At-Home Accountable Complex Care

Seniors don’t become seriously ill all at once.
They cascade into it.

The heart failure slows a wound from healing. The wound turns into an infection. The infection means a hospital stay, and the hospital stay costs the strength that was holding everything else together. Silver Health Plus finds the cascade while it is still early. It sends its own clinicians into the home to interrupt it. It contracts to be paid on what that prevents.

Talk to our clinical team
Silver Health Plus · 40-second overviewAnimated explainer · 8 scenes · narrated · soft music
Silver Health Plus · 40-second overview · storyboard

1. Meet Mary. Diabetes, heart failure, five prescriptions from four doctors.
A composite patient, and a common one. The numbness in her feet she puts down to age. No one sees the whole picture.

2. A steroid raises her glucose. She falls. The ER never learns why.
Each specialist treats one problem. The medication conflict behind it goes home with her.

3. Then, in a spot she cannot feel, a wound appears.
Heart failure slows the healing. The wound her nurse dresses keeps returning, because nothing behind it is being treated.

4. One condition triggers the next. That is the cascade.
Wound to infection, infection to hospital, each crisis leaving her weaker than the last. Not bad luck. A pattern.

5. Most of the 5% of seniors who drive half of Medicare’s spend got there this way.
68 million Americans are on Medicare. Roughly half of everything it spends goes to seniors living with compounding conditions like Mary’s.

6. We find the cascade while it is still early.
A recent admission. A medication list that has stopped making sense. Weight quietly dropping. A wound that will not heal.

7. Our own clinicians go into the home and interrupt it.
For Mary, that means the medicine cabinet, the refrigerator, and the conversation her doctors do not have time for.

8. And we contract to be paid on what that prevents.
Not every acute event can be prevented. We take accountability for the share that can be measured across the population, against the terms of the contract.

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1 Where we focus

Half of Medicare’s spend comes from 5% of its people, and most of them got there by cascade.

68M
Americans are on Medicare today.
5%
account for roughly half of everything Medicare spends. By the time a patient is counted here, the expensive part has already happened.
79%
of people over 65 live with two or more chronic conditions. The 5% came from here, moved by a cascade that ran six to eighteen months before the first acute event.

This is our cohort. Findable early. Reachable at home. Preventable by intervention.

We watch for several signals at once. The first is a recent hospital admission. Others are a medication list that has stopped making sense, weight that is quietly dropping, and a wound that will not heal.

The wound matters most because it is the one you can actually see. 16.4% of Medicare beneficiaries, about one in six, some 10.5 million people, live with a chronic wound. In this cohort it is usually the first outward sign that the conditions underneath have begun to compound.

CMS Medicare enrollment data · Peterson-KFF Health System Tracker (MEPS) · CDC, Preventing Chronic Disease, 2025 · chronic wound prevalence per Carter, Fife et al., Journal of Medical Economics, 2023. Full citations on the Disclosures page.

2 What we do

Find the cascade. Interrupt it. Stand behind the result.

01 · We meet the cascade in more than one place

In the home, continuously. From the first days of a high-risk admission. At the wound center. Every visit screens for what is underneath. The same care plan runs in all three.

02 · We put our own clinicians in the home

Nurse practitioners and nurses who practice under our protocols and clinical governance, not a referral service, not a call center. They open the medicine cabinet, look in the refrigerator, and treat what they find.

03 · We run one care plan across every setting

Home, hospital, wound center, rehabilitation, home again. One plan and one record travel with the patient, updating after every encounter.

04 · We take accountability for the outcome

Value-based contracts with MA plans, ACOs and at-risk health systems. We are paid on what the care prevents rather than on the visits we perform.

There is no single front door, because a cascade does not announce itself in one. We engage it where it actually plays out month after month. We engage it at the moment an admission signals it has accelerated. We engage it at the visit where it first becomes visible. The same care plan is running in all three.

The platform determines what is due and records what happened; the clinician at the bedside decides what is done.

Taking accountability is the part that makes the rest of it real. We hold value-based contracts on defined populations, and we are paid on what the care prevents rather than on the visits we perform. Not every acute event can be prevented; we take accountability for the share that can be measured across the population against the terms of the contract.

3 The cascade

One patient, eighteen months. The risk was on every chart. Nothing intervened.

Figures are annual cost of care for a composite patient built from named clinical events. Not a single patient’s claims history; not a prediction for any individual. Sources on the Disclosures page.

The wound is not the disease. It is the thing that finally becomes visible.

Neuropathy, vascular disease, and impaired healing converge quietly; the wound is where they surface. Found early, the path is treatment at home. Missed, the path runs through infection and admission.

4 Who we work with

We sit alongside the people already caring for these patients.

Health systems

Accountability from the high-risk admission through the thirty days after discharge. Your admissions and referral relationships stay where they are.

For health systems →

Medicare Advantage plans & ACOs

Narrow-slice total-cost accountability on a defined cohort, the members where intervention actually changes the number.

For payers →

Home health & wound care groups

A funded path from fee-for-service into complex care, on the census you already have.

For affiliates →

Start with the patients you are already worried about.

Forty-five minutes is enough to be specific. We will walk through your complex senior population and show where the cascade is already running. We will set out what our clinical team would do and what we would contract on. Share discharge, claims, or wound-census data, and we will return a defined cohort, an operating design, an implementation path, and an economic model.

Talk to our clinical team

HIPAA compliant* · SOC 2 Type II in progress · HITRUST in progress · Built for Medicare Advantage

Our Approach

The medicine cabinet.
The refrigerator.
The conversation.
The floor.

That is where complex seniors are cared for, or quietly missed.

The compounding crisis doesn't start in the hospital. It starts in the home, in the conflicting prescriptions, the missed vital signs, the gaps between specialists that no clinic visit can see. SHP is built to find it there.

Our Approach · 23-second overviewAnimated explainer · 5 scenes · narrated · soft music
Our Approach · 23-second overview · storyboard

1. Home is where complex seniors are cared for, or quietly missed.
The medicine cabinet, the refrigerator, the conversation, the floor. The compounding crisis starts there, long before any clinic visit can see it.

2. When the signal fires, a care protocol activates.
Proactive signals, clinical signals, and acute events all open the same door. A condition-specific protocol, activated before the crisis rather than after it.

3. Our clinicians go into the home and treat what they find.
High-frequency clinical care for seniors with compounding chronic conditions, delivered where early intervention changes outcomes.

4. One organization, accountable across settings, under one contract.
SHP authors one care plan per patient and drives it across every setting. Financial accountability follows the outcome.

5. One model, configured to you, your population, and each patient.
Engagement and contract structure set to your organization. Episodes designed around your population. Each patient re-profiled as the clinical picture changes.

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The medicine cabinet

Polypharmacy. Missed doses. Drug interactions. 5 prescriptions, 4 doctors, 0 reconciliation.

The refrigerator

Malnutrition. Uncontrolled diabetes. Weight loss. Sparse shelves, poor appetite, weight dropping.

The conversation

Beliefs. Motivation. Isolation. Living alone, skipping meals, not telling anyone.

The floor

Fall risk. Immobility. The next hospitalization. A fall at 2am, 20 minutes alone, no one knows.

SHP sees the whole picture.

1 Clinical entry points

Complex care protocols activate when the signal fires, not after the crisis.

SHP monitors complex seniors through multiple clinical channels. When a signal pattern crosses a threshold, a condition-specific care protocol activates.

Proactive signals

Multi-condition interactions, medication conflicts, functional decline. The pattern across conditions is the signal. 1, 2

Clinical signals

A wound or condition change reveals deeper risk. The wound is visible. Behind it: CHF, PAD, diabetes, polypharmacy. 3

Acute event triggers

ED visit. Admission. Readmission. The first crisis happened. SHP prevents the next one. 4, 5

A structured clinical response that activates at the point of care and coordinates across every provider and setting the patient touches.

  • Full multi-condition assessment across 13 body systems
  • Medication reconciliation across all prescribers
  • Cross-specialist coordination and escalation
  • Continuous RPM monitoring between visits
  • Care plan that follows the patient across every setting
  • Documented outcomes linked to VBC contracts

What SHP is not:

Home health staffingGeneric remote monitoringHospital-at-home onlySoftware dashboard without care execution

Sources 1–5: published clinical research. See Disclosures for full citations.

2 Two loops. Opposite directions.

The problem compounds against the patient. SHP compounds for the partner.

Each condition triggers the next. The cascade is not linear, it is exponential. It plays out quietly, at home, between visits.

For payers. Total cost of care drops for the members driving the most avoidable spend. The same members experience fewer acute events, fewer hospitalizations, and more continuous clinical support, which shows up in satisfaction scores and plan loyalty. The value accrues to the member and the plan simultaneously.

For health systems. Every patient discharged into the program generates a longitudinal clinical record that comes back, conditions, interventions, transitions, responses. Visibility into the home you didn't have before.

3 The SHP execution model

At-home clinical care. Cross-setting accountability. One organization. One contract.

One · At-Home Complex Care

High-frequency clinical care for seniors with compounding chronic conditions, delivered in the home, where early intervention changes outcomes.

48h
In-home deployment†
4+
Conditions managed
30d
Post-discharge window

Two · Cross-Setting Accountability

SHP authors one care plan per patient and drives it across every setting. Every transition briefed. Every encounter re-profiles the patient.

4
Settings in one plan
3
Payment model types
1
Accountability loop

Neither engine works alone. At-home care without orchestration is a silo. Orchestration without at-home care is a dashboard. SHP runs both, and the data flows between them.

At-Home Complex Care

  • Episode opens at the high-risk admission; clinical team in the home within 24–48 hours of discharge or enrollment,† before the highest-acuity window closes
  • CHF, PAD, diabetes, polypharmacy managed as one clinical picture, condition-specific protocols, integrated into a single care plan
  • One accountable team for the whole patient, not one specialist per organ

Cross-Setting Accountability

  • One cross-setting care plan, authored by SHP, re-profiled continuously to reflect current clinical reality
  • Every setting transition briefed on current patient status and next priorities
  • Patient outcomes as the measure, financial accountability follows

† Target from patient handoff to first at-home visit. Subject to operational readiness, payer credentialing, and affiliate onboarding. Actual timelines may vary.

4 Configured, not custom

One model. Configured to you, your population, and each patient.

SHP runs one operating model, configured down three levels, never rebuilt from scratch, every configuration assembled from a standard SHP protocol library. That is what lets SHP take accountability in precision slices: each contract backed by a precisely defined service and the delivery model built to run it.

Level 1 · To your organization

The engagement mode, contract structure, and accountability loop are configured to who carries the risk: a health system, a payer, or an ACO. The same model engages all three. You enter it on your terms.

Level 2 · To your population

MPARC episodes are designed around your discharge and risk profile. Episode length, visit cadence, monitoring intensity, and protocol set are configured per department (ortho, CHF, vascular, med-surg), each drawn from the standard SHP protocol library.

Level 3 · To each patient

The cascade is individual. Each patient's protocol is designed to re-profile as the clinical picture changes: the right intervention, at the right intensity, at the right moment.

Configured, not custom. Every unit is assembled from standardized, validated components, which is what lets SHP craft a tailored risk unit, delegate it, and manage its performance at scale.

“A Stage 4 pressure ulcer in the home is not a wound care problem. It's a systems failure. SHP treats the system.”

5 Who built this

Operators who have run this before.

SHP is not a first attempt at complex care. The leadership team has built, scaled and exited the businesses this model depends on.

Wound care at national scale

Built the largest wound care company in the United States by EBITDA, and deployed the largest post-acute clinical wound care program.

Mobile provider operations

Scaled a fully digitized mobile provider group across five states.

Payer and platform experience

Operating experience across 40+ payer customers, and healthcare interoperability and administrative software built at scale.

Clinical evidence

160 peer-reviewed publications across wound healing, tissue repair and complex chronic care.

