Joe Nalley built behavioral health programs that served 200,000+ patients. 80%+ residential completion. 90%+ IOP. Single-digit readmission. Took it through acquisition by a national BH company. Then moved to the payer side and now manages specialty risk across six high-acuity clinical books at a Fortune 25 national payer.
He saw three gaps from the inside:
Gap 1 (Curated): When someone needs high-acuity behavioral health care, nobody routes them to the program with the best outcomes. Nobody checks whether the care worked. The quality variance between programs is extreme and unmeasured. The wrong program isn't a clinical failure. It's a routing failure.
Gap 2 (Cadence): When someone starts a high-cost specialty therapy, the system heavily governs the initiation (prior auth, step therapy, formulary). Then the prescription refills for a year. Nobody governs the continuation. Nobody checks whether it's still working. The gate is governed. The corridor is not.
Gap 3 (Caliber): When a high-cost claim is submitted, the TPA processes it, edits it, and pays it. Nobody independently verifies that what was billed matches what was delivered. Every public company audits its books. No self-funded employer audits its claims.
Curated fixes the routing failure. Cadence fixes the continuation failure. Caliber fixes the verification failure. Three structural gaps. One governance platform. Same buyer.
Curated is an independent behavioral health care network for self-funded employers. Licensed navigators match members to vetted programs across 13 clinical areas. Episodes are bundled. Outcomes are measured at intake, discharge, and 90 days. The navigator stays with the member across every episode for as long as they're on the plan. If a member is readmitted to SUD residential within 30 days, Curated covers the second episode.
The one-line: "One navigator. Every episode. For as long as they're covered."
What makes it different: Independence. Curated doesn't own the programs. Doesn't employ therapists. Has no downstream economic interest in where the member lands. Every integrated platform (Spring, Lyra, Carrum+Lyra) routes to its own clinicians first. Curated routes to the best outcome.
Cadence is a governance layer for high-cost specialty therapy continuation. It answers the question: "The prescription was approved. It refilled for a year. Is anyone governing the continuation?"
The system takes a de-identified claims extract, flags patients whose therapy continuation shows governance signals (duration without reassessment, dose escalation without response, missing monitoring labs, no measurable outcome data), sends those flagged cases to external clinical reviewers, and produces a sealed governance artifact documenting what was found.
The one-line: "The gate is governed. The corridor is not. Cadence governs the corridor."
What makes it different: Structural independence. Cadence is advisory-only. No clinical relationship with members. No duty to act. No supply chain ties. No financial interest in whether the therapy continues or stops. It produces intelligence, not instructions.
Caliber is an independent billing governance layer for self-funded employers. It verifies high-cost healthcare claims before the employer pays them. The TPA already holds claims above a threshold for 14-60 days. During that hold, nobody independently checks whether what was billed matches what was delivered. Caliber fills that window.
Seven verification checks (CODEVAL, DUPCHECK, RATEVAL, DURVAL, CREDVAL, SVCVAL, BUNDLEVAL) applied by external credentialed reviewers. Four determinations: Verified, Adjust, Hold, or Escalate. Advisory-only — Caliber produces the intelligence. The employer decides the payment action.
The one-line: "The claim was processed. It was about to be paid. Nobody verified it."
What makes it different: Every existing payment integrity company sells to health plans. Caliber sells to the self-funded employer — the entity that actually writes the check, carries ERISA fiduciary duty, and absorbs the cost when inaccurate claims are paid.
