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40 million seniors live with multiple chronic conditions. Every day, thousands of them begin a catastrophic decline.

One condition worsens the next, and the decline accelerates toward hospitalization, amputation, or worse. We call that decline the cascade. Silver Health Plus is building the operating system for Accountable Cascade Management. That is the discipline of seeing the decline before it starts, and changing where it ends when it has.

$22M, staged to milestones 12 to 18 mo. window Two exits, one above $200M
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The decline crosses every silo.
The cost compounds with it.
Accountable Cascade Management intercepts it.

Three 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.

40M seniors living with multiple chronic conditions A signal appears a wound, a shift in vitals, a new fall risk, an acute event Thousands a day begin to escalate, inside a detectable window ~3.4M the top 5% of Medicare half of all Medicare spend We enter here Where the system finds them today

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.

$300B+estimated annual U.S. spend across the Wound, PAD & CHF cascades, direct and downstream.

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.

$153K $13K We intercept here while the trajectory is still open Stable Compounding Cascade Crisis

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.

METRIC A
Payers · MA plans & 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. A total-cost blowout that coding alone won’t fix.

METRIC B
Health systems · hospitals & IDNs

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.

BUYER 01 Health systems hospitals, health systems, wound clinics BUYER 02 Payers Medicare Advantage plans and ACOs Paid per hospital stay · per visit Paid per member, every month ONE PRODUCTION SYSTEM One care model. One at-home delivery network. One platform. One cost base. Two ways to get paid, produced by the same factory.
Customer 01 · hospitals and health systems

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.

Moves metric B. These patients return to the hospital 1.8× more often than the Medicare average. Medicare fines the hospital when they do. The hospital keeps its admission revenue. The family doctor keeps the patient.
A flat fee for each patient, each hospital stayA fee for each clinic visit

Known in the industry as episodic and encounter-based care.

Customer 02 · Medicare Advantage plans and ACOs

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.

Moves metric A. Roughly 25 to 30% of what these members cost is avoidable. The insurer’s Medicare quality rating and payment accuracy improve alongside it.
A fixed amount per member, every monthPlus a share of the money saved

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.

In a market
More revenue streams land on the same local operating base. The fixed cost of standing up that market spreads further.
In a customer
One hospital buys more than one service. One payer contract triggers episodic work alongside it. More value from each relationship already built.
At the patient
The same patient can sit inside both customer models at once. A single patient touch supports more than one value pool.

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*
25 to 30%lower total cost of care
50%fewer amputations
25%fewer readmissions

*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.

01
Shape the service around the population
Every population carries its own conditions, its own epidemiology, its own social and clinical context. The factory is designed to configure the care model to that context. What this group needs to avoid the cascade, or to change where it ends.
02
Build the alignment structure out of existing reimbursement
No new payment model has to be invented and no regulation has to change. The factory is designed to assemble the economics from reimbursement primitives that already exist. Every party in the chain gets paid for the behavior the care model needs.
03
Underwrite that slice
The care model fits the population. The economics fit the care model. That makes the cost of that population something we can price and stand behind. One cascade at a time, rather than a whole panel under one actuarial assumption.

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 development
1
Clinical Delivery Engine
Designed to build care plans, map findings to interventions across conditions, and guide each encounter.
2
Administrative Engine
Designed to automate documentation, coding, auth, ordering and audit.
3
Orchestrator Engine
Designed to plan, coordinate and optimize journeys across settings.
4
Patient Agency Engine
Designed to turn patients into active participants.
5
Alignment Engine
Designed to set economic value, then coordinate billing and payment flows.
INPUT A cascade-prone population CONFIGURE Context analytics, service configuration OUTPUT Measured outcomes, aligned revenue FIVE ENGINES · IN DEVELOPMENT Clinical Delivery · Administrative · Orchestrator · Patient Agency · Alignment Every service makes the next one cheaper to launch

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.

What accumulates is the clinical knowledge itself, not any one workflow. That is the asset the next service inherits.

Design targets for the factory
25 to 30%Target · clinician productivity gain against current at-home delivery benchmarks
25 to 60%Target · reduction in care-planning time per patient

Design 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
The raise

Let’s build the operating system for Accountable Cascade Management.

Raising $22M, released in four milestone tranches.

$10M of priced equity into the delivery network and $12M into the Accountable Care Service Factory. Both are drawn across four capital gates. Each gate retires a named risk before the next dollar is called.

What the $22M is meant to build

Affiliate revenue, consolidated Care delivery and platform fees Value-based care TARGET · 2027 REVENUE as the four capital gates complete $172.9M $27.0M risk-adjusted EBITDA 65% 17% 18% TARGET · 2028 REVENUE first full year running all three markets $447.6M $139.6M risk-adjusted EBITDA 57% 16% 27% Value-based care grows from 18% of revenue to 27% while the acquired base carries the fixed cost.

Existing provider revenue creates the operating base. Value-based care becomes the expanding engine on top of it. That is where the margin comes from. Affiliate revenue is consolidated from home-health agencies and wound provider groups. Those are minority acquisitions with operational control, so the revenue arrives with the affiliation. Segments are drawn before intercompany eliminations. They total slightly above the consolidated figure.

How $22M consolidates that much revenue. Each affiliation buys a 15% stake at roughly 6× EBITDA. Contractual control consolidates the affiliate under ASC 810. Around 60% of each purchase is cash and 40% is a seller note. Total cash consideration across every affiliation through 2028 is roughly $11M.

These are modeled projections from the operating model, carried after risk adjustments. At a 12× multiple on 2028 risk-adjusted EBITDA, enterprise value is roughly $1.67B. HoldCo carries $79M of cash at that point. Tranche-level return math and the full multiple sensitivity grid sit in the data room.

T1 · $6.0M T2 · $5.0M T3 · $6.0M T4 · $5.0M OPEN NOW MILESTONE GATED
Tranche 1
$6.0M
Capital close, team and platform stand up, anchor affiliate consolidating. One market.
Open now
Tranche 2
$5.0M
First health system signed as an episodic ACO partner. Second market opens. Four affiliates.
Tranche 3
$6.0M
First payer contract live, two further health systems live. Two payers, five affiliates.
Tranche 4
$5.0M
Third payer and third market, affiliate onboarding completing. Ten affiliates.

How the capital is called. Each gate is opened by a milestone. Tranche 1 is open now at $6M. Tranche 1 participants hold pro rata rights in the later tranches, exercisable at their option. Every first-round dollar carries identical terms whenever it enters. Proceeds fund minority acquisitions of home-health and mobile provider groups, with operational control. They also fund the Accountable Care Service Factory and the rollout across three MSAs.

What you are buying, and what protects the entry price. 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. It carries a valuation cap and a discount to the next round. Both sets of terms are set at Tranche 1 and hold for every first-round dollar. Cap, discount and the full term sheet are in the data room.

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