The payer can't occupy the post-authorization space without triggering its own utilization management obligations. An independent party can. That structural asymmetry is the entire portfolio.
Authorization determines whether a treatment begins. Almost nothing systematic determines whether it should continue, whether the episode is coordinated, or whether the claim is accurate. Three structural failures in the space between approval and outcome.
The payer can't occupy this ground without triggering its own UM obligations. An independent party can. That structural asymmetry is the moat.
High-cost therapies refill on autopilot. Nobody reviews whether the clinical basis for renewal still holds. The population-level governance gap that no standard edit library was built to catch.
→ CadenceBehavioral health treatment has no episode architecture. No intake-to-follow-up continuity. No outcome measurement. No readmission accountability. The member falls through every handoff.
→ CuratedBehavioral health claims process through standard edit libraries that weren't designed for the billing patterns unique to BH and SUD. The inaccuracy rate is 4–6%.3 The employer pays anyway.
→ CaliberMost of the waste in post-authorization healthcare has a name, a patient, and a billing code. The question is whether anyone is reading them.
One platform, three governance layers. Cadence, Curated, and Caliber sit at the depth each one governs—three illuminated doorways set into a single passage that runs from the payer's gate to the patient's outcome.
Three governance doorways between the payer's gate and the patient's result. Each one measures what the system currently ignores.
Structured review of high-cost chronic therapies refilling without documented clinical justification. Cadence measures the population-level continuation gap—the patients who keep refilling because nobody checked whether they should.4 Documented methodology. Three independent cohorts. Sealed governance certificate at each cycle.
One navigator per episode. Outcome measurement at intake, discharge, and 90 days. Bundled pricing with no balance billing. Every referral tracked from intake to follow-up. The behavioral health benefit your members need, with the outcome data most plans have never been able to produce.
Independent billing verification during the TPA hold window. Seven checks on every claim above threshold. Advisory-only—Caliber never contacts providers, never issues payment instructions. The verification layer standard edit libraries weren't built to provide.
The payer built the gate.
Nobody built the corridor.
Not a report. Not a dashboard. A versioned governance certificate with methodology, population scope, findings, and signature. The kind of document an auditor can hold.
One person from intake through follow-up. Not a call center. Not a rotating queue.
Bundled pricing. No balance billing. The cost is known before treatment begins.
90-day follow-up is standard, not optional. Someone checks whether the outcome held.
High-cost therapies are evaluated for continued clinical basis. No autopilot refills.
A sealed, versioned document with methodology, scope, and findings. Not a slide deck.
29.1% of the specialty population flagged for governance review. Quantified, not estimated.
Claims checked before they pay, not after. Seven checks per claim above threshold.
Every flag, every review, every decision documented. The record an auditor can hold.
Sealed, versioned document per review cycle. Methodology, population scope, flag rate, findings, and signature. The artifact that proves the governance happened.
Population-level quantification. Not a projection. Not an estimate. The actual percentage of the book that governance identifies for review. Currently 29.1% across three cohorts.
Every flag, every review, every decision. Timestamped. Documented. The kind of record that survives a regulatory review or a stop-loss audit.
Governance measures.
Something still has to deliver.
Continuum is the only entity in the portfolio that delivers care directly. Virtual-first substance use disorder and MAT treatment. Every patient gets a named navigator who stays with them from intake through follow-up. SAMHSA-certified. DEA-licensed. The delivery layer that makes the governance measurable.
One founder. Both sides of the table. Every product built from the gap between them.
CEO of a multi-service health system through acquisition. 200,000+ patients across the entire system.2 13 locations. DEA-licensed, SAMHSA-certified, JCAHO-accredited narcotic treatment programs. Behavioral health, SUD/MAT, primary care, urgent care, lab, imaging, surgical center, and a community hospital.
Founded and sold ClearBill, a billing integrity platform that returned $9.2M to payers in its first six months of full deployment.1
Staff Vice President of Carelon Growth (Elevance Health) across six specialty clinical risk books and $50B+ in spend. The view from the authorization side.
Built the programs. Managed the risk. Now building the governance layer for every gap between them.
I built the programs the payer was trying to govern. Then I sat inside the payer and saw what they couldn't reach. Corridor is the infrastructure for that space.
— Joe NalleyWhether you're a broker, consultant, stop-loss carrier, PE partner, or strategic advisor, the conversation starts with 30 minutes.