| Term | What it means | Which company |
|---|---|---|
| PEPM | Per-employee-per-month. The fixed access fee employers pay. | Curated |
| Episode-chain | Longitudinal navigator assignment across all BH episodes. Not per-episode. Per-member. | Curated |
| Bundled episode | Pre-negotiated all-in price for a treatment stay. No surprise billing. No balance billing. | Curated |
| Self-funded employer | Employer that pays claims directly (vs. buying insurance). ~60% of covered workers. ERISA-governed. | Both |
| Stop-loss | Insurance employers buy to cap catastrophic claims. Specific (per member) and aggregate (total). | Both |
| OON | Out-of-network. BH episodes billed at rates 2-4x in-network. 40% of SUD claims are OON. | Curated |
| RIR | Reviewer Influence Rate. % of cases where a reviewer recommended trajectory change. | Cadence |
| DAR | Documented Appropriateness Rate. % of cases confirmed clinically appropriate. RIR + DAR = 100%. | Cadence |
| GSV | Governance Signal Value. TAF-weighted economic signal. Directional, not causal. | Cadence |
| GPR | Governance Persistence Rate. % of advisory signals that persisted without compulsion. | Cadence |
| PHQ-9 / GAD-7 / AUDIT-C | Validated clinical instruments for depression, anxiety, substance use. Curated measures at intake, discharge, 90 days. | Curated |
| CGS | Cadence Governance Standard. The published methodology. Versioned. Immutable. | Cadence |
| Governance Certificate | The cycle deliverable. Sealed artifact with metrics, audit trail, configuration fingerprint. | Cadence |
| BGS | Billing Governance Standard. Caliber's published methodology for verification cycles. Versioned (v1.0). | Caliber |
| Billing Governance Certificate | Caliber's quarterly deliverable. Verification rates, discrepancy distribution, prevented overpayment, provider scores. | Caliber |
| CODEVAL / DUPCHECK / RATEVAL / DURVAL / CREDVAL / SVCVAL / BUNDLEVAL | Caliber's seven required verification checks. Coding, duplicates, rates, duration, credentials, service delivery, bundle compliance. | Caliber |
| Governance Portfolio | Unified document combining all three certificates. One artifact, three governance layers, one stop-loss renewal story. | All three |
| Curated Governance Certificate | BH episode outcome documentation. Completion rates, readmission rates, clinical instrument scores, provider quality. | Curated |
Step 1: Access. Member or family contacts Curated. Same-day response from a licensed clinical navigator. Not a call center. Not a chatbot. A clinician.
Step 2: Assessment. The navigator evaluates diagnosis, acuity, clinical history, what's worked, what hasn't, geography, preferences. This isn't a referral. It's clinical matching.
Step 3: Placement. Member is matched to a program that earned network inclusion on measured outcomes. The episode is bundled. Price is set before care begins. Member pays nothing.
Step 4: Monitoring. Navigator tracks the episode. Not managing the care — the program does that. Monitoring completion, flagging concerns, coordinating family when appropriate.
Step 5: Measurement. Validated instruments at intake, discharge, and 90 days post. PHQ-9, GAD-7, AUDIT-C, DAST-10, EDE-Q, PCL-5 depending on category. MAT retention at 6 months.
Step 6: Continuity. The navigator doesn't disappear. They stay assigned for as long as the member is on the plan. SMS check-ins at days 7, 14, 30, 60, 85. If the member needs care again — six months or two years later — same navigator, same context, no starting over.
Input: De-identified claims extract. Four required fields: member ID, drug, dose, therapy start date. Six optional fields that improve trigger calibration.
Flagging: The system scans the population against seven required triggers: DUR12 (duration >12 months without reassessment), dose escalation without documented response, missing monitoring labs, comorbidity change, NOOUT (no measurable outcome data), BIOSIM (biosimilar available but unconsidered), LABGAP (monitoring labs overdue >90 days). First-cycle flag rate: 25-29% across all three studied populations.
Review: Flagged cases go to external clinical reviewers (PharmD, MD). Minimum two reviewers per cycle. External to the plan sponsor. Each case: ~4 minutes. 120 cases per reviewer per day. Four possible outcomes: Continue (therapy is appropriate), Adjust (dose/frequency change warranted), Taper (discontinuation pathway recommended), Switch (alternative therapy recommended).
Artifact: Sealed governance artifact with configuration fingerprint, outcome distribution, metrics (RIR, DAR, GSV), immutable audit trail. This is the deliverable. It comes with a Governance Certificate.