Track record

Three companies built to market leadership. Two exits across healthcare services and software.

Clinical governance

Clinical protocols are owned by SHP’s Chief Medical Officer. Every clinical decision rests with the treating clinician at the point of care.

Operating history refers to prior companies and is not a representation of SHP’s own performance. Leadership and clinical governance are introduced by name under NDA.

6 Performance benchmarks

What comparable programs have achieved.

41%
Hospitalization reduction in comparable programs
Strive Health / AJMC, 2025; VA HBPC Program
25%
Fewer 30-day readmissions in similar models
Advances in Wound Care, 2020
>60%
Of hospital spend estimated as avoidable
AHRQ PAC Analysis; Vascular Surgery Literature
$18K
Modeled cost avoidance per patient
Modeled from AJMC / AHRQ literature

All figures reflect published benchmarks from comparable programs or modeled projections from peer-reviewed literature. They are not representations of SHP's own performance history.

Walk your clinical team through the modelView the Platform
The Platform

Three places where accountability breaks down. One system that closes all three.

At the bedside

High-acuity patients are managed differently by every clinician, at every visit.

At transitions

Every setting starts from scratch. The patient deteriorates in the gap.

At payment

Savings are claimed but rarely documented at the encounter that produced them.

Solving any one of these in isolation does not change outcomes. SHP connects all three into a single closed-loop system, from the bedside encounter to the performance contract, with no gaps.

1 Integration

No rip-and-replace. No parallel system. Designed for 90-day go-live.

FHIR R4 · HL7v2 · Direct Secure Messaging · Standard API endpoints. Go-live within 90 days of data access and executed contracting, subject to your change-control and security review.

Standards-based integration targets

Epic · Cerner · Athena · MatrixCare · WellSky · PointClickCare

These are integration targets, not live production interfaces. Connectivity is scoped and validated with each partner during implementation.

Remote Monitoring (RPM/RTM)

Continuous vital ingestion · Alert escalation · Medication adherence signals · Same-day clinical response to alerts meeting escalation criteria

Data Standards

HL7 FHIR · CDA · ADT feeds · Claims data ingestion · SDoH data layers

Deployment

API-first · 90-day go-live target · Start with a defined patient cohort

2 How the platform works

One closed loop. Risk to proof to payment.

Whether the contract is with a payer or a health system, the architecture is the same. Watch the loop run, or step through it below at your own pace.

The Platform · 23-second overviewAnimated explainer · 5 scenes · narrated · soft music
The Platform · 23-second overview · storyboard

1. Accountability breaks in three places.
At the bedside, where decisions vary by clinician. At transitions, where context is lost. At payment, where savings are claimed but not documented.

2. Every encounter produces structured evidence.
Guided assessment and guided interventions at the point of care. The same protocol and the same data model, at every visit.

3. Context follows the patient across every setting.
The hand-off is briefed, the care plan travels, and no setting starts from scratch.

4. Every outcome reconciles against the contract.
The evidence assembles at the encounter that produced it, and reconciles against the terms of the agreement.

5. Risk to proof to payment. The loop closes.
One architecture for payers and hospitals. Built from operating experience, not bought.

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One architecture. Payer or hospital. The loop is the same. You cannot buy this loop. You have to build it from operating experience.

3 Security & compliance

Built for the regulatory environment of enterprise healthcare.

HIPAA Compliant*

All data handling, storage, and transmission meets HIPAA Privacy and Security Rule requirements.

SOC 2 Type II

Audit in progress. Controls are designed and operating for availability, confidentiality, and security.

HITRUST

Certification in progress: the gold standard for healthcare information security risk management.

Structured Data

Every clinical encounter generates auditable structured data: the documentation contracts require.

SOC 2 Type II and HITRUST certifications are in progress; current status and expected completion available on request. *HIPAA compliance is self-attested; see Disclosures.

See how it connects to what you already run
Health Systems

Reduce readmission risk from the admission, not from the discharge.

SHP opens the episode at the high-risk admission and is in the home within 24–48 hours of discharge.† Coordination runs through 30 days, aligned to measurable outcomes. No structural change is required. Index admissions are unaffected: DRG revenue is protected, referral relationships are left where they are, and the capacity a return admission would have consumed stays available.

See your population
Post-acute discharge (MPARC) · 37-second overviewAnimated explainer · 8 scenes · narrated · soft music
Post-acute discharge (MPARC) · 37-second overview · storyboard

1. We start from your data, not a template.
We analyze your admission and discharge cohort to find where intervention actually changes the number, CHF, vascular disease, wounds, polypharmacy, prior readmissions. The program is scoped to what your population needs, not to what we sell.

2. Every service line gets the protocol built for its patients.
Episode length, visit cadence, monitoring intensity and protocol set are configured per service line and then per patient. All assembled from one standard library. An ortho discharge is watched for falls and wound complications; a CHF discharge is watched for daily weight and diuretic response.

3. The hand-off is arranged while the patient is still in the building.
Durable medical equipment ordered and delivery confirmed, the primary care physician briefed, specialist follow-ups booked. Medications reconciled against what changed during the stay. Day one at home is then not the day everyone starts making phone calls.

4. Our clinical team is in the home within 24–48 hours.†
Remote monitoring live, medications reconciled, wound protocol active, inside the window where the readmission is still preventable.

5. What happens in the home comes back to your team.
Structured findings flow continuously into your care management team, weight trending, wound trajectory, medication changes, escalations. The kind of visibility a discharge summary cannot give you, and it is the same signal that decides how long the episode should run.

6. Thirty days is a starting point, not a rule.
Every re-assessment can extend, narrow or close the episode. A patient whose wound is closing and whose weights are stable comes off early. A patient who deteriorates at day 24 keeps the team, the monitoring and the guardrails until the risk has actually passed. Your team sees the decision and the reason behind it.

7. Preventing a readmission also gives you the bed back.
Every readmission avoided is capacity released for the cases your system is actually built for, surgical volume, higher-acuity referrals, shorter waits. The penalty avoided is only half the value.

8. A better experience for the patient, and a better use of your capacity.
The patient recovers at home instead of in an ambulance bay, with one team that knows them. The bed you do not spend on a preventable readmission is a bed you spend on the work your system is built for. † Target timeline; see the footnote on this page.

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Wound Center Transformation · 28-second overviewAnimated explainer · 6 scenes · narrated · soft music
Wound Center Transformation · 28-second overview · storyboard

1. Every wound in your center is a systems signal.
One in six Medicare beneficiaries, 10.5 million people, lives with a chronic wound. The wound is the visible edge of a polypathology picture your system is already paying for somewhere else.

2. Every visit becomes a screening event.
The same appointment that treats the wound surfaces the heart failure, the vascular disease, the diabetes and the medication conflicts behind it. It routes them to cardiology, vascular, endocrinology and primary care inside your system rather than out of it.

3. Documentation that supports the diagnosis and survives review.
Coverage criteria, medical necessity and frequency rules are checked before the encounter closes. The audit pack assembles itself per encounter. It is generated at the point of care rather than reconstructed for a retrospective reviewer.

4. From a wound center to a risk mitigation and referral center.
Same center, same clinicians, a different role in your system: polypathology managed, service lines connected, and complex cases flowing back to you for procedures instead of to a competitor.

5. Avoided admissions, retained volume.
Wounds caught and managed early are admissions that can be avoided. For the patient, that means less pain, fewer procedures and more time at home. For the system, it means volume that stays inside your network.

6. Your wound center starts participating in value.
Documented interventions count toward the shared savings your ACO contracts already support, and SHP’s Medicare Advantage VBC contracts add a revenue stream your wound center has never participated in.

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† Target from patient handoff to first at-home visit. Subject to operational readiness, payer credentialing, and affiliate onboarding. Actual timelines may vary.

1 Illustrative value map

Start with readmissions avoided. Then decide what one is worth to you.

Most vendor calculators produce a blended dollar total. This one shows the arithmetic. It shows how many of your discharges qualify and how many readmissions that avoids. It shows what an avoided readmission is actually worth given how you are paid. The answer differs for a penalized fee-for-service system and for one holding risk. MPARC applies across your Medicare book, traditional and Medicare Advantage alike; how you are paid changes what the avoided readmission is worth, not who is eligible. One note: the HRRP and VBP lines below reflect Medicare fee-for-service hospital mechanics. MA, ACO, bundle and owned-plan economics follow the applicable risk arrangement and are handled by the payment-position selector.

Northside Regional, an illustrative system

420 beds, 88% medical-surgical occupancy, orthopedics and cardiovascular service lines, 22,000 Medicare discharges home each year, penalized under HRRP. MPARC enrols the top 13%. These are the discharges going home with an active wound, heart failure, vascular disease and polypharmacy. Their 30-day readmission rate runs near 31% rather than the house-wide 15–20%. Each figure below is set to Northside, and each is adjustable. Set the inputs to your system.

Your system
Medicare discharges to home traditional and MA22,000
Meeting MPARC criteria the high-risk discharge cohort13%
Enrollment take-up60%
30-day readmission rate in that cohort, not house-wide31%
Average medical length of stay7.0 days
Clinical effect
Readmissions that are addressable all-cause median is 27%40%
Modeled success rate on those in the home within 48 hours75%
Capacity
Bed-days you can actually backfill occupancy-dependent60%
Contribution margin per backfilled bed-day your number$1,300
Regulatory exposure
Medicare base operating DRG payments annual$200M
Your HRRP penalty median is 0.69%, cap is 3%0.69%
Penalty from cohort conditions HF, COPD, pneumonia40%
VBP withhold you expect to recover via MSPB and outcomes5%
Do you hold risk on these patients?
The arithmetic
Medicare discharges to home–
× meeting MPARC criteria–
× enrolled –
× baseline readmission rate–
× addressable –
× modeled success rate –
Readmissions avoided each year–
What that is worth
Bed-days returned–
× backfilled–
Capacity value · your P&L–
Avoided readmission cost · accrues to the payer–
HRRP penalty you pay today–
HRRP penalty relief modeled · your P&L–
VBP withhold at stake · 2% of base DRG–
VBP recovery modeled · your P&L–
HAC exposure · 1% if in the worst quartile–
Annual value in your P&L
––

–
–

Why the quality programs belong here. Hospital VBP withholds 2% of your base operating DRG payments and redistributes it on a Total Performance Score built from four domains weighted 25% each. One of them, Reduction of Cost and Efficiency, is measured by Medicare Spending Per Beneficiary. That measure counts spending from three days before admission through 30 days after discharge. That is the exact window MPARC operates in. Clinical Outcomes covers mortality in heart failure, pneumonia and COPD. The HAC Reduction Program takes a further 1% from the worst-performing quartile, and pressure ulcers sit in that measure set. All three are peer-relative. You can improve and still lose. The recovery slider is therefore set low and left to you.

Illustrative. This is value created, not net return. Commercial terms are set in your agreement and are not modeled here. The readmission reduction is derived, not borrowed: addressable share × success rate, both set above. It is not an SHP result.

Medicare pays per case, not per day. A returned bed is worth its contribution margin, and only if it is refilled.

Relief is capped. HRRP charges for excess readmissions. You cannot recover more than you are being charged.

The reduction is derived, not quoted. Addressable share times success rate, both on sliders above.

Why capacity is the honest hospital number. A returned bed-day is only worth something if you fill it. At 88% medical-surgical occupancy with a surgical backlog, most of it converts; at 65% occupancy, very little does. That is what the backfill slider is for, and it is the assumption most vendor models quietly set to 100%. Contribution margin per backfilled bed-day is your figure, not ours, it depends on your case mix, your payer mix and your cost structure. We default to $1,300 as an illustration, roughly $2,900 of revenue per occupied Medicare bed-day at a 45% contribution margin, and expect you to change it.

