JN.
Portfolio / 2026 The gap between authorization & outcome Seven Products · Four Tools

JoeNalley.

Operator/Founder/Payer Exec/Builder
I stay in the ambiguity until it's architecture. Every product here lives in the layer the incumbents had no incentive to build.
01 / Record

The Record

The receipts
Lifetime · Patients served
200K+

Across the lifetime of the companies I've led — behavioral health, SUD/MAT, primary, urgent, lab, imaging, surgical, hospital.

ClearBill · First six months
$9.2M

Returned to payers in the first six months of full deployment. Founded it. Sold it.

Carelon Growth · Specialty spend
$50B+

Six high-acuity clinical risk books — MSK, Oncology, CHF, Maternity, Autoimmune, Dementia.

Cadence · Evidence cohort
65,234

Patients across three governed cohorts — $14.3M first-cycle GSV, 58.7% Reviewer Influence Rate. (NIH All of Us validated.)

02 / Layer

The Independent Layer

Between auth & outcome
Upstream Authorization
Utilization management decides whether something starts. One decision, at initiation. Then the case clears and attention moves on.
The layer Independent
The stratum that owns the question nobody upstream or downstream owns. Independent by construction, fee at risk against the outcome.
Downstream Outcome
The obligation to account for the result. In a standard benefits stack, nothing is built between the gate and this line unless someone puts it there on purpose.

Each one occupies the orange band.

03 / Thesis

The Gap

One structural argument

The gate fires once — at the start. Renewals re-check the paperwork, not the patient. No one in the payment chain governs whether the thing should still be running.

Between the decision to authorize and the obligation to account for the result, high-cost categories operate on autopilot by default. That's true wherever the dollar is authorized and then unwatched. It's sharpest in self-funded plans, where the payer and the loser are the same entity.

The entities with visibility — the PBM, the TPA, the network, the navigator — all profit from the thing they would need to question. None will build the layer that governs their own revenue.

That layer has to come from outside. Independent. No facility ownership, no network fee, no downstream interest. And it has to carry skin in the game — accountability held on its own books, fee at risk against the outcome.

04 / Products

The Products

Seven · Built
01 Cadence Continuation-governance intelligence — the structured reassessment layer for high-cost chronic therapies approved correctly and never re-checked. $2–$6 PMPM. showyourwork.health Continuation 02 Caliber Independent pre-payment claims verification — moves the check to the moment of maximum leverage, before it clears. Post-payment recovers ~12¢ on the dollar; a dollar caught before it leaves never needs recovering. verifythebill.com Claims 03 Curated Independent, episode-based behavioral-health network — one licensed navigator, every episode, plus a 30-day readmission warranty. $4–$7 PEPM. curatedhealth.care Behavioral 04 KEEP The benefit manager for the chronic wound — a home-care spine, an evidence formulary, and the closure registry claims data can't see. North-star metric: limbs kept. keepwhole.com Wounds 05 Waybright Warranty-backed maternity navigation — one named navigator from confirmation through 12 weeks postpartum. 85.6% steerable; $376,003 modeled savings (10K plan). waybright.health Maternity 06 Continuum Virtual SUD treatment continuity — a named navigator from induction through 14-month maintenance, permanent telehealth buprenorphine. KY launch, OH next. continuumhealth.care SUD / OUD 07 SmartShot Remote medication delivery — a wearable that detects an emergency and delivers medication autonomously. Four initial conditions. Pre-prototype concept IP. smartshot.health Device / IP
05 / Tools

The Tools

Four · Open
T-01
Compass VBC financial-modeling tool across 8 lines of business. 4 live calculators — bundled, capitation, scenarios, term sheets, legibility benchmarking.
T-02
Covenant Published delegation-governance standard (DGS v1.0) and self-assessment — independent oversight criteria for delegated health-plan functions.
T-03
Equipoise MHPAEA parity engine — run a full NQTL comparative analysis on sample data, no account needed. Regulatory-grade reports; white-label available for plans and TPAs.
T-04
FORGE Product-lifecycle framework for healthcare teams. 24 templates, 13 mechanisms, 7 archetypes. Two-lane architecture with built-in self-diagnostics.
06 / Operator

The Operator

Payer + provider

Most of my career has been walking into rooms where something was wrong and nobody could agree on what. I don't need the consensus to start. I just need the problem to be real.