Cycle duration: 90-120 days. Repeating. Each cycle recalibrates triggers based on prior results. GPR is measured at Cycle 2: what percentage of Cycle 1 advisory signals persisted without anyone forcing them to.
Cadence has been measured across three independent populations totaling 65,234 patients.
| Cohort | Size | Type | Flag Rate | RIR | Key Finding |
|---|---|---|---|---|---|
| 1 | 25,000 | Commercial payer, GLP-1 only | 25% | 60% | $8.6M GSV. Per-member GSV: $345. |
| 2 | 9,500 | Self-funded employer, multi-category | 25% | 58% | $5.3M GSV. PA blind spot: 62% of flagged cases had no PA. |
| 3 (NIH) | 30,734 | NIH All of Us, EHR data | 29.1% | 95% (AGD) | 22.3% had zero relevant labs during entire continuation. |
The convergence: 25-29% flag rate regardless of who measures, where, or how. The gap is structural, not population-specific.
The critical distinction on Cohort 3: The 95% AGD-RIR measures something different from the 60% RIR. The 60% means "a reviewer saw the picture and recommended a change." The 95% means "the picture doesn't exist — there isn't enough documented evidence to say the therapy is appropriate." That's a governance finding about monitoring infrastructure, not about the therapy itself.
Step 1: Extract. Weekly claims extract from TPA. Claims in hold status above threshold ($25K+ for Tier 1, $10-25K for Tier 2). Eight required data fields. No TPA integration. No workflow disruption.
Step 2: Verify. External billing governance specialists (CPC/CCS/RHIA credentialed, 3+ years) review each claim against seven checks: CODEVAL (coding accuracy), DUPCHECK (duplicate detection), RATEVAL (rate verification — correct network tier and contract), DURVAL (duration/LOS verification), CREDVAL (credential verification — billing level matches provider credentials), SVCVAL (service verification — triggered only when other checks flag), BUNDLEVAL (bundle compliance — CMS/industry guidelines).
Step 3: Return. Each claim gets one of four determinations: Verified (pay as submitted), Adjust (correctable inaccuracy documented), Hold (needs provider documentation), Escalate (material discrepancy, employer/TPA decides). NOT Deny — Caliber is advisory-only.
Step 4: Certify. Quarterly Billing Governance Certificate. Verification rate, discrepancy rate, prevented overpayment, provider accuracy scores, trend analysis.
Turnaround: 10 business days standard, 5 for short-hold TPAs (14-day windows).
Advisory-only: Caliber never contacts providers, never communicates with members, never issues payment instructions.
Curated revenue model (initial sales):
Two streams, not three. PEPM access fee ($4-7/employee/month, volume-tiered) + per-episode bundled spread ($3-8K). Gain-share enters year 2+ after a savings baseline is established. Pilot: $2-3 PEPM for 6 months, no episode spread.
Readmission warranty is priced at 15% built into the bundled episode rate. 10% annual cap on warranty episode volume per client. Warranty activates after 100+ episodes of measured readmission data — tied to evidence, not client count.
Cadence Sustain pricing:
$4.50-6.00 PMPM (specialty members), 90-day governance cycle. Entry point: Facilitated Assessment at $15-25K. Break-even RIR: ~3.1%. Measured RIR: 58-60%. Cost-to-signal ratio: ~19:1.
Cadence Sentinel pricing:
$6.00-12.00 PMPM (total plan members), 90-day cycle. Entry point: Catastrophic Risk Assessment at $25-50K. Framework stage — no pilot data yet.
Caliber pricing:
$2-5 PEPM (volume-tiered) + 15-20% of prevented overpayment. Pilot: $2 PEPM, no overpayment share, 90 days. Expected discrepancy rate: 4-6% on high-cost claims above $25K threshold. Employer keeps 82.5% of prevented overpayment. Dispute resolution: 10-day employer review window with independent third-party arbiter.