The defaults describe a precision slice of your discharges, not a broad post-discharge sweep. That is deliberate, and it is how MPARC is designed to be run. The share meeting MPARC criteria is set at 13% of discharges: the patients going home with an active wound, heart failure, vascular disease, polypharmacy or fall history together. In that group a 30-day readmission rate near 31% is the relevant baseline, not the 15–20% you would quote house-wide. Note the two move together. Widen the criteria and the cohort rate falls, because you are reaching further down the risk curve. Enrollment take-up of 60% reflects a cohort this sick, identified before discharge, with the hand-off arranged while the patient is still in the building.

Why the targeting matters more than any other input. The number of episodes needed to avoid one readmission is 1 ÷ (baseline rate × reduction). At a 31% baseline and a 30% reduction that is roughly eleven patients; sweep the same program across an 18% baseline population and it is nineteen. The same program then costs more than twice as much per readmission avoided. Widen the criteria slider and you will watch the value per enrolled patient fall. That is the honest behaviour of the model. It is also the reason MPARC is scoped with precision rather than sold by volume.

MPARC is not gated by Medicare Advantage. Eligibility is clinical. Traditional Medicare and MA discharges both qualify, and both are counted above. What Medicare Advantage changes is the value of an avoided readmission, which is what the payment-position selector handles.

What an avoided readmission is worth. Under fee-for-service, an avoided readmission removes revenue as well as cost. The near-term value is therefore the bed and the penalty position, not a cash saving. We do not add avoided cost to your total. Under HRRP the penalty is up to 3% of base operating DRG payments across all Medicare discharges. It is driven by excess readmission ratios. A single avoided readmission therefore moves a ratio rather than producing a dollar. We do not put a figure on it. Where the system holds risk, the avoided cost is genuinely yours. AHRQ puts the average Medicare 30-day readmission at $18,100 (HCUP, 2020). Only then does it enter the total.

Why the reduction is derived rather than quoted. Published coordinated-care programs report 20–30% reductions in readmission rates, and it is tempting to just use that figure. It is the wrong figure twice over. It comes from broad, largely telephonic care management across unselected post-discharge populations, a weaker intervention on an easier-to-miss cohort than a nurse practitioner in the home inside 48 hours. And it hides what it is made of.

A population-level reduction is the product of two things. How many readmissions could have been prevented at all, and how many of those you actually prevent. A systematic review of 34 studies puts the median share of potentially preventable readmissions at 27% of all readmissions. The share ranges widely by setting. It is driven by information-transfer failures, premature discharge, inadequate care planning and emergency department decision-making. The four things MPARC is built to intervene on.

So a 25% population-level reduction does not imply a 75% failure rate. Against a 27% addressable share it implies success on more than nine in ten of the readmissions that could have been prevented at all. Read the other way: the defaults above, 40% addressable, 75% success, produce a reduction of roughly 26–34%. The same headline number, with the mechanism visible and each half separately arguable. The addressable share is set above the 27% all-cause median because this cohort is selected for deterioration rather than disease progression. That is a judgement, and it is on a slider.

How penalty relief is modeled. Your HRRP penalty today is the percentage you enter applied to your base operating DRG payments. HRRP charges for readmissions above what your case mix predicts. The statute prices one excess readmission at roughly one base DRG payment divided by the ~18% expected rate. That is about five and a half payments. Relief is therefore the cohort-driven share of your penalty × the share of that excess the avoided readmissions remove, capped at 100%. You cannot recover more than you are being charged. Your finance team will raise three cautions. We agree with each. HRRP is peer-relative. Improving while peers improve faster still leaves you penalized. The adjustment lags the performance period by roughly two years. Only six conditions are measured. Heart failure, COPD and pneumonia overlap this cohort. Acute myocardial infarction, CABG and joint replacement largely do not. The cohort-share slider is where you encode that. Median FY2026 penalty across penalized hospitals is roughly 0.69% of inpatient Medicare reimbursement, with about three-quarters of subject hospitals penalized and a 3% statutory cap.

How VBP recovery is modeled. The withhold is 2% of your base operating DRG payments, redistributed on a Total Performance Score built from four domains weighted 25% each. MPARC touches two of them. The first is Reduction of Cost and Efficiency. That domain is measured by Medicare Spending Per Beneficiary across a window from three days before admission to 30 days after discharge. The second is Clinical Outcomes. It includes mortality in heart failure, pneumonia and COPD. We do not claim a score movement. The slider asks what share of the withhold you expect to recover and defaults to 5%, deliberately low, because VBP is budget-neutral and peer-relative. The pool is fixed and your gain is another hospital’s loss. The modeled range runs from 70% to 100% of whatever you set. The HAC Reduction Program is shown as exposure rather than value. It is a binary 1% for the worst-performing quartile. Pressure ulcers sit in its measure set. Exiting a quartile, however, is not something a coordination program can promise.

Sources: AHRQ HCUP Statistical Brief #307, Clinical Conditions With Frequent, Costly Hospital Readmissions by Payer, 2020, average Medicare readmission cost $18,100; Medicare all-cause 30-day readmission rate 17.0%. Hospital Readmissions Reduction Program, 42 U.S.C. § 1395ww(q). Preventable-readmission share: median 27% across 34 studies, per the systematic-review evidence summarised in Reducing Hospital Readmissions (StatPearls, NCBI Bookshelf). CMS FY2026 IPPS/LTCH final rule, VBP 2% withhold, HAC 1% for the worst-performing quartile. CMS FY2026 Hospital VBP Quick Reference Guide, four domains at 25% each, MSPB within Reduction of Cost and Efficiency.

Wound center program · your P&L

Where the system operates a wound center, converting it into a polypathology screening and referral engine adds professional revenue. Downstream cardiology, vascular and nephrology work stays inside the network. Modeled separately because it does not depend on the readmission chain above.

Affiliate economics · not your P&L

MPARC coordination revenue and home health census growth accrue to the affiliated agency, not to the hospital. Shown for completeness because it is what funds the at-home network serving your discharges, but it is their revenue, and we do not count it as yours.

Plan-side value · only if you hold risk

Shared savings and Star-rating movement are health-plan economics. They reach a health system only where it participates in an ACO, holds bundles, or owns a plan. If none of those apply, this value accrues to the payer and we do not show it as yours.

2 How the program is built, and what it returns

Scoped to your population. Configured to your service lines. Reported back to your team.

01

We scope the program from your data, then configure it per service line

Nothing starts from a template. We analyze your admission and discharge cohort to identify where intervention actually changes the number, then configure episode length, visit cadence, monitoring intensity and protocol set per department. An ortho discharge is not managed like a CHF discharge, and then per patient as the clinical picture moves.

Level 1: your organization. Engagement mode, contract structure and the accountability loop are set to who carries the risk: a health system, a payer, or an ACO.

Level 2: your population and service lines. MPARC episodes are designed around your discharge and risk profile. Ortho, CHF, vascular and med-surg each draw a different protocol set, episode length and visit cadence from one standard SHP library. That is what lets the model be tailored and still scale.

Level 3: each patient. The cascade is individual. Each patient’s protocol re-profiles as the clinical picture changes: the right intervention, at the right intensity, at the right moment.

Including how long the episode runs. Guardrails, not a fixed budget, define intensity and scope. Improving → guardrails narrow and the episode can close early. Deteriorating → guardrails widen and the episode extends. New risk → the journey re-scopes. The continuous signal from the home is what makes that a clinical decision rather than a guess, and the decision and its rationale are shared back to your team.

Configured, not custom. Every unit is assembled from standardized, validated components. The reason this can be delegated and performance-managed at scale rather than rebuilt for each partner.

02

The loop closes back into your care management team

Discharge is usually where your visibility thins out. Here it is where the signal starts. Structured findings flow continuously from the home back to your team while the patient is still inside your accountability window. The findings cover weight trending, wound trajectory, medication changes, escalations, and transitions. Every setting the patient touches briefs the next one, and the record comes back to you.

That loop is also what sets the episode length. Thirty days is where the program starts, not where it is required to end. Each re-assessment can narrow the episode when a patient is clearly recovering. It can extend the episode when the risk has not passed. It can re-scope the episode when a new risk appears. Post-acute intensity is therefore matched to that patient's actual risk profile rather than to a calendar. Every extension is a documented clinical decision, visible to your team with the reasoning attached.

Real-time structured data from every encounter is shared back to your care management team. It covers condition trajectory, risk indicators, intervention history and readmission-prevention performance. It is generated at the point of care rather than reconciled from claims months later.

Every patient discharged into the program generates a longitudinal clinical record that returns to you, conditions, interventions, transitions, responses. That is visibility into the home you did not previously have, and it is what makes the next admission avoidable rather than merely regrettable.

03

Preventing a readmission also gives you the bed back

The penalty avoided is only half the value. Every readmission that does not happen is capacity released. A bed, a slot, a nursing shift, and it is released for the cases your system is actually built for: surgical volume, higher-acuity referrals, shorter waits, better case mix. A complex senior cycling through your emergency department is the most expensive way to occupy a bed you could be using for the work you do best.

Capacity, then case mix. Avoided readmissions free beds and staffed hours. Those hours go to the higher-acuity, better-fit work your system is designed around. That is both better medicine and better economics than readmitting the same complex senior every few weeks.

Then the ecosystem tightens. Complex cases route back to your wound center for procedures rather than to a competitor. Your affiliated home health partner grows census. Documented outcomes strengthen the Medicare Advantage contracts you hold. Each turn of the loop makes the next one easier, and none of it exists in your P&L today.

13 body systems assessed at every visit, for every patient. Protocol sets are drawn from a standard SHP library and configured per department; capabilities reflect designed program architecture. See Disclosures.

3 Programs for health systems

Two programs. One accountability model.

Mobile Post-Acute Risk Care (MPARC)

The safety net for your highest-acuity patients, opened at the admission rather than at the door. It wraps wound, CHF, polypharmacy, and fall-risk discharges in continuous monitoring and rapid intervention before the readmission window closes.

48h
Deployment†
30d
Coverage
60–90d
To pilot
  • RPM monitoring, med reconciliation, same-day video, next-day in-home clinical response
  • Focused on wounds, CHF, polypharmacy, fall history: your HRRP exposure cohort
  • You discharge. We take it from there. Admission revenue protected.
  • Outcomes in the contract: HRRP reduction targets designed and measured from Day 1

Wound Center Transformation

Your wound center already delivers expert wound care. SHP takes it beyond, from treating the wound to managing the polypathology risk behind it. SHP also connects your wound center economics to your ACO performance and SHP’s MA VBC contracts.

Beyond
Polypathology
↓ Admin
Docs + automation
VBC
ACO + MA contracts

Beyond wound care. SHP surfaces the CHF, PAD, diabetes, and vascular signals behind every wound. It applies the most advanced clinical modalities for wound care. At the same time, it identifies and manages the conditions that caused the wound.

Service line coordination. Every wound center visit becomes a routing event, conditions identified at the bedside connect to cardiology, vascular, endocrinology, and primary care across your system.

Administrative efficiency. Documentation that supports the diagnosis, justifies the treatment, and withstands retrospective review, generated at the point of care. DME ordering, lab management, and supply coordination automated. Less paperwork. Lower audit exposure.

Improved ACO performance. Documented interventions that prevent hospitalizations now count toward the shared savings your ACO contracts already support. Same contracts, better performance.

SHP MA VBC contract economics. Shared savings, PMPM, and episode-based economics that flow through SHP’s accountability model directly to your system.

Step 1

Identify target population. Your admission and discharge data → the highest-acuity cohort.

Step 2

Configure care pathways. Condition-specific protocols from our standardized clinical architecture.

Step 3

Deploy through partner network. No new infrastructure required on your end.

Step 4

Track outcomes and economics. Real-time structured data back to your care management team.

From signed agreement to first patient enrolled, 60–90 days, subject to your EHR change-control and security review, and to credentialing. Your existing post-discharge workflows keep running; SHP operates alongside them rather than replacing them.

How much DRG revenue is at risk? See your population
Payers & Risk-Bearing Organizations

Own the cascade before it becomes the cost.

