Six high-acuity clinical books at a top-five national payer. Oncology, MSK, CHF, maternity, autoimmune, dementia. Built the utilization management infrastructure from inside the payer. 200,000+ patients as CEO of a health system — behavioral health, primary care, urgent care, surgical, imaging, lab.
Built the programs. Managed the risk. Designed the governance layer for each.
Every product generates a certificate. Together, they form the only portfolio that documents what happened between authorization and renewal.
"The prescription was approved. It refilled for a year. Nobody governed the continuation."
Specialty pharmacy continuation governance. Three independent cohorts. Published methodology.
"The member needed care. They were sent wherever. Nobody measured whether it worked."
Independent BH care network. Licensed navigators. Bundled pricing. Outcome measurement at intake, discharge, 90 days.
"The claim was processed. It was about to be paid. Nobody verified it."
Independent pre-payment billing verification. Seven checks during the TPA hold window. Advisory-only.
Each product stands alone. The value compounds when you run all three — one portfolio conversation at renewal.
Governance requires independence. The entities that process, pay, and profit from claims cannot certify their own accuracy. That is the structural moat.
Share your population size and renewal timeline. We'll build a preliminary portfolio sketch.
We'll have a preliminary governance sketch for your population within one business day.
Pick a 20-minute slot →Most calls are 20 minutes. We'll have your preliminary portfolio sketch ready.