Curated's field:
Carrum + Lyra (Jan 2026 partnership) is the primary threat. Together: bundled SUD + outpatient therapy. Curated's wedges: 13 clinical areas vs SUD-only, independent outcome measurement, no downstream economic interest, readmission warranty.
Spring Health Specialty Care (Oct 2024): direct overlap on navigator model. Spring avoids residential. Curated owns residential.
The actual competitor is the carrier network. The default. The thing where members get sent to whoever has availability and nobody measures what happened.
Cadence's field:
Empty. No direct competitor occupies the continuation governance position. Claims analytics vendors (Cotiviti, Verisk) report what was spent. Independent medical review companies (MCMC, AllMed) review individual cases on referral. PBMs govern initiation. Nobody governs continuation at population scale with published standards, external reviewers, and sealed artifacts.
If the industry builds this without Cadence, the gap still gets fixed. "The gap is the enemy, not the competition."
"You have no clients." Correct. Every company starts at zero. Lantern had zero before its first surgical COE. The model is proven in surgery (Carrum, Lantern). We're applying it to BH with operational experience nobody else has. We're offering pilot terms that eliminate the buyer's risk: 90 days, one clinical area, walk away if the data doesn't justify expansion.
"What if the programs don't accept bundled rates?" BH facilities run at 60-80% occupancy. A guaranteed volume channel with pre-negotiated rates and payment within 15 days is economically attractive. The trade is lower per-episode revenue for predictable volume and faster cash. Lantern proved this in surgery.
"How is this different from Spring Health?" Spring owns its clinicians. Their navigator routes to Spring therapists first because that's where their margin is. We don't own programs. We don't employ therapists. Our navigator routes to the best outcome because there's no economic reason to route anywhere else.
"30% savings seems high." It's the default. The calculator lets you model at 15%. Even at 15%, the PEPM is net-positive when you account for the OON redirection alone. The 40% of SUD claims that are OON are running at 2-4x in-network rates.
"We already have an EAP." Great. Keep it. EAPs handle outpatient therapy and coaching. We handle the $40K residential stay, the acute psychiatric admission, the eating disorder episode. Complementary, not competitive.
"Our carrier already has a BH network." Your carrier's network is a list. Inclusion is based on credentialing, not outcomes. Nobody compares completion rates across the programs in that network. Nobody measures what happened 90 days later. That's the gap.
"What about adverse selection?" Curated serves the employer's entire covered population. The PEPM covers access, not utilization. Whether 30 or 60 members use the service in a year, the employer pays the same PEPM. No adverse selection because there's no risk-rated enrollment.
"The readmission warranty sounds like a liability." It's capped at 10% of episode volume annually. AMA voids it. Refusal of recommended step-down voids it. The 15% built into the bundled rate covers the actuarial exposure — the warranty is profitable at every readmission rate because the volume cap is the structural protection. It doesn't activate until we have 100+ episodes of measured readmission data. It's a financial guarantee, not an evidence claim.
"Are you full-time on this?" Not yet. The payer-side role gives me current access to claims data, underwriting relationships, and clinical operations that I couldn't replicate from the outside. The plan is full-time transition after the first signed contract demonstrates market fit.
Six entities touch a high-cost case. Each is structurally disqualified from producing independent governance intelligence:
TPA: Administrative contract. No clinical governance infrastructure. UM is service-level, not trajectory-level.
Stop-loss carrier: Financial conflict. Reviews cases that determine its own reimbursement obligations.
Case management: Clinical relationship with the member creates a duty-to-act. Any finding must be acted on. Cannot produce sealed advisory artifacts.
PBM: Sees pharmacy claims only (no full trajectory). Revenue conflicts (rebates, dispensing fees incentivize continuation).
Employer: No clinical governance capability. A bank or manufacturer will never hire a clinical governance team.
Provider: Can't independently govern its own cases. Internal review only. Revenue conflict.
