for managing these conditions together, so the cascade builds undetected. Reimbursement structures aggravate it.
Schematic. Bar widths are illustrative rather than to scale.
The 5% is the end state of the cascade. It is where the system finds these patients today, after the cost is already spent. Our population sits upstream of it. A signal is showing, and the trajectory can still be changed.
The cascade announces itself in several ways. A wound opens. Vitals drift. Fall risk climbs. Medications stop working together. An acute event lands. Each of these is a door into the same underlying decline. The platform is being built to recognize them as one cascade surfacing in different places.
Why we start with the wound. Of all the signals, a chronic or surgical wound is the loudest and the easiest to act on. It is visible, and someone is already treating it. Underneath it sits the cascade: CHF, PAD, diabetes, renal decline. That group alone is roughly 12 million Medicare lives. It is a large enough door to build a business behind. The other signals widen the door from there.
Figures from public Medicare data and SHP analysis; illustrative and pre-diligence.
One patient strains two P&Ls at once, the health system’s and the payer’s. Neither can directly change the outcome. The wound cascade alone spans ~12M Medicare lives, the doorway to a far larger complex-care population.
Composite patient profile. Illustrative cost trajectory drawn from public Medicare data and SHP analysis.
That one curve lands on two balance sheets at the same time, and each one loses in a different way.
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. A total-cost blowout that coding alone won’t fix.
1.8× the Medicare 30-day readmission baseline
These admissions trigger HRRP penalties. Roughly 50% of an ACO’s cost variance traces back to the top 5%. Margin compression on every cascade admission.
Nurse practitioners who see patients at home. A virtual care team behind them, coordinating everyone else involved. The home health agency, the primary care doctor, the specialists, the hospital. One care model runs underneath all of it, Accountable Cascade Management, built on published clinical science. Two kinds of customer pay for it, and each of them has a different number to fix.
We run the first 30 to 60 days after discharge at home, and we turn routine clinic visits into risk checks
After a hospital stay. Our software sits inside the hospital’s own medical record system. It is being built to flag the right patient at admission, for the hospital to approve. Our care navigator starts while that patient is still in the bed, working alongside the discharge planner. Before the patient leaves, we have the primary care doctor briefed and the medical equipment ordered. A nurse practitioner from our team is in the home within 24 hours. Visits continue on a schedule set by how sick the patient is. Between visits, our virtual team runs the case. They track vitals and medications. They stay in contact with the home health agency, the primary care doctor and any specialist involved. When something changes, they pull those people together and reset the plan. We remain responsible for that patient for 30 to 60 days, and longer when the risk holds.
Inside the clinic. Wound centers already see these patients every week. Our software is being built to turn each of those visits into a risk check. It scores the patient for readmission risk and for the early signs that a cascade is starting. The standard of wound care in the center goes up at the same time. The software is designed to recommend the interventions the published evidence supports. Each recommendation carries the reasoning behind it, so it is defensible on medical necessity. When the score comes back high, the clinic staff can reach our virtual specialist team on the spot. A routine visit becomes the moment the escalation is caught.
Known in the industry as episodic and encounter-based care.
We look after a named list of their sickest members, year after year
The insurer hands us a defined list of members. We watch for the early warning signs and step in before things escalate. We coordinate every doctor, clinic and hospital those members touch. We take responsibility for one clearly defined group of people and one clearly defined pocket of cost. The rest of the insurer’s membership stays with the insurer.
Known in the industry as longitudinal, or PMPM plus shared savings.
One patient journey · Two value pools · One cost baseBoth customers are served by the same nurses, the same protocols, the same network and the same software. Adding the second customer adds revenue without adding a second company.
The cascade needs weekly contact, specialty judgment at the bedside, and settings outside the office. Home-based primary care and broad value-based care are structurally challenged to fund that combination. Their economics are built around a quarterly office visit for a whole panel. Ours are underwritten against one cascade at a time.
Target clinical outcomes**Modeled projections from publicly available value-based-care program data and SHP internal analysis. Citations on request.
Build the care model once, at the center. Manufacture tailored services for many populations and payers at low marginal cost. Software-like economics, applied to care delivery.
One care model sits underneath, Accountable Cascade Management. It is designed to be configured to produce a tailored service for each population and payer. The same protocols, workforce, network and platform adapt to each population and service. Each new service is a configuration of what already exists. Designing them once is the easy part. Manufacturing them repeatedly, economically, and at scale is the hard part. Capability is built once, at the center. The delivery network is designed to carry it to every bedside. Affiliates run on the same platform, the same protocols and the same measurement as the rest of the network. The factory standardizes how care is produced. Each care plan stays personal to the patient, addressing every population’s unique gaps. Attribution stays with the PCP or ACO. SHP supplies and scales the service rather than competing for it.
- Input. A complex, cascade-prone population from a health system or any risk-bearing entity. A large pocket of avoidable cost the system can identify but is structurally challenged to manage.
- Configure. Context Analytics finds the gaps, the causality of decline and the cascade-attributed costs. Service Configuration then matches the model to the charter across clinical, workforce, admin and economics.
Output. Measured outcomes and aligned revenue, designed to reach every bedside through the network.
Every new accountable care service makes the next one faster to launch and cheaper to deliver. Each one lands smarter at the bedside.
Target operating gainsThree shifts opened the door. Years of operating experience let us walk through it first.
- AI changes the labor equation. Skill uplift and admin automation finally make high-touch complex care scalable.
- At-home dislocation. Reimbursement pressure reset valuations at home-health and mobile provider groups. The acquisition path is easier now.
- Risk is shifting. New CMS models (V28, HHVBP, TEAM) are moving complex-care risk onto plans, ACOs and hospitals. That risk is arriving faster than their tools can manage. That creates demand for an operator who can take it on.
The dislocation is temporary. As rates stabilize and capital returns, the window to acquire the network narrows.
Decades of execution experience with this population, across payer, post-acute, and provider.
- Payer operating experience across 40+ payer customers
- Built healthcare interoperability and administrative software at scale
- Scaled a fully digitized mobile provider group to 5 states
- Built the largest U.S. wound-care platform by EBITDA
- Designed and deployed the largest post-acute clinical wound-care program
- 160 peer-reviewed publications
- Three companies built to market leadership, two exits across healthcare services and SaaS