I built a 13-location integrated health system from the ground up — behavioral health, SUD/MAT, primary care, urgent care, lab, imaging, a surgical center, and a community hospital — and ran it as CEO through acquisition. 30,000+ patients in the behavioral-health system; 200,000+ served across the lifetime of the companies I've led.

I founded and sold ClearBill, a billing-integrity platform that returned $9.2M to payers in its first six months of full deployment. The gap was visible from the provider side. The fix had to come from outside.

Today I'm Staff Vice President of Carelon Growth (Elevance Health's specialty health-services arm), where I own six high-acuity clinical risk books — MSK, Oncology, CHF, Maternity, Autoimmune, and Dementia — across $50B+ in specialty medical spend. I design products and I ship them. No handoff in between. Specialty risk is the fastest-growing liability in American healthcare, and the products on this page are built to govern it before it becomes a claim.

M.S. Applied Behavior Analysis · Northeastern University
B.S. · University of Louisville
DEA-Licensed · SAMHSA-Certified · JCAHO-Accredited

2012 — 2025
Built

A 13-location health system from the ground up — behavioral health, SUD/MAT, primary care, urgent care, lab, imaging, surgical center, community hospital. Ran it as CEO through acquisition.

2023 — 2025
Sold

Founded and sold ClearBill, a billing-integrity platform deployed against payer waste.

2024 — Now
Now

Staff Vice President of Carelon Growth (Elevance Health) — six high-acuity clinical risk books across $50B+ in specialty spend. The books are where I see what breaks in managed care. So I build the answers: the products and tools in this portfolio, designed and shipped on my own.

07 / Engage

Ways To Work

Operator first

Operator first. Open to the full range when the problem is real.

Run it, lead the product, sit on the board, advise, go fractional — I'm open to all of it. I work with health plans, health systems, self-funded employers, digital-health companies, and investors on specialty risk, value-based contracts, governance, and product. No decks. No junior team. The engagement is built around the problem.

AOperate
BLead Product
CBoard
DFractional
EAdvise
FBuild
Learn More
08 / Filed · Published · Read
09 / Fit

Where I Fit

Six doors
A / Payers

Health Plans & Payers

I run specialty risk on the payer side now — six high-acuity clinical books across $50B+ in spend. I know where programs stall because I've unstuck them from the inside. Bring me on to run it, lead the product, or build the next one. Start with Cadence or Continuum.

I'll run it, not just advise it
B / Providers

Health Systems

Entering value-based care without owning the math kills margin. I built a 13-location system from the ground up, ran it as CEO through acquisition, and modeled the contracts from the provider side. I've sat in your chair. Start with Curated or Compass.

Built it. Ran it. Sold it.
C / Employers

Self-Funded & Stop-Loss

Your plan is carrying SUD spend you can't see, continuation gaps nobody measures, and claims that were never verified. Every product here was priced for the renewal you're already running. Start with Waybright, Caliber, or Cadence.

The renewal, upgraded
D / Startups

Digital Health

Your product dies in payer procurement because nobody told you what kills a deal on the other side. I've been the payer executive and the founder across the table. Advisor, board seat, or fractional product lead — whatever moves it. Start with Caliber or Equipoise.

Both sides of the table
E / Capital

PE & Investors

I don't diligence from a spreadsheet. I read the asset from operating history — clinical viability, regulatory exposure, unit economics, what breaks at scale. Then I can run it after close, chair the board, or step in to fix it.

Can run it, not just rate it
F / Anyone

The Pattern

One pattern: independent governance and navigation layers, each carrying its own accountability. Built in about 90 days of nights and weekends.

Show your work
© 2026 — Intellectual property of Cadence, LLC Seven Products · Four Tools · One Structural Argument · Show Your Work Set in Archivo / Demo E — Swiss · v4
Corridor Assistant
What are you looking for? I can help you find the right product, answer questions about pricing, or explain how the governance model works.