The four structural requirements: Plan independence. Supply chain independence. Population-level instrument. Published standard with certification. Cadence clears all four. Nobody else clears more than two.
Five entities touch a high-cost claim. None can independently verify it:
1. TPA — processor and verifier are the same entity. Throughput incentive, not accuracy incentive.
2. Stop-loss carrier — reviews for its own reimbursement exposure, not the employer's billing accuracy.
3. Provider — can't verify its own billing. Revenue conflict. Internal compliance catches egregious errors only.
4. Benefits consultant — benchmarks spend, doesn't verify individual claims. Tells you the total looks high, not which specific claims are wrong.
5. Employer — a bank, a manufacturer, a retailer. No clinical billing expertise.
The structural requirement: independent of TPA, independent of provider, independent of stop-loss, operating on published methodology with external reviewers and sealed artifact.
"We already have a retrospective audit firm." Good. Keep them. Caliber catches the biggest errors before payment. Your audit firm reviews what's left. Complement, not replacement.
"Our TPA already reviews high-cost claims." Your TPA processes, edits, AND reviews. That's the CFO auditing their own books. The independence is the point.
"4-6% inaccuracy seems high." At 1% inaccuracy, the PEPM alone carries the model. The prevented-overpayment share is upside. The Caliber Baseline Study (first pilot) establishes the actual rate for your population.
"Won't this create friction with our TPA?" Position as ERISA fiduciary best practice. The same way a company hires external auditors without firing the CFO. The TPA already holds these claims. Caliber fills the review step that's already in their process.
"What if you flag something incorrectly?" Advisory-only. You and your TPA decide the payment action. 10-day dispute window. Independent third-party arbiter for disputed findings. An incorrect flag costs Caliber revenue, not the employer.
"You have no data." Correct. The Caliber Baseline Study is the first pilot. 300-400 claims, full BGS methodology, 90 days. The first Billing Governance Certificate is your evidence base.
"We're not self-funded." Caliber is designed for self-funded employers under ERISA. Fully insured employers don't have the same fiduciary exposure or claims visibility. If you're ASO, you're our buyer.
Never say "we save money." Cadence produces governance intelligence. The economic signal is directional. Whether anyone acts on it is not Cadence's decision. Curated documents savings against carrier network pricing — that's measurable. But "we save money" sounds like a PBM pitch. Say: "We document the gap between what was spent and what evidence supports."
Never say "AI-powered." All three companies use intelligence layers. But leading with AI marks you as a company that built technology looking for a problem. Lead with the problem. The technology serves the relationship (Curated), the methodology (Cadence), or the verification process (Caliber).
Never trash competitors by name. Describe the structural problem they share: downstream economic interest (Curated), inability to govern continuation (Cadence). Let the buyer connect the dots.
Never promise outcomes you can't evidence. "We will reduce your BH spend by 30%" is a promise. "Our model shows a 25% savings rate on bundled episodes; the calculator lets you adjust" is a tool. Give them the tool.
Never use: leverage, utilize, robust, comprehensive, cutting-edge, innovative, holistic, synergy, empower, revolutionize, disrupting, reimagining, game-changing, best-in-class. If any of these words appear in anything you write or say, delete them and start the sentence over.
Three people have to say yes for either company to work:
The benefits VP (Sarah). She's practical, skeptical of new vendors, trusts her broker. She's frustrated with BH outcomes but afraid of being the one who recommended the vendor that failed. She wants to see one cycle of data. She wants the calculator, not the pitch. She wants to know what her HR team needs to do. She'll say "let me think about it" unless you give her a reason to say yes today. The pilot guarantee is that reason.
The broker (James). He manages 50 self-funded clients and evaluates 20+ vendor proposals per year. He won't recommend something without contracted rates against his client's actual claims data. He wants a broker toolkit, not a landing page. He wants to know how Curated affects his renewal conversation with the stop-loss carrier. He wants to know if Curated pays a broker fee. If you can't answer these questions, he'll evaluate and pass.