Condition-specific care programs for high-acuity Medicare members, aligned to shared savings and episode-based models. We work upstream of the 5% who drive half of spend, intercepting the members whose cascades are carrying them there, before the expensive part has happened. Configured to your population, assembled from a standard SHP protocol library, not built from scratch.

See your population
For payers · 23-second overviewAnimated explainer · 5 scenes · narrated · soft music
For payers · 23-second overview · storyboard

1. 5% of your members drive half your spend.
By the time a member is counted in the 5%, the expensive part has already happened.

2. The wound is the signal that too often goes unread.
85% of lower-extremity amputations are preceded by a diabetic foot ulcer. One in six Medicare beneficiaries lives with a chronic wound.

3. We manage the whole clinical picture in the home.
CHF, PAD, diabetes, polypharmacy surfaced at every encounter, coordinated across every setting.

4. Comparable programs report 25–35% lower total cost of care.
Modeled projections from published benchmarks, not SHP performance history.

5. We are paid on documented value, not volume billed.
Shared savings, PMPM, or episode-based, configured to your book. And the member experiences it as fewer emergency trips, fewer avoidable procedures and one team that knows them. That is what quality scores and member loyalty are actually made of.

▶ The animated, narrated version plays when this page is opened in a browser.

1 Outcomes and cost of care

Fewer wounds, faster healing, more recovery at home. The total cost of care follows the outcome.

Wound Risk Management is the first Accountable Cascade Management service. For the member, it changes what being sick is like. Wound care and the complex care around it are delivered where they live. The impact of underlying conditions such as vascular disease or medication conflicts is mitigated to enable timely wound healing. For members at risk, the program is built to prevent wounds from forming at all. Where a wound exists, it is built to close it sooner and to catch deterioration before it becomes an emergency trip, an admission, or an amputation. More of the member’s recovery happens at home. The economics follow the clinical result. When wounds heal and crises are prevented, the total cost of care for these members falls. The arithmetic below models that reduction. Commercial terms are set in contract.

Lakeshore Advantage, an illustrative plan

50,000 Medicare Advantage members. Roughly 5% carry interacting chronic conditions with a wound in the picture. Engagement is set to 40%, because these members are reached by outreach rather than at a hospital bedside. Each figure below reflects Lakeshore, and each is adjustable. Set the inputs to your book.

Your book
Medicare Advantage members50,000
Complex-cascade prevalence interacting conditions, wound in the picture5%
Engagement rate outreach-based, not discharge-bedside40%
Baseline cost
Total cost of care per engaged member all Medicare spend, per year$64,000
Share of it the wound drives the pool under management36%
Modeled savings
Net savings rate on the managed pool first-year modeled rate, net of all program economics69%
Contract structure
The arithmetic
Medicare Advantage members–
× complex-cascade prevalence –
× engaged –
Members in the program–
What that is worth
Total cost of care, engaged cohort –
× share the wound drives –
Wound-driven spend under management · modeled as displaced by delivered care and prevented deterioration–
× net savings rate –
Modeled reduction in cost of care
annual · engaged cohort–
≈ per engaged member per year–
≈ PMPM across your whole book–
Reduction in the engaged cohort’s total cost of care–

–
–

Illustrative. Each input is adjustable because each is contract-specific. The defaults are drawn from SHP’s operating model. The same figures the company plans against. All figures are modeled, not observed program results.

The wound drives roughly 36% of an engaged member’s total cost of care. Your claims data refines that figure.

Savings are measured against a trend-adjusted baseline. Never against the member’s own prior year.

The first-year rate compresses as a book scales. The slider covers the modeled range, not one favorable year.

Why 36%. A wound is not a wound line-item. Nussbaum et al., Value in Health, 2018, published a Medicare analysis of chronic wounds. It puts total Medicare wound cost at $28.1–$31.7 billion a year across roughly 15% of beneficiaries. It identifies hospital outpatient as the largest single site of service. It documents a shift out of inpatient over the last decade. We work from per-wound cost analysis across the seven wound types we manage, weighted to our expected case mix. On that basis, the wound and what it drives comes to roughly $27,500 of a $76,000 patient, about 36%. That is the pool on the slider. Plan-specific claims data will refine it, and is the first input we request.

Why a 69% net savings rate. The operating model projects that, in the first full contract year, roughly 69% of the wound-driven pool is realized by the plan as net savings. The rate compresses as a book scales and case mix broadens; the model carries it toward 52% by the second full year. The input therefore spans 30% to 80% rather than reflecting a single favorable year.

Replacement and prevention are both in that pool, and they are not the same thing. Part of what leaves your claims file leaves because we deliver it instead, the clinic visits, the debridement, the dressings and tissue products, the monitoring, the equipment. That part is a straight substitution and carries no clinical risk to you. The rest leaves because the wound does not deteriorate. The admission that does not happen, the nursing days that are not needed, the amputation that is avoided. That component depends on clinical performance, and it warrants the closest actuarial scrutiny. They are not separated on this page; plan claims data separates them more accurately than external assumptions can.

What your actuary will raise, and where we agree. A cohort selected on high recent cost improves somewhat on its own. Regression to the mean is real. It applies to the prevention half rather than the substitution half. It belongs in the baseline construction rather than buried in a vendor’s reduction rate. So: savings measured against a trend-adjusted or matched concurrent baseline, never against the member’s own prior year. Claims run out over three to six months, so interim reporting is flagged incomplete and reconciliation waits for complete claims. Quality gates sit alongside the savings calculation, which forecloses the path of saving by withholding care.

What this model does not count. No Stars or quality-bonus revenue. No member-retention value. No risk-adjustment or documentation-integrity benefit. No fraud recovery. That discipline belongs to the plan’s special investigations unit and prior-authorization controls; SHP is not a payment-integrity vendor. Those four are real, they are yours, and their size is specific to your plan. This page prices one thing: medical spend that stops being incurred.

Sources: Nussbaum et al., Value in Health, 2018: chronic wounds affect ~15% of Medicare beneficiaries at $28.1–$31.7B annually; hospital outpatient the largest site of service at $9.9–$11.4B. Carter, Fife et al., Journal of Medical Economics, 2023: chronic wound prevalence 16.4% of Medicare beneficiaries (10.5 million people). Mitchell, AHRQ Statistical Brief #535, 2022: the highest-cost 5% of beneficiaries account for roughly half of spend. Per-wound cost analysis and savings rates are drawn from SHP’s internal operating model and are modeled, not observed.

2 The four vectors

One result, four kinds of value. We model one of them.

An avoided acute event shows up in four places in a payer’s economics. The first is modeled above. The other three are real and accrue to the plan; their size is plan-specific, and we do not model them.

Avoided medical spend · modeled above

Claims that stop being incurred: the wound clinic, the products, the equipment, the nursing days, the admission that does not happen. The estimator above prices this vector and only this vector.

Stars & quality · not priced

Readmission, transitions-of-care and medication-reconciliation measures sit inside the window this program operates in. A ratings movement carries direct quality-bonus revenue; its magnitude is plan-specific. We claim the mechanism, not the dollars.

Documentation integrity · audit-positive

Point-of-care documentation by the clinician who performed the assessment, supporting diagnoses actually present. No retrospective chart review, and no compensation tied to risk-score movement. Against a documented 9.5% improper-payment rate, that is a structural safeguard, not a product feature.

Retention & experience · not priced

The member experiences the program as fewer emergency trips and one team that knows them. Complex members are costly to acquire and most likely to disenroll after an adverse episode; the retention economics are the plan’s to quantify.

3 Today vs. with SHP

Fragmented, reactive, expensive. Or integrated, proactive, value-driven.

Today’s reality · published benchmarks
$64,000/yr total cost of care per complex wound patient
20% readmitted within 30 days
85% of amputations preceded by a diabetic foot ulcer
$45–$150 PMPM avoidable cost across your MA population
With SHP · modeled projections
25–35% reduction in total cost of care
20–40% lower acute utilization · published range
Point-of-care documentation, not retrospective chart review
Provider and payer economics aligned in one contract

Today’s reality

$64,000/yr total cost of care. Per complex wound patient. Base Medicare + wound care + comorbidity management + ER + hospitalizations + amputations.

9.5% of MA payments improper. $23.67B in gross improper payments per CMS/OIG, primarily unsupported diagnoses. Documentation gaps, not fraud.

20% readmitted within 30 days. ~19% of those readmissions are preventable. $15K+ average cost per readmission. Up to 3% HRRP penalty on base DRG payments.

85% of amputations preceded by DFU. ~$100K per amputation. Many are considered preventable with earlier polypathology management. The wound was a signal that was not acted on in time.

$45–$150 PMPM avoidable cost. Across your total MA population, driven by the 5% of members no existing model manages effectively.

Risk profiling without intervention. Documentation-first models record deterioration. By the time claims show the signal, the admission has usually already happened.

With SHP

25–35% reduction in total cost of care. Proactive at-home intervention at a fraction of the cost it prevents. Published results from comparable coordinated care programs.

Point-of-care encounter documentation. Generated by the clinician who performed the assessment, supporting the diagnoses actually present and the treatment actually delivered. Reduces both under-capture and unsupported capture. SHP does not perform retrospective chart review and is not compensated on risk-score movement.

20–40% lower acute utilization. The published range across home-based primary care and coordinated complex-care programs, CMS’s Independence at Home demonstration and VA Home-Based Primary Care among them. Hospitalizations, ED visits and readmissions reduced before the acute event occurs.

Meeting patients where they are. Episodes open at the high-risk admission; at-home teams deploy within 24–48 hours of discharge, then coordinate across every setting.

Measurable quality improvement. Wound closure, healing time and patient experience measured against contract terms. Coordinated specialist wound programs in published literature report 12-week closure rates of 60–80%. SHP has no closure data of its own.

Provider and payer economics aligned. Providers earn from both clinical service delivery and the value-based economics generated by better outcomes. One contract structure in which provider and payer benefit from the same result.

Sources: CMS/OIG improper payment reports; Milliman actuarial analysis; Armstrong et al., Diabetes Care; AJMC 2025; CMS Independence at Home demonstration; VA Home-Based Primary Care. See Disclosures.

4 The program

Accountable Cascade Management. Wound Risk Management is the first service.

Chronic wound patients are the most identifiable high-acuity segment of your book. One in six Medicare beneficiaries lives with a chronic wound (Carter & Fife, 2023). These patients sit on a disproportionate share of avoidable spend. SHP uses the wound as the entry point to manage the whole clinical picture. The contract is a precision slice of your book: a defined cohort, a defined service, a defined measurement. Accountability your actuaries can underwrite. SHP earns from documented value generated, not volume billed.

Contract structure

Per patient per year, calibrated to population acuity and complexity. Shared savings, episode-based, or PMPM structures available.

Payback

12–18 months to full shared savings realization, per published performance timelines from comparable programs. Measurement begins in the first program quarter; early indicators may be available before final claims reconciliation.

What comes next

As outcomes data accumulates, additional Accountable Cascade Management services extend the model across the cascade: wound first, then PAD, lymphedema, and onward.

How does the contract actually work?

Shared savings, PMPM, or episode-based, configured to your existing requirements. SHP earns from documented value generated, not volume billed. Savings-share percentages are set per contract.

How do you identify the right members?

Clinical signals, claim history, and early decline indicators rather than risk scores alone. Wound patients are the entry point. The wound is the most visible signal of a compounding cascade. We target the members your risk models flag but your current network isn't reaching.

What does it cost to get started?

No upfront infrastructure cost. SHP deploys through its own delivery network and funds clinical operations under the terms of each contract. Configuration, cohort ID, and protocol setup are included.

How long before we see results?

Measurement begins in the first program quarter, with early indicators ahead of final claims reconciliation. Full shared savings realization typically 12–18 months based on comparable programs.

What data do we get back?

