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. 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. We call it Accountable Cascade Management, and it is 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, 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 identify the members heading into a cascade and the ones already in one, then stay accountable for them
Finding the right members, continuously. We give the plan the criteria for who belongs in the program. Those criteria are built around cascade risk rather than a single diagnosis. The plan runs them against its membership on an ongoing basis. Members qualify as their risk changes, not only at the start. Each time a member qualifies, we reach out and enroll them if they agree to take part. The panel keeps refreshing as the population moves.
One person who stays with them. Every enrolled member is assigned a care navigator who stays with them for the whole journey. It starts with a full assessment in the member’s home. That assessment produces a care plan. The navigator is responsible for making it happen across every setting the member touches.
A plan that keeps changing. Our nurse practitioners visiting the home are one part of it. So is getting the member in front of the right specialists. So is the other care they need to stay off the cascade. Underneath, the platform is being built to read that member continuously. It tracks where they sit against the cascade and which way they are moving. When the picture changes, it puts forward the change to the care plan. A nurse practitioner approves it and carries it out. The navigator makes it happen across settings.
What the payer or ACO gets back. Lower total cost of care on that population. Continuous engagement means care gets delivered at the right time and to the right standard. Less of it is wasted on avoidable episodes. Fewer hospitalizations and fewer readmissions. Documentation that supports accurate risk capture. A monthly view of who is deteriorating and what was done about it.
For the member it means fewer trips to the hospital and more time at home. It means a better chance of holding on to the life they have.
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. Serving both raises density in three ways, and density is where the leverage comes from.
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 a single body of clinical science. Which findings matter, what they mean together, and which interventions the evidence supports. That body of science stays the same from one population to the next. What gets built on top of it changes every time.
Designing a service once is the easy part. Manufacturing services repeatedly, economically, and at scale is the hard part. The factory is what does the second thing. It runs the same three steps for every new population.
That sequence is the product. Each new population runs the same three steps on the same infrastructure. That is why the fourth service costs less to launch than the first.
The delivery network carries the result to every bedside. Affiliates run on the same platform and protocols as the rest of the network. They are measured the same way. Each care plan stays personal to the patient. Attribution stays with the PCP or ACO. SHP supplies and scales the service instead of competing for it.
The engines · in developmentOutput. 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.
What accumulates is the clinical knowledge itself, not any one workflow. That is the asset the next service inherits.
Design targets for the factoryDesign targets for the engines under development, not results achieved.
Three 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