The CFO (Victor). He approves all benefits expenditures over $500K. He cares about three things: total cost, ROI, and whether the vendor can scale. He doesn't care about clinical outcomes except as proof that the model works. He wants net savings after PEPM, not gross savings before. He wants to know the break-even point. The calculator is his favorite part of the site.
This is the argument that connects all three companies to the $27B stop-loss market.
Curated's angle: OON BH spending has surged to 40% of SUD claims. Every OON episode is a stop-loss event waiting to happen. Curated redirects those episodes into bundled in-network pricing. Documented outcome data builds evidence that supports the employer's stop-loss renewal. Year 2-3, Curated positions the Governance Certificate as a risk differentiation tool with stop-loss carriers.
Cadence's angle: 49% of employers now report $1M+ claimants (up from 23% in 2019). Stop-loss carriers are looking for signals that distinguish well-governed populations from ungoverned ones. The Governance Certificate documents structured reassessment of the therapies driving the highest claims. An employer with a Cadence certificate is demonstrably lower risk than one without it.
The convergence: An employer that uses both Cadence (governing specialty pharmacy continuation) and Curated (governing BH episodes) can present their stop-loss carrier with outcome evidence across the two highest-variance clinical categories. That's the Phase 5 endgame: Curated and Cadence hold enough data to price BH-specific and specialty-specific stop-loss layers directly.
An expert knows the limits of the evidence. Here are the things we can't prove yet:
Curated: (1) Whether programs will accept bundled rates at the margins we model — assumed from surgical COE analogy, not negotiated. (2) Whether capture rate will reach 30% in Year 1 — modeled from comparable COE launch data, requires benefits design integration and HR communication infrastructure. (3) Whether the readmission warranty exposure will stay within the 15% reserve — we believe it will based on network curation and the 10% volume cap, but we haven't honored a single warranty yet. (4) Whether the navigator model scales past 15-18 active cases per navigator — clinical operations question, not answered until we're operating.
Cadence: (1) Whether GPR (50%) holds across diverse populations — measured in two cohorts, needs more cycles. (2) Whether stop-loss carriers will actually price Governance Certificates into underwriting — thesis, not proven. (3) Whether Sentinel's framework produces the same signal quality as Sustain — no pilot data yet. (4) Whether the DAR will gain regulatory or accreditation recognition — early conversations, no commitments.
Caliber: (1) The actual discrepancy rate — industry sources say 4-6%, but Caliber hasn't run a verification cycle yet. The Caliber Baseline Study (first pilot) establishes the real number. (2) Whether TPAs will cooperate smoothly with claims extracts. (3) Whether the 14-60 day hold window provides enough time for verification. (4) Whether stop-loss carriers will recognize the Billing Governance Certificate.
When someone asks about something we don't know, say: "We don't know that yet. Here's what we do know, and here's when we'll have the answer."
In year one, Curated's advantage is the founder's experience and the curated network. Both are real. Neither is durable.
After two years of measuring outcomes across programs, clinical areas, patient populations, and geographies, Curated holds the only independent quality dataset for high-acuity BH programs in the country. The predictions get sharper. The matches get better. The network improves itself. Nobody can replicate this without running the same episodes through the same measurement apparatus for the same amount of time.
The data moat enables: network quality management (remove underperformers), provider negotiation advantage (prove which programs perform), stop-loss risk credentialing (documented evidence for underwriters), and employer retention (outcome reports are non-replicable by competitors).
Alan Whitfield's assessment: "Economically sound but has a longer time horizon than the canon implies." True. Year 1 is founder advantage. Year 2 is emerging moat. Year 3+ is durable.
The standard IS the defensibility. CGS defines what valid governance looks like. Any competitor either builds to the specification or builds against published evidence.
CGS (Cadence Governance Standard) defines what a valid governance cycle is: required triggers, reviewer qualifications, completion thresholds, artifact structure, evidence tiers. Any competitor who enters the space would either (a) build to Cadence's specification, validating the standard, or (b) build a different specification, which the market would evaluate against Cadence's published evidence.