Real-time structured clinical data from every encounter, generated at the point of care, not reconciled from claims. Auditable, formatted for contract reconciliation. Your medical director team has dashboard access.

What data do you need from us to get started?

Claims data (12–24 months), member eligibility files, and current care management enrollment. Standard 837/835 formats. Most payer teams assemble these within two to six weeks, depending on internal data governance and security review.

Who delivers the care?

NP-led clinical teams with wound care and complex care certification. Protocol adherence monitored through SHP’s platform with real-time clinical governance oversight. Every intervention evidence-based, every encounter auditable.

What's the avoidable cost pool in your book?
At-Home Affiliates

The model is changing.
We fund the runway to get there.

SHP affiliation provides the capital, the technology and the payer contracts. Those resources move a mobile clinical business from a shrinking fee-for-service format into value-based mobile complex care. It starts with additive revenue on Day 1. This is not a vendor relationship. It is a structural partnership.

Coverage for cellular tissue products is tightening, and with it a reimbursement line that has helped support mobile wound care. The clinical work is not the problem. Most of what your clinicians already do around the wound has never had a billable home. Affiliation converts wound expertise into mobile complex care: same clinicians, same patients, wider recognized scope, and economics that rest on several programs rather than one coverage rule.

Model your wound census with us
For mobile wound provider practices · 37-second overviewAnimated explainer · 8 scenes · narrated · soft music
For mobile wound provider practices · 37-second overview · storyboard

1. Coverage for cellular tissue products is tightening.
A policy change on one category can reset the economics of a practice regardless of how well the wounds are managed. The clinical work is not the problem. Most of what happens around the wound has never had a billable home.

2. The wound is the most reliable entry point in senior care.
One in six Medicare beneficiaries lives with a chronic wound. You are already at the bedside of Medicare’s costliest spend.

3. Every clinician runs your best clinician’s protocol.
The assessment is built for this patient before the visit. Interventions are proposed with the evidence attached, the wound, and the heart failure, vascular disease and medication conflicts behind it. Your clinician approves or declines each one.

4. The paperwork is finished before you leave the driveway.
SOAP note, DME and supply orders with medical necessity attached, and codes supported by what was documented. Prior authorization is checked before the visit. Everything is generated as the visit happens and signed by the clinician.

5. Into your EMR, and your hospital’s.
The signed encounter lands in your own system, and outcomes flow back to the referring health system. The hospital refers directly to you and sees what happened, so the referral relationship becomes structural. Referrals follow clinical need and patient choice; no volume is promised.

6. The denial is prevented at the bedside, not appealed six months later.
Coverage criteria, medical necessity, frequency limits and formulary class are checked before the encounter closes. The audit pack assembles itself per encounter, with the evidence behind every decision attached.

7. More value out of the same visit.
A wider set of billable complex care work, coordination fees, performance bonuses and shared savings, spread across several programs rather than one coverage rule.

8. Mobile complex care.
Same clinicians, uplifted. Same visit, worth more, and patients seen earlier, managed more completely, and spared avoidable trips to hospital.

▶ The animated, narrated version plays when this page is opened in a browser.

Aggregate payments rise modestly. The base underneath keeps being cut. A 3% temporary clawback runs through CY2026 and is proposed to continue. MedPAC has recommended a further 7% reduction. The freestanding all-payer margin sat at 5.0% in 2024. Meanwhile, the patients being referred to you keep getting more medically complex. Your census, your clinicians and your homes are the asset. Affiliation converts episodic home health into mobile complex care, additive coordination revenue on the census you already have, from the first qualifying episode.

To be clear about the direction of money: SHP pays your agency for documented coordination on qualifying patients. There is no subscription, no license fee, no revenue share out of your episode, and no financial risk passed to you. Nothing about this arrangement bills your agency.

Model your census with us
For home health agencies · 41-second overviewAnimated explainer · 9 scenes · narrated · soft music
For home health agencies · 41-second overview · storyboard

1. The base rate is still being taken down.
A one-year 3% temporary reduction is running through CY2026 to recoup prior-period overpayments. CMS has proposed continuing it into CY2027. MedPAC has recommended Congress cut the base rate a further 7%. The freestanding all-payer margin was 5.0%.

2. The referrals arriving are more complex than the period is built for.
An active wound, heart failure, vascular disease and ten or more medications at once. The clinical judgement is not the issue. Managing that much concurrent medical complexity sits outside what a 30-day home health period is scoped and paid to cover. The work gets done. There is no line to bill it to.

3. Coordination starts while the patient is still in the building.
Equipment ordered and delivery confirmed, the primary care physician briefed, specialist follow-ups booked, medications reconciled against what actually changed during the stay. Your start-of-care visit opens on a running start instead of a phone call.

4. One action brings our clinicians in. Your episode stays yours.
Your staff keep working in your system, on your OASIS, on your plan of care. When a patient needs wound or complex care, one action dispatches the SHP clinical team alongside your episode, no new charting system to learn.

5. Findings return while your assessment window is still open.
Wound stage and measurements, the secondary diagnoses actually present, functional observations from the home. Under PDGM the clinical grouping and the comorbidity adjustment are set by what is documented. The period is therefore grouped on the patient in front of you rather than on what was visible at intake.

6. Fewer hospitalizations now move up to 5% of your Medicare payment.
The expanded Home Health Value-Based Purchasing model adjusts Medicare fee-for-service payments between minus 5% and plus 5% on performance against peers. CY2026 is the second payment year, and the claims-based measures are the ones complex seniors drive.

7. The hospital’s discharge list is getting shorter.
Hospitals carry their own readmission exposure and manage it partly by choosing where they discharge. Documented performance on preventable hospitalization is what keeps an agency on the list rather than competing on availability.

8. We pay you. There is no cost to your agency.
Under MPARC, a flat coordination amount for documented coordination on qualifying post-discharge patients already on your census, on both Medicare Advantage and traditional Medicare. No subscription, no license, no share of your episode revenue. Money moves in one direction, to you, and you take on no financial risk.

9. Paid for working with our program, not paid twice for the same work.
The coordination amount pays for coordinating with Silver Connect, our virtual care hub: the hand-off, the shared care plan, the data exchange. Where SHP is accountable for the population, visit fees pay for encounters your staff performs for the SHP program, outside your plan of care. Fair market value, for services actually rendered, never for referrals.

▶ The animated, narrated version plays when this page is opened in a browser.

1 What is happening to your business

The clinical skill is intact. The revenue format underneath it is not.

Coverage is tightening

CMS and Medicare Advantage payers are narrowing coverage for cellular tissue products, and reimbursement for the same clinical work is falling with it.

Most of the clinical work is unreimbursed

The comorbidity assessment, medication review and cross-specialist coordination your clinicians already perform around the wound rarely has a billable home. A coverage change on one category therefore resets the economics regardless of how well the wounds are managed.

Clinical talent walks

Without a viable economic model, experienced wound clinicians leave for hospital employment or retire. The mobile wound workforce disperses.

The path: from wound care paid through a narrowing set of codes → to complex care across the full polypathology spectrum. Same wound expertise, recognized scope, and economics that do not hinge on a single coverage decision.

The episode is being asked to carry more than it is scoped or paid to cover.

The patients arriving are sicker

Referrals routinely carry an active wound, heart failure, vascular disease and ten or more medications at the same time. The clinical judgement is not the issue. The issue is this. Managing that much concurrent medical complexity sits outside what a 30-day home health period is scoped and paid to cover. The work gets done. There is no line to bill it to.

A 3% clawback is running through the base rate

Aggregate payments are not collapsing, CMS has proposed a 2.4% aggregate increase for CY2027. The pressure sits underneath it. A permanent behavior adjustment of −1.023% runs alongside a one-year temporary reduction of −3.0%. The temporary reduction recoups roughly $471M of prior-period overpayments. That temporary adjustment is proposed to continue. The headline update rises; the base it applies to keeps being cut.1

The margin that runs your business is thin

MedPAC put the freestanding all-payer margin at 5.0% in 2024, and has recommended Congress reduce the base payment rate by a further 7% for CY2027. The headline Medicare fee-for-service margin is not the number your agency actually operates on.2

The path: not a different kind of agency. The same agency, with a complex care layer that runs alongside the episode. Documentation that arrives in time to be useful. Revenue attached to coordination work you are currently doing unpaid.

2 Where the value comes from

You stop being a wound vendor and become a complex care provider.

Three things change at once: what you can bill for, where in the referral flow you sit, and what your revenue depends on.

01

A billing surface far wider than the wound

Today the group bills for the wound. The same clinician, in the same visit, is already assessing the heart failure, the vascular disease, the diabetes and the medication list. Almost none of that is captured or billed. Under SHP protocols it is documented at the point of care and supports the complex care programs the patient already qualifies for.

  • Chronic care management and principal care management, for the polypathology you are already managing between visits.
  • Remote physiologic and remote therapeutic monitoring, continuous vitals and wound progression, with same-day clinical response, deployed through the SHP platform.
  • Transitional care management, for the post-discharge window, which is exactly where SHP opens the episode.
  • Advance care planning. The conversation your clinicians are already having in the home.
  • Evaluation and management at the complexity the visit actually reflects, a polypathology assessment documented as a polypathology assessment.

SHP supplies the protocols, the documentation structure and the decision support. Eligibility, medical necessity and code selection remain the responsibility of the treating clinician under applicable payer rules. All coordination fee arrangements are subject to healthcare regulatory counsel review. See Disclosures.

02

Upstream in the referral flow, not at the end of it

Wound patients reach mobile groups late, after the ulcer is established, often after an admission that has already happened. SHP holds performance contracts with health systems and opens the episode at the admission. Affiliated groups receive those patients on discharge: earlier in the disease, with the hospital's clinical context attached, and with the referral relationship structural rather than competed for.

Wounds engaged earlier cost less to heal and measure more cleanly. A wound caught in the post-discharge window responds to conservative management; a Stage 4 pressure ulcer that arrives six months later does not. When you are paid on outcomes, the stage at which the patient reaches you is the single biggest determinant of your performance.

The referral becomes structural. Volume arrives through SHP's health-system performance contracts rather than through individual physician relationships you have to rebuild every year.

The hospital's context travels with the patient. Admission diagnoses, medication changes and risk profile arrive electronically instead of being reconstructed at the bedside.

03

Revenue that does not hinge on one coverage decision

Coordination fees, performance bonuses and shared savings are earned on documented services and documented outcomes across several programs. A single policy change on one product category stops being an existential event. Your clinicians get a career path in complex care rather than a reason to leave for hospital employment.

Five effects on the census you already have.

Two are payments from SHP for work performed with our program. One improves the value of the episodes you are already paid for. Two protect the position you hold with payers and with the hospitals that refer to you. None of the five costs your agency anything, none asks you to take on financial risk, and none pays you twice for the same work.

01

MPARC coordination revenue, paid to you, at no cost to your agency

Under MPARC (Mobile Post-Acute Risk Care), SHP pays your agency a flat amount for documented care coordination on qualifying post-discharge patients already on your census, and it applies to both Medicare Advantage and traditional Medicare patients, not one book or the other. There is no subscription, no license fee, no revenue share taken out of your episode, and nothing for your agency to pay. No new patients, no operational change, and no financial risk transferred to you. The money moves in one direction, and it starts from the first qualifying episode. It lands hardest where you need it most, on Medicare Advantage episodes, where rates are lower and the coordination work is heaviest. There the payment drops straight onto the thinnest margin you carry.

The payment runs from SHP to your agency. MPARC coordination fees are structured as fair market value compensation, paid to the agency, for documented care coordination services actually performed, and are designed in compliance with applicable Medicare program requirements including the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) and the Physician Self-Referral Law (Stark, 42 U.S.C. § 1395nn). Coordination fees are never contingent on, or varied by, the volume or value of referrals. Fee arrangements are subject to healthcare regulatory counsel review prior to implementation.

