Authorization decides whether care starts. Nobody governs what happens between the first dose and the renewal. Three products. Three layers. Each generates a governance certificate — documenting what happened, what it cost, and whether it worked.
At renewal, the portfolio replaces anecdotes with evidence. Not a report. A certified governance record.
Governance requires independence. The entities that process, pay, and profit from claims cannot certify their own accuracy. The same company that manages the pharmacy benefit cannot govern continuation. The same company that routes the referral cannot measure the outcome. That structural separation is the moat.
Every product generates a certificate. Together, they form the only portfolio that documents what happened between authorization and renewal.
Specialty pharmacy continuation governance. Three independent cohorts. Published methodology.
Episode-based behavioral health with outcome measurement at intake, discharge, and 90 days. 30-day readmission warranty.
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.
Six high-acuity clinical books at a top-three national payer. Oncology, MSK, CHF, maternity, autoimmune, dementia. Founded and sold ClearBill, a billing integrity platform that returned $9.2M to payers. CEO of a multi-service health system through acquisition — 200,000 patients, 13 locations.
Built the programs. Managed the risk. Designed the governance layer for each.
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Adjust the sliders. The calculator models each product independently, then combines them into a single portfolio ROI.