This is the NCQA analogy. NCQA didn't build health plans. They defined what a well-governed health plan looks like and certified compliance. Cadence defines what well-governed continuation looks like and certifies compliance. The standard IS the moat.
Published evidence (three cohorts, 65,234 patients, convergent flag rates) makes the standard evidence-based, not arbitrary. That's the difference between "we wrote some rules" and "we wrote rules validated across 65,000 patients in three independent populations."
In year one, Caliber's advantage is the methodology (BGS v1.0) and the structural independence argument. Neither is durable against a well-funded competitor.
After two years of verification cycles across multiple employers, Caliber holds:
Provider billing accuracy scores — which facilities bill accurately, which have systematic upcoding or LOS discrepancies.
Category-level discrepancy benchmarks — what's the typical inaccuracy rate for cardiac surgery vs NICU vs SUD residential.
TPA accuracy comparison — which TPAs catch the most errors in their own editing, which let the most through.
Clinical-billing intersection data — combined with Curated's outcome data, staffing-level accuracy correlates with clinical outcomes.
This dataset compounds with every cycle. Nobody else has it because nobody else is doing pre-payment verification for self-funded employers.
Three companies. Three structural gaps. One governance platform for self-funded employers.
Cadence (Sustain + Sentinel) governs specialty pharmacy continuation and catastrophic case escalation. Curated governs BH episode routing and outcomes. Caliber governs high-cost claims billing accuracy. Together, they cover the highest-variance, highest-cost dimensions of employer health plan spend.
An employer that uses all three can present their stop-loss carrier with a Governance Portfolio: documented continuation governance (Cadence), documented episode outcomes (Curated), and documented billing verification (Caliber). No other employer can produce this package.
Pilot sequencing: Lead with Caliber. Simplest value proposition, fastest ROI, least behavioral change. Caliber opens the door. Cadence and Curated walk through it. By month 12, the employer has three governance layers and a Governance Portfolio for their stop-loss renewal.
The platform doesn't require all three. Each stands alone. But the combined data asset compounds. The cost of acquiring the employer once and cross-selling three products is the platform economics that makes this a fundamentally different business than three separate companies.
Scenarios you haven't been briefed on. Answer them anyway.
"We tried a BH carve-out in 2019 and it didn't work." Ask what they tried, what failed, and what they measured. Most failed BH carve-outs were EAP expansions, not episode-level navigation with outcome measurement. The model is structurally different. But listen first.
"Can you share the data behind the 40% OON claim?" It's from commercial claims analysis (2024-2025). If they push further, cite the structural drivers: BH providers are disproportionately OON because carrier reimbursement rates are 30-50% below what BH facilities need to operate. The facilities that stay in-network have the lowest quality standards. The best programs go OON because they can command higher rates.
"Why should I trust a governance artifact from a company I've never heard of?" The artifact documents what the reviewer found. The reviewer is external, credentialed, and named. The methodology is published. The standard is versioned. The audit trail is immutable. The trust isn't in the company. The trust is in the structure.
"What happens if you get hit by a bus?" The methodology is documented. The standard is published. The evidence is in three populations. The operational playbook exists. A solo founder is a risk. It's also the reason the model isn't polluted by investors who'd push for premature scaling. The plan is to build a team around the methodology, not around the founder.
"We tried an audit program before and it wasn't worth the hassle." Ask what they tried. Most audit programs are retrospective — they found errors 18 months later and recovered 50-70% after provider disputes. Caliber prevents the overpayment before payment. Different model, different math.
"Our TPA says they already do independent review." Independent from whom? The TPA reviews its own claims processing. That's not independence. A TPA offering "independent review" has the same conflict as a company auditing its own financials.
You can know everything in this guide and still sound wrong. The voice matters.
Be direct. Short sentences. Plain words. "We measure whether the care worked" not "We leverage our proprietary analytics platform to assess post-discharge clinical outcomes."