Economics depend on your payer mix, census composition, documentation compliance and the qualifying time thresholds that apply to each program. We model your actual census with you rather than publishing a table that would mislead.

02

Paid for coordinating with our program, and separately for work you perform for it

These are two different services, compensated separately, not two payments for the same work. The coordination amount pays your staff for coordinating with our program and with Silver Connect, our virtual care hub. That work covers the pre-discharge hand-off, the shared care plan, and the scheduling and data exchange between your team and ours. Where SHP also holds a value-based contract and is accountable for a defined population, visit fees apply. They pay for visits your clinicians perform for the SHP program under our care plan. These are distinct encounters. They sit outside your home health plan of care and are not billed under your episode. Nothing is paid twice for the same service, and your Medicare or Medicare Advantage episode billing is untouched.

What the coordination amount is for. Working with our program. Receiving and acting on the pre-discharge hand-off from Silver Connect. Participating in the shared care plan. Exchanging structured findings with our clinicians. Scheduling across both teams. Keeping the joint record current. This is administrative and coordination work performed with SHP, outside your home health plan of care, and it is not reimbursed under your Medicare episode. That is the reason it is separately compensated.

What visit fees are for. Clinical encounters your staff performs for the SHP program, under an SHP care plan, on a population SHP is accountable for under a payer contract. These are distinct visits with their own documentation. They are not visits on your home health plan of care. They are not counted as your episode visits. They are not billed to Medicare or the plan by your agency.

The boundary is the point. No service is compensated by SHP if it is already covered by your episode payment, and no visit is paid for twice. Each arrangement is scoped so that the work SHP pays for is identifiable, documented and separate from the work Medicare or the plan is already paying you to do.

How it is structured. Both are fair market value compensation for services actually performed and documented, set in advance, commercially reasonable, and not determined in any manner that takes into account the volume or value of referrals or other business between the parties. Nothing here is an inducement to refer, to order, or to select a provider. Arrangements are subject to healthcare regulatory counsel review prior to implementation and to the home health consolidated billing rules that apply during a home health period of care.

03

Better PDGM periods, because the complexity is documented and grouped correctly

Under PDGM every 30-day period is grouped on five case-mix variables, admission source, timing, clinical grouping, functional impairment level and comorbidity adjustment, across 432 payment groups, and wounds are one of the twelve clinical groupings. SHP clinicians assess and document the wound, the CHF, the PAD, the diabetes and the polypharmacy that are already present. That documentation reaches your team while your assessment window is still open. The period is then grouped on the patient in front of you rather than on what was visible at intake.3

The clinical grouping. The principal diagnosis reported determines which of the twelve clinical groupings the period falls into. When a complex wound is assessed and documented by a wound clinician rather than inferred, the grouping reflects what is being treated.

The comorbidity adjustment. The comorbidity adjustment is set by the secondary diagnoses documented. Complex seniors routinely carry conditions that are present and treated but never captured. Accurate capture at the point of care means the period is grouped correctly. This is about documenting what is actually there, not about capturing more.

Admission source. PDGM distinguishes institutional from community admission source. Where SHP holds a performance partnership with a health system, affiliated agencies are inside the pre-discharge coordination workflow, which tends to shift census mix toward institutional-source periods. Patient choice of home health agency is preserved in every case, and no arrangement conditions payment on referrals.

Episode margin. The complex wound and polypathology patients are the ones that consume unplanned visits and end in a transfer. With wound expertise, remote monitoring and same-day clinical response wrapped around them, those episodes run closer to plan.

Source: CMS, Home Health Patient-Driven Groupings Model, five case-mix variables across 432 payment groups. Payment outcomes depend on accurate clinical documentation and applicable CMS rules; nothing here is a representation of expected reimbursement.

04

Fewer hospitalizations, now worth up to 5% of your Medicare payment, in both directions

The expanded Home Health Value-Based Purchasing model adjusts agency Medicare fee-for-service payments between −5% and +5% on quality performance relative to peers. It is no longer a pilot. The first performance year was CY2023, the first payment year was CY2025, and CY2026 is the second payment year. The claims-based measures are within-stay Potentially Preventable Hospitalization and Discharge to Community, with Medicare Spending Per Beneficiary–Post-Acute Care added from CY2026. Preventing avoidable hospitalizations in complex seniors is what SHP is built to do.4

The mechanism. Performance is scored against peer cohorts and converted into a payment adjustment of up to ±5% on Medicare fee-for-service payments, applied two years after the performance year. It is a redistribution, not a bonus pool. The agencies that do not move are paying the ones that do.

What is being measured. Within-stay Potentially Preventable Hospitalization and Discharge to Community have been in the applicable measure set since CY2025. From CY2026 the set adds Medicare Spending Per Beneficiary–Post-Acute Care and OASIS-based functional improvement measures, and CMS increased the weight of the OASIS and claims-based measures for larger-volume agencies from 35% to 40% of the total performance score while reducing HHCAHPS from 30% to 20%. The measures are moving toward exactly the thing complex seniors drive.

What SHP contributes to it. Continuous monitoring on the patients most likely to deteriorate, and same-day clinical response to an alert. Wound and polypathology management in the home, and a documented record of what was done. Those are the inputs to the measures you are scored on.

Sources: CMS Innovation Center, Expanded Home Health Value-Based Purchasing Model; CY2026 HH PPS final rule (published 2 December 2025). Payment adjustment outcomes depend on agency performance relative to peers. Nothing here is a representation of expected payment, and SHP does not guarantee any HHVBP outcome.

05

The hospital’s discharge list is getting shorter

Hospitals carry their own readmission exposure under the Hospital Readmissions Reduction Program, and many manage it partly through preferred post-acute networks built on readmission performance. Patients keep their choice of agency, but the list a discharge planner works from is not infinite. Documented performance on preventable hospitalization is what keeps an agency on it, rather than competing on availability.5

The same performance works on both sides. The outcomes that move your HHVBP adjustment are the outcomes the referring hospital is judged on. One clinical improvement, recognized by CMS and by the referral source.

Institutional-source census is worth more. PDGM pays differently by admission source. A census that shifts toward post-acute referrals is a census that groups differently, on top of the volume itself.

SHP sits on the hospital side of the conversation. Where SHP holds a performance partnership with a health system, affiliated agencies are the ones already inside the coordination workflow. They are there when the discharge decision is made, with the record to support it.

Referral relationships are established on documented clinical performance. SHP does not pay for, condition any payment on, or otherwise compensate any party for referrals, and no arrangement described here varies with the volume or value of referrals between the parties.

Sources for this section
  1. CMS, CY2026 Home Health Prospective Payment System final rule (CMS‑1828‑F), published 2 December 2025: permanent behavior adjustment of −1.023%, one‑year temporary adjustment of −3.0% recouping approximately $471M, 30‑day base payment rate of $1,933.61 for quality‑reporting agencies. CMS, CY2027 HH PPS proposed rule (CMS‑1844‑P), issued 1 July 2026, is proposed, not final. It proposes a 2.4% aggregate increase ($420M) built from a 2.1% market basket update. It proposes no additional permanent adjustment and continuation of the −3.0% temporary adjustment.
  2. MedPAC, Report to the Congress: Medicare Payment Policy, March 2026, ch. 8, freestanding home health all‑payer margin of 5.0% in 2024; fee‑for‑service Medicare margin of 21.2% in 2024, projected 19% in 2026; recommendation that Congress reduce the 2026 base payment rate by 7% for CY2027.
  3. CMS, Home Health Patient‑Driven Groupings Model. Five case‑mix variables (admission source, timing, clinical grouping, functional impairment level, comorbidity adjustment) across 432 payment groups. Twelve clinical groupings. Non‑routine supplies bundled into the 30‑day payment.
  4. CMS Innovation Center, Expanded Home Health Value‑Based Purchasing Model, applicable percent of −5% to +5%. First performance year CY2023; first payment year CY2025. Claims‑based measures within‑stay Potentially Preventable Hospitalization and Discharge to Community apply from CY2025. Medicare Spending Per Beneficiary–Post‑Acute Care and OASIS‑based functional measures are added from CY2026 per the CY2026 HH PPS final rule. Measure weights are revised from CY2026 per the same rule.
  5. Hospital readmission exposure arises under the Hospital Readmissions Reduction Program, 42 U.S.C. § 1395ww(q). The use of preferred post-acute networks as a readmission-reduction strategy is documented in the peer-reviewed literature. See McHugh JP, Foster A, Mor V, et al., “Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities,” Health Affairs 2017;36(9):1591–1598, doi:10.1377/hlthaff.2017.0211 (via PubMed, PMID 28874486). That study examined skilled nursing facilities rather than home health agencies. The same paper notes that hospitals must supply patients with a list of Medicare-eligible providers. It also notes hospitals cannot explicitly restrict patient choice. Referral behavior varies by market and by health system. Nothing here should be read as a claim that a hospital can or will direct patients to a particular agency.

Figures describe the Medicare program environment, not SHP performance. Nothing in this section is a representation of the reimbursement, payment adjustment or referral volume any agency will receive.Disclosures.

Actual implementation timelines, performance outcomes, and revenue figures vary with affiliate readiness, payer contracting, documentation compliance, and market conditions.

3 The technology

Your clinicians, uplifted. Your visit, worth more.

Encounter Co-Pilot and Journey Orchestrator deploy into your workflow and into your EMR, not a portal your staff has to remember to open. Four things change across a single visit.

1 · Guided assessment
Today

Assessment depth varies by clinician and by day. Your most experienced specialist and your newest hire produce different visits on the same patient.

With SHP

Before anyone leaves, the platform builds an assessment protocol for this patient and this visit. The protocol is sequenced so findings that unlock other findings come first. It is bounded by the time, equipment and credentials actually available. A chart summary leads with what changed: new labs, medication changes, remote-monitoring anomalies, authorizations about to expire. The day's supply manifest is the packing list.

2 · Guided intervention: the wound and everything behind it
Today

You treat the wound. The heart failure driving the oedema, the undiagnosed PAD, the medications that conflict, often visible at the bedside, mostly outside your scope, and largely uncaptured.

With SHP

The risk and standard-of-care engines propose the full clinically correct set. That set includes debridement and offloading alongside the diuretic review, the vascular referral and the medication reconciliation. Each carries its goal, protocol and evidence grade. Your clinician approves or declines every one. Guidance verbosity is tuned per clinician: concise rationale with citation links for your specialists, expanded protocol context for newer staff. That is how a heterogeneous group performs to one standard.

3 · The administrative work, done during the visit
Today

Charting after hours. DME orders faxed and sometimes denied for missing justification. Coding reconstructed from memory. Prior authorization discovered at the door.

With SHP

The SOAP note and the DME and supply orders with medical necessity attached are generated as the visit happens. So are the codes supported by what was actually documented. Prior authorization is validated before the visit, not at the bedside. It runs on the device, offline, no signal needed in a patient's home. The clinician reviews and signs before the encounter closes; nothing executes on the engine's say-so.

4 · Reimbursement guardrails, and an audit pack that builds itself
Today

You often find out the claim was wrong when the denial arrives, months later, on an encounter no one recalls in detail. Reconstruction then consumes days of clinical and administrative time: photos, measurements, prior conservative care, product justification. Some of it was never captured, so the appeal fails on the record rather than on the medicine.

With SHP

The rules run during the encounter, not after the claim. Coverage criteria for the product class, medical necessity elements, frequency limits and formulary binding are checked before the encounter can close. Where a required measurement or a prior-therapy note is missing, the clinician is told. This happens while the patient is still in front of them. The audit pack assembles itself per encounter: assessment, findings, the intervention chosen, the evidence grade behind it, and the clinician's decisions. All of it is written to a reasoning graph as a byproduct of care. When a payer, an auditor or a plaintiff asks why, the answer already exists.

5 · Both directions: your EMR and your referral partner's
Today

Referrals arrive by fax from whoever remembers you. Nothing goes back. The hospital has no idea what happened to the patient it sent.