Be specific. "$38,000 average episode" not "episodes can cost tens of thousands." "PHQ-9 at 90 days" not "we track outcomes over time." Numbers, instruments, timeframes. Specificity signals that you've done the work.
Be honest. "We don't have clients yet" is a fact. "We're in stealth mode" is a dodge. The former builds trust. The latter destroys it. Say what's true. Omit what's confidential. Never fabricate.
Be calm. You're not pitching. You're explaining. If they're interested, they'll ask more. If they're not, no amount of enthusiasm will change that. The model either survives their scrutiny or it doesn't. Let it stand.
Let silence work. After you say something that lands — the readmission warranty, the 60% RIR, the independence wedge — don't fill the silence. Let them process. The best sales happen in the pause after a strong statement, not in the follow-up sentence that dilutes it.
You're ready when you can do all of the following without notes, without hesitation, and in your own words — not memorized phrases from this guide:
The standard: If a former UHC Networks president who now advises a16z asks you a question about either company, you should be able to hold the conversation for 30 minutes without needing to defer to the founder. That's expert level. That's what this guide is designed to produce.
| Document | What it is | Where |
|---|---|---|
| Curated Canon | Complete internal strategy. Everything the company believes and why. | curatedhealth.care/curated_canon.html |
| Curated Deck | 11-slide executive briefing for external audiences. | curatedhealth.care/curated_deck.html |
| Curated Field Guide | 9-section operational playbook. Episode lifecycle, provider vetting, navigator model. | curatedhealth.care/curated_field_guide.html |
| Curated Growth Playbook | GTM strategy. Client sequencing, broker channel, conference plan. | curatedhealth.care/curated_growth_playbook.html |
| Curated Employer Brief | One-page printable for benefits VPs. | curatedhealth.care/curated_employer_brief.html |
| Cadence Canon | Complete internal strategy. Methodology, evidence, pricing, competitive position. | showyourwork.health (internal) |
| Cadence White Paper | Published methodology and evidence synthesis. | showyourwork.health (internal) |
| DURA Study | NIH All of Us validation. 30,734 patients. 29.1% flag rate. | Under review |
| Platform Overview | Combined Cadence + Curated + Caliber deck for strategic audiences. 11 slides. | curatedhealth.care/corridor_platform_deck.html |
| Caliber Canon | Complete internal strategy. 16 sections. Methodology, evidence, pricing, competitive position. | verifythebill.com (internal) |
| Caliber Site | Public site. Calculator, seven checks, certificate preview, triad platform section. | verifythebill.com |
| Number | What it means | Company |
|---|---|---|
| 200,000+ | Patients served by the founder across BH operations | Both |
| 13 | Clinical areas Curated covers | Curated |
| 30-day | Readmission warranty window (SUD residential + acute psych) | Curated |
| $4-7 | PEPM range for Curated | Curated |
| 65,234 | Total patients across three Cadence validation cohorts | Cadence |
| 25-29% | Convergent flag rate across all three populations | Cadence |
| 58-60% | RIR range across Cohorts 1 (60%) and 2 (58%) | Cadence |
| 3.1% | Break-even RIR. Measured: 60%. Headroom: 19x. | Cadence |
| 22.3% | Patients with zero relevant labs during entire continuation (NIH) | Cadence |
| 40% | SUD claims that are out-of-network | Curated |
| 50% | GPR — advisory signals that persisted without compulsion | Cadence |
| $13.9M | Cross-cohort first-cycle GSV | Cadence |
| 4-6% | Documented billing inaccuracy on high-cost claims (OIG, AHLA, MGMA) | Caliber |
| 7 | Required verification checks per claim above threshold | Caliber |
| 14-60 days | TPA payment-hold window. Caliber operates within it. | Caliber |
| $2-5 | PEPM range for Caliber billing governance | Caliber |
| $1.8M | Triad revenue per employer (Year 2, modeled, employer sizes vary) | All Three |