With SHP

The signed encounter package is designed to submit into your own EMR, automatically where the integration is live. Outcomes flow back to the referring health system under SHP's performance contracts. The hospital refers directly to you and sees what happened. The relationship becomes structural rather than personal. Referrals follow clinical need and patient choice; no volume is promised, and no compensation varies with referrals. An unfamiliar EMR is onboarded by writing a context document describing how that system represents encounters and orders, not by building a new integration. That is why go-live is measured in weeks.

The point: the same clinician, in the same home or facility, delivers a materially larger and better-documented piece of care. The evidence trail is generated as a byproduct rather than reconstructed for an auditor later.

Your episode stays yours. The complex layer plugs into it.

This is not a request to move your agency onto new software. Your staff keep running your home health episode, in your system, on your OASIS and your plan of care. The platform gives you a clean way to bring our clinicians in. That applies to the patients whose medical complexity runs past what the episode is scoped to cover. That work starts before they are discharged. What we find comes back to you while it still counts.

1 · Before the patient is discharged
Today

You find out you have the patient when the referral arrives. Start-of-care is a discovery exercise. What changed in the hospital, which medications are current, whether the equipment is coming, who the follow-up is with. The first days of the period go to reconstructing a picture that already existed upstairs.

With SHP

Coordination starts while the patient is still in the building. Where SHP holds a partnership with the discharging hospital, the hand-off is arranged before discharge. Equipment is ordered and delivery confirmed. The primary care physician is briefed and specialist follow-ups are booked. Medications are reconciled against what actually changed during the stay. The discharge summary and current problem list are in your hands before the first visit. Your period opens on a running start rather than on a phone call.

2 · Bringing us in
Today

A complex wound turns up on a routine visit. You call around for a wound specialist, or the episode absorbs it. That means more visits, more supplies, and management of concurrent conditions that the period was never scoped or funded to cover. Too often the patient ends up in the emergency department anyway.

With SHP

One action dispatches the SHP wound and complex care team alongside your episode. No new charting system for your staff to learn, and no second workflow. The referral carries the patient's context. Scheduling and status are visible to both sides without phone tag. The patient stays yours.

3 · What comes back, and when
Today

If a specialist does see the patient, the note often arrives weeks later, after your assessment is locked and your claim has gone out.

With SHP

Structured findings return while your assessment window is still open. They cover wound stage and measurements, the secondary diagnoses actually present and being treated, and functional observations from the home. Under PDGM your functional impairment level comes from OASIS items. Your comorbidity adjustment comes from the secondary diagnoses reported. Having specialist findings in hand at the time of assessment therefore matters. It is the difference between documenting the patient accurately and documenting them from memory.

4 · The cost side that rarely gets discussed
Today

The complex wound patient is a margin problem. Under PDGM, non-routine supplies are bundled into your 30-day payment. Every dressing change comes out of your margin, on top of the extra visits, and the episode still ends in a transfer.

With SHP

Specialist wound management runs alongside your episode rather than inside it, with remote monitoring and same-day clinical response wrapped around the patient. Fewer of the visits your staff absorbs. Less of the supply spend that lands in your bundle. Fewer episodes that end in a hospitalization you are now measured on under HHVBP.

The point. You are not being asked to change how you deliver home health. You are being given a complex care layer you can call in. Coordination begins before the patient reaches you. Documentation arrives in time to be useful. Revenue is attached to the coordination work you are already doing.

Coordination arrangements are structured under applicable Medicare requirements, including home health consolidated billing rules, and are subject to healthcare regulatory counsel review. Clinical documentation, OASIS completion and claim submission remain the responsibility of the agency and its clinicians.

Encounter Co-Pilot is clinical decision support designed to augment clinician workflows. It does not replace, override, or substitute for the independent clinical judgment of a licensed healthcare professional. Platform capabilities reflect designed architecture; deployment timelines vary by partner and EMR. PDGM and HHVBP references describe program mechanics, not expected payment. See Disclosures.

4 The revenue transition

New revenue layers on. Nothing rips out.

Your existing wound care revenue stays intact while coordination fees, performance bonuses and shared savings stack on top, so the business stops depending on a single reimbursement rule.

Your fee-for-service episodes stay intact and untouched. Alongside them, SHP pays your agency a flat coordination amount for coordinating with our program on qualifying patients you already serve. This applies on both Medicare Advantage and traditional Medicare. It is most valuable on the MA book, where episode margin is thinnest. Where SHP is accountable for the population under a payer contract, visit fees compensate encounters your staff performs for the SHP program, outside your plan of care. Separate services, separately paid. Nothing is deducted, and nothing is billed to you.

Existing revenue stays. MPARC starts Day 1. Performance bonuses follow as outcomes data builds. Shared savings grow as payer contracts mature. Projections are illustrative and reflect designed program architecture; actual figures depend on payer contracting, patient enrollment, and affiliate readiness. See Disclosures.
5 The affiliation structure

A minority equity partnership, not an acquisition, not a vendor contract.

Affiliation with SCG (Silver Care Group, a subsidiary of Silver Health Holdings LLC and sister company of Silver Health Plus): SHP brings infrastructure and market access. You bring your clinicians, your patients and your relationships. SCG is the delivery network, and SHP is the accountability layer that contracts with payers on the outcomes your clinicians produce.

Step 1 · MPARC activation

Coordination revenue paid to you on your existing patients, before any equity conversation and at no cost to your agency. The model proves itself on your book first.

Step 2 · Platform deployment

Co-Pilot and Orchestrator in your workflows. Your organization begins generating the structured data VBC contracts require.

Step 3 · Payer contract access

Shared savings arrangements and episode-based programs, without the actuarial infrastructure a standalone operator would need.

Step 3 · Specialist network access

Standing access to SHP wound and complex care teams for the patients your staff should not be absorbing alone. The coordination, scheduling and findings loop is already built.

Step 4 · Equity partnership

SCG affiliates via a minority equity stake (7–15%). You retain operational control. SCG brings capital, infrastructure and strategic positioning.

Step 4 · Where it can go

Some agencies stay at coordination. Others go further into a structural partnership with SCG. That is a separate conversation, on your timetable, nothing about the coordination relationship depends on it.

At-Home Affiliates are the delivery backbone of SHP's care network. For specialists, primary care physicians, and DME suppliers who interact with SHP patients, see Network Partners.

Model your wound census with usOur Approach
Model your census with usOur Approach
Network Partners

Three ways to connect. One accountability network.

Treatment partners grow a clinical service line with SHP technology. Collaboration partners close the referral loop electronically. Supply partners get clean orders with documentation that protects reimbursement.

For network partners · 18-second overviewAnimated explainer · 4 scenes · narrated · soft music
For network partners · 18-second overview · storyboard

1. Three ways to connect. One accountability network.
Every provider who touches an SHP patient plays one of three roles.

2. Treatment Partners grow a service line.
Encounter Co-Pilot in your workflows, patients reaching you through the SHP care pathway when a clinical need is identified, and access to the VBC bonus pool. Participation is never conditioned on, and compensation never varies with, the volume or value of referrals.

3. Collaboration Partners close the loop.
Referrals arrive with full clinical context and close back electronically. No more fax machine.

4. Supply Partners get clean orders.
Documentation and medical necessity justification built into every order. Fewer denials, less audit exposure.

▶ The animated, narrated version plays when this page is opened in a browser.

Which one are you? Pick your role.

Tier 1 · Treatment Partners · VBC bonus pool

Providers who directly treat SHP patients, podiatry groups, independent wound clinics, mobile wound groups, PCPs with wound care service lines, vascular surgery practices, using the SHP platform to build a clinical service line around complex wound care.

  • Encounter Co-Pilot in your workflows, clinical decision support, standardized documentation, risk profiling at every visit
  • Center of excellence positioning, structured protocols, quality benchmarks, documented outcomes that differentiate your practice
  • Growth engine. The SHP referral pipeline drives patient volume to your practice. Referrals follow clinical need and patient choice; compensation never varies with referral volume or value, and no volume is guaranteed.
  • Risk mitigation, the right documentation captured at every encounter, reducing audit exposure and supporting reimbursement integrity

VBC bonus pool access. Documented outcomes from your encounters contribute to the value pool, and you earn from the value you help generate.

Platform access. Full Co-Pilot + Orchestrator deployment. Deepest integration tier.

Onboarding. Platform deployment, protocol configuration, staff training, and VBC contract enrollment. Typically 60–90 days to first connected encounter.

Become a Treatment Partner

Tier 2 · Collaboration Partners · Closed-loop referrals

Specialists and primary care providers who receive referrals from SHP and close the loop back. Electronic, bidirectional, designed around the patient, not the fax machine.

  • Faster patient routing, patients who need cardiac intervention, vascular workup, or PCP escalation routed electronically with full clinical context
  • Better documentation on every referral, structured clinical data, risk profile, medication list, and intervention history travel with the patient
  • Closed-loop confirmation, you close the loop back electronically; the care plan updates automatically where the integration is live

The referral loop that so often breaks at the fax machine becomes an electronic closed loop. That loop benefits the patient and every provider in the chain.

Platform access. Referral portal + care plan visibility, configured for your specialty workflow.

Onboarding. Electronic referral integration and closed-loop workflow setup. Lightweight, designed to fit into your existing practice without disruption.

Join as a Collaboration Partner

Tier 3 · Supply Partners · Clean orders + audit protection

DME providers, DMEPOS suppliers, CTP distributors, and lymphedema equipment providers who fulfill orders generated by SHP clinical teams. Transactional but electronic, designed to protect both sides.

  • Electronic orders with full documentation, structured clinical documentation, risk assessment, and medical necessity justification built in
  • Reimbursement exposure minimized, proper documentation travels with the order, reducing the audit and denial risk that costs DME providers millions annually
  • Closed-loop fulfillment, delivery confirmation flows back to the care plan

Platform access. Order portal + documentation exchange. API-first integration with your fulfillment systems, minimal operational change.

Register as a Supply Partner

Clinical decisions remain the responsibility of the treating licensed clinician. Encounter Co-Pilot is clinical decision support designed to augment clinician workflows. It does not replace, override, or substitute for independent clinical judgment.

1 How it connects

Every encounter. Every referral. Every order. One patient record.

1 · SHP identifies the need

An at-home encounter surfaces a clinical need, specialist treatment, cardiac workup, a DME order.

2 · Electronic referral or order

Structured clinical data, risk profile, and documentation travel to the right partner.

3 · Partner acts

Treatment with Co-Pilot guidance. Collaboration with full context. Supply with documentation attached.

4 · Loop closes

Outcome flows back to the care plan automatically where the integration is live. Patients are far less likely to fall through the gaps.

Treatment Partners earn from the outcomes they help generate. Collaboration Partners get patients who arrive with context. Supply Partners get clean orders that protect reimbursement. Every tier benefits. The patient benefits most.

Which tier fits? Get a network fit assessment
Get in touch

Start the conversation.

We work with health systems, Medicare Advantage plans, home health agencies, and clinical partners. Tell us who you are and what you're trying to solve, we respond within one business day.

Please do not include patient-identifiable information or clinical details. This form is not a secure channel for protected health information.

Or email us at hello@silverhealthplus.com.

Form submissions and anonymous page-engagement data (time per page, interactions, referrer, screen size) are processed by our forms provider and sent to SHP. We do not sell this data or use it for advertising. See Disclosures.

Legal & Regulatory

Disclosures, Citations & Regulatory Notices

Source citations, regulatory status disclosures, and legal notices for information presented on this website. All claims are subject to the qualifications stated below.

General Disclaimer

Silver Health Plus, Inc. ("SHP") describes on this website the programs and operating model it delivers. Statements regarding clinical outcomes, cost savings, and operational performance are based on published benchmarks from comparable coordinated care programs and the operating experience of SHP's leadership team. No performance figure on this website is a representation of SHP's own results. Individual outcomes vary with population characteristics, contract structure, and program implementation.

Nothing on this website constitutes medical advice, legal advice, investment advice, or a solicitation of any investment. All information is provided for informational purposes only.

Silver Health Plus, Inc. is a Delaware C-Corporation and a subsidiary of Silver Health Holdings LLC, a Delaware limited liability company. Silver Care Group (SCG) is a planned subsidiary of Silver Health Holdings LLC and sister company of Silver Health Plus.

Source Citations
Amputation and diabetic foot ulcer statistics

Armstrong DG, Lavery LA, Harkless LB. "Validation of a Diabetic Wound Classification System." Diabetes Care. 1998;21(5):855-859. · Armstrong DG, Boulton AJM, Bus SA. "Diabetic Foot Ulcers and Prevention." Diabetes Care. 2006;29(3):726. · Armstrong DG, et al. "Diabetic Foot Ulcers and Their Recurrence." New England Journal of Medicine. 2017;376(24):2367-2375. The 85% figure reflects the clinical finding that the majority of lower-extremity amputations are preceded by a diabetic foot ulcer.

Wound closure rates

Closure rates referenced on the Payers page reflect published outcomes from coordinated specialist wound programs in the peer-reviewed literature and are stated as a range. No closure rate on this site is a representation of SHP's own performance. SHP publishes its own outcome data only once measured, with the population and measurement period stated.

Healthcare spending concentration

Mitchell EM. "Concentration of Health Expenditures and Selected Characteristics of High Spenders, U.S. Civilian Noninstitutionalized Population, 2019." AHRQ Statistical Brief #535, Agency for Healthcare Research and Quality, 2022.

Hospitalization reduction and readmission benchmarks

Performance benchmarks cited on this site (41% hospitalization reduction, 25% fewer 30-day readmissions, 20-40% avoidable cost reduction) reflect published results from comparable coordinated care programs including Strive Health / American Journal of Managed Care (2025) and Veterans Affairs Home-Based Primary Care programs. These figures are not representations of SHP's own performance history. Individual results will vary based on population characteristics, program implementation, and contract structure.

PMPM cost modeling

The $45-$150 per member per month (PMPM) figure represents a blended portfolio impact across a total Medicare Advantage population, derived from Milliman actuarial analysis and CMS Medicare Advantage rate data. Actual PMPM costs vary by plan, population demographics, geographic market, and contract structure.

Home health reimbursement data

Home health payment figures on the At-Home Affiliates page reference the CMS CY2026 Home Health Prospective Payment System final rule (published 2 December 2025), which applied a permanent behavior adjustment of −1.023% and a one‑year temporary adjustment of −3.0% to recoup approximately $471 million of prior‑period overpayments, and set the CY2026 30‑day base payment rate at $1,933.61 for agencies meeting quality reporting requirements. The CY2027 HH PPS proposed rule (CMS‑1844‑P, issued 1 July 2026) proposes continuing the −3.0% temporary adjustment and proposes no additional permanent adjustment. Margin figures reference MedPAC, Report to the Congress: Medicare Payment Policy, March 2026, chapter 8: a freestanding home health all‑payer margin of 5.0% in 2024, a fee‑for‑service Medicare margin of 21.2% in 2024 projected at 19% for 2026, and a recommendation that Congress reduce the 2026 base payment rate by 7% for CY2027. Where this site refers to home health margin pressure it refers to the all‑payer margin and to the dispersion MedPAC reports across agencies, not to the aggregate fee‑for‑service Medicare margin. Payment rules change annually; figures should be confirmed against the current CMS rule at the time of reading.

Founding team operating history

References to the founding team's operating experience reflect a track record of scaling three healthcare companies to market leadership and two successful exits, including leadership of the largest wound care operation in the United States by EBITDA. This operating history belongs to prior entities; it is not a representation of SHP's performance.

Clinical entry points, source citations

1. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 2002;162(20):2269-2276.
2. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 2011;365(21):2002-2012.
3. Sen CK. Human wounds and its burden: updated 2020 compendium of estimates. Advances in Wound Care, 2021;10(5):281-292.
4. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare Fee-for-Service Program. New England Journal of Medicine, 2009;360(14):1418-1428.
5. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians. JAMA, 2007;297(8):831-841.



Regulatory & Compliance Disclosures
Clinical decision support, Encounter Co-Pilot

Encounter Co-Pilot is a clinical decision support tool designed to augment clinician workflows. It is not intended to replace, override, or substitute for the independent clinical judgment of a licensed healthcare professional. All clinical decisions remain the responsibility of the treating clinician. SHP's CDS architecture is designed under the framework established by Section 3060 of the 21st Century Cures Act. Regulatory classification status is under review with qualified FDA regulatory counsel.

MPARC coordination fees

Mobile Post-Acute Risk Care (MPARC) coordination fees are structured as fair market value compensation for documented care coordination services rendered by affiliated providers. Payment flows from SHP to the affiliated provider. SHP does not charge home health agencies a subscription, license, platform or access fee for participation in MPARC coordination. SHP does not take a share of an agency's episode revenue. Fee arrangements are designed in compliance with applicable Medicare program requirements, including the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) and the Physician Self-Referral Law (Stark Law, 42 U.S.C. § 1395nn). Compensation is set in advance, is consistent with fair market value, and is not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. All fee structures are subject to healthcare regulatory counsel review prior to implementation.

Affiliate coordination and program visit compensation

Affiliated agencies may be compensated by SHP for two distinct categories of service. The first is care coordination performed with SHP’s program and its virtual care hub, Silver Connect, including receipt and action on pre-discharge hand-offs, participation in the shared care plan, structured exchange of clinical findings, and cross-team scheduling. The second, available only where SHP holds a value-based contract under which it is accountable for a defined population, is clinical encounters performed by agency staff for the SHP program under an SHP care plan. Such encounters are distinct from, and are not part of, the agency’s home health plan of care; they are separately documented and are not billed to Medicare or a Medicare Advantage plan by the agency. No service compensated by SHP duplicates a service for which the agency is already reimbursed under its episode payment, and no service is compensated twice. Compensation in both categories is for services actually rendered and documented, set in advance, consistent with fair market value, commercially reasonable, and not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. No payment described here is intended or offered as an inducement to refer, order, arrange for or recommend any item or service. Neither category replaces, reduces or is deducted from an agency’s Medicare or Medicare Advantage episode payment. These arrangements are subject to applicable Medicare requirements, including home health consolidated billing rules under 42 U.S.C. § 1395fff and 42 CFR § 484.205, to the terms of the applicable payer contract, and to healthcare regulatory counsel review prior to implementation. Availability depends on whether a given patient falls within a population covered by an SHP value-based contract.

Explainer media

The narration voice in the animated explainers is synthesized. Background music: Erik Satie, “Gymnopédie No. 1,” performed by Kevin MacLeod (incompetech.com), licensed under Creative Commons BY 4.0.

Website data and privacy

The contact form and anonymous page-engagement reporting on this website are processed by a third-party forms provider (Web3Forms) and delivered to Silver Health Plus by email. Engagement reporting captures time spent per page, interactions with on-page elements, estimator input settings, referrer, screen dimensions, and any campaign tag included in the link used to reach the site. It does not capture names, email addresses, or any content typed into the contact form except where a visitor submits that form. This data is used solely to understand how the website is used and to respond to enquiries. It is not sold, and it is not used for advertising. Visitors are asked not to submit patient-identifiable information or clinical details through this website; the contact form is not a secure channel for protected health information, and no Business Associate Agreement governs it. Requests to access or delete website data may be sent to hello@silverhealthplus.com.

Pre-discharge coordination

Pre-discharge coordination activity described on the At-Home Affiliates and Health Systems pages is available where SHP holds a partnership with the discharging facility. It does not direct, restrict or influence a patient's choice of post-acute provider. Patient freedom of choice of home health agency is preserved in accordance with 42 CFR § 482.43 and applicable state law, and discharge planning remains the responsibility of the discharging facility and its clinicians.

Payment models

Payment model structures described on this website, including shared savings, per-member-per-month, and episode-based arrangements, are subject to applicable CMS regulations and individual payer contract terms. Payment model descriptions reflect the contract structures SHP offers; specific terms are set in each executed agreement.

HIPAA compliance

HIPAA compliance reflects SHP's implementation of required administrative, physical, and technical safeguards under the HIPAA Privacy Rule (45 CFR Part 164, Subpart E) and Security Rule (45 CFR Part 164, Subpart C). HIPAA compliance is self-attested and is not independently certified by any government agency or accrediting body. Business Associate Agreements (BAAs) will be executed with all applicable partners prior to any protected health information exchange.

SOC 2 Type II and HITRUST certifications

SOC 2 Type II and HITRUST certifications are currently in progress with a target completion of Q3 2026. These certifications are not yet achieved. Current security controls reflect SHP's designed architecture and are subject to independent audit verification.

EMR integration

EMR systems listed on the Platform page reflect designed integration compatibility via FHIR R4, HL7v2, and Direct Secure Messaging standards. These integrations represent planned technical capabilities. Live integration status with each EMR vendor will depend on individual implementation timelines and partner agreements.

Composite Patient Narratives

Patient narratives presented on this website, including the "Mary" case study, are composite patient profiles. The medical cascades, medication interactions, and clinical outcomes depicted are consistent with peer-reviewed literature on diabetic foot complications, polypharmacy, congestive heart failure, and peripheral arterial disease in complex senior populations. These composites do not represent any actual patient, and the outcomes depicted do not constitute a guarantee of clinical results. Individual patient outcomes will vary based on clinical circumstances, treatment adherence, comorbidity burden, and other factors.

Estimator, Visualization & Financial Projection Disclaimers
Compounding effect visualization, data sources

The cascade visualization on the Home page illustrates the non-linear cost behavior when multiple chronic conditions co-occur in Medicare populations aged 65+. Per-condition annual cost estimates: AHRQ Medical Expenditure Panel Survey (MEPS); CMS Medicare Current Beneficiary Survey (MCBS); published disease-specific cost studies. Comorbidity interaction multipliers: Charlson ME, Pompei P, Ales KL, MacKenzie CR. Journal of Chronic Diseases. 1987;40(5):373-383, with subsequent validation by Quan H, et al. (2011) and Elixhauser A, et al. (1998). Compounding factor (0.35x per additional condition): conservative estimate derived from Charlson Comorbidity Index literature. All figures in 2023 USD equivalents, capped at 8.0x to prevent extrapolation beyond the evidence base. Illustrative; not specific patient outcomes or guaranteed cost projections.

Revenue stacking visualization, data sources & methodology

The revenue visualization on the At-Home Affiliates page is illustrative and reflects designed program architecture, not historical performance. Fee-for-service baseline per current CMS reimbursement schedules (PDGM for home health, physician fee schedule for wound provider groups), with the slight decline reflecting published CMS rate pressure trends and CTP revenue compression. MPARC eligibility rates assume 30-40% of active census based on comorbidity prevalence in complex post-discharge populations. For mobile wound provider practices, performance bonuses are shown from approximately Month 6 (minimum data accumulation period) and shared savings from approximately Month 9 (typical payer reconciliation cycle). For home health agencies the visualization shows only two SHP-paid layers, a coordination amount and, on populations covered by an SHP value-based contract, visit fees. Home health agencies are not shown participating in performance bonuses or shared savings, and no such participation is offered. The visit fee layer is shown from approximately Year 1 because it depends on an executed payer contract covering the population. Actual revenue depends on payer mix, patient enrollment rates, documentation compliance, contract terms, market conditions, and affiliate operational readiness.

ROI estimators

The Population ROI Estimator (Payers page) and Economic Impact Estimator (Health Systems page) are illustrative modeling tools based on published benchmarks from comparable programs and standard actuarial assumptions. They are not guarantees of financial performance. Actual results will vary based on population size, acuity mix, payer contract terms, geographic market, program implementation fidelity, and other factors.