Joe Nalley
show your work.
High-cost categories run on autopilot between authorization and outcome. No one in the payment chain independently checks whether the therapy should still be running, whether the bill was right, or whether the outcome was preventable.
65,234 patients studied · $9.2M returned to payers in its first six months · Published in Pharmacy Times
13 locations built · 2 companies exited · Both chairs, same table
joenalley25@gmail.com · joe-nalley.com
Joe Nalley
02

Between authorization
and outcome, nobody's paid to check.

A therapy starts. Nothing in the standard stack checks whether it should still be running eighteen months later. A TPA processes the claim. No independent party verifies it before payment. A navigator routes the member. No fee is forfeited when the outcome fails. It happens wherever the dollar is authorized and then goes unwatched. It's sharpest in self-funded plans, where the payer and the loser are the same entity.
Seven products. Each one stands in a gap nobody else will.
Employer healthcare costs have risen 9–10% for the third year running (KFF 2025), and the answer has been more point solutions, not fewer gaps. These aren't more point solutions. They're governance standards that work inside your existing stack. No facility to own, no network fee, no downstream interest, and the fee is at risk against the outcome.
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Joe Nalley
03
The Portfolio

Seven products. Four tools.
One structural argument.

Each product stands in a gap the standard stack leaves open. Independent, advisory-only, the fee at risk against the outcome. The tools are free: the published standards that keep the products honest.
Spend integrity
Specialty Rx continuation governance 29.1% flag · NIH · Pharmacy Times Pre-payment claims verification $9.2M returned · first six months
Care & conditions
Behavioral-health navigation + readmission warranty Virtual SUD / OUD treatment continuity Maternity navigation + provider warranty Remote medication delivery, concept IP KEEP Chronic-wound benefit management
The instruments · free
Compass VBC financial modeling · 4 calculators · 8 LOBs Covenant Delegation-governance standard · DGS v1.0 FORGE Product-lifecycle framework · 24 templates Equipoise Parity engine · free on sample data
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Joe Nalley
04
verifythebill.com
Caliber · Claims Verification · Proof

$9.2 million returned to payers.
In the first six months of full deployment.

ClearBill, the engine Caliber is built on.
Claims above $25K pass through the TPA without independent verification. Caliber runs a seven-check audit during the hold window, before the money leaves. It's advisory-only: it issues a Billing Governance Certificate and never denies a claim. It's independent of the network being audited, and no broker or consultant referral fee is paid or taken, so no channel compensation can bias a verification.
4–6%
expected discrepancy on
claims >$25K · OIG/AHLA/MGMA
7
checks · CODEVAL→BUNDLEVAL
BGS v1.0 · pre-payment
Your carrier reimburses verified claims, not unverified ones. Pre-payment verification stops overpayment before it hits your spec.
verifythebill.com
Recovery rate by verification timing A dollar caught before payment is kept in full; post-payment recovery returns about 12 cents on the dollar (OIG 2023). 100¢ 0¢ 100¢ Pre-payment Caliber · in the hold window 12¢ Post-payment pay-and-chase recovery
A dollar verified before it leaves is worth eight of the same dollar chased after.
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Joe Nalley
05
showyourwork.health
Cadence · Specialty Rx Governance · Proof
29.1%
of specialty patients continuing therapy that warrants reassessment. Nearly one in three.
29.1% is the flag rate across the 30,734-patient NIH All of Us validation subset, the federal-data anchor inside the 65,234-patient evidence base.
65,234 patients · 3 locked cohorts · NIH All of Us validation
$14.3M first-cycle gross savings · Published in Pharmacy Times, April 2026
Prior auth decides whether a therapy starts. Nothing decides whether it should still be running a year and a half in. Cadence is a governance standard, eight sections and seven reassessment triggers, that audits continuation appropriateness across biologics, specialty injectables, and high-cost oral therapies.
The prescription refills and the spend accrues. Nobody reassesses.
For your stop-loss renewal: identifies continuation waste before it inflates your loss run. The governance artifact documents what your plan did about it.
showyourwork.health
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Joe Nalley
06
Episode Ownership · Fee at Risk

One navigator. The whole episode.
Fee at risk against the outcome.

Behavioral Health

One navigator per member. Every BH episode. For as long as they're covered.

Quality-scored provider database across 13 clinical areas. Episode-chain continuity. 30-day readmission warranty on SUD residential and acute psych. Fee forfeited on a miss.

30K+
BH patients managed across
13 locations (2012–2025)
curatedhealth.care
Maternity

Claims-integrated risk identification. A warranty held on Waybright's own books.

Convener model. When a readmission Waybright should have caught slips through, Waybright pays the cost of it from its own reserves, held at 1.75× expected loss. Facility-level quality data in the consumer's hands.

$376,003
modeled savings, 10K-employee plan
85.6% effective steerable fraction
waybright.health
Virtual SUD continuity, induction through 14-month maintenance. National 90-day buprenorphine retention is 48.4%.
Equipoise
MHPAEA parity + NQTL comparative analysis in minutes. Defends $100/day-per-individual excise exposure.
Remote Medication Delivery: wearable concept IP across 4 emergency conditions. Pre-prototype.
NICU shock claims ($200K–$500K) move your spec. Maternity steering reduces them. Readmission warranties offset specific-stop-loss exposure directly.
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Joe Nalley
07
How It Works

Your data, read by credentialed reviewers.
You keep the findings. Nothing is compelled.

Step 1

You send a claims extract

Standard flat file. De-identified or under BAA. We configure the triggers. No platform install. No integration. No IT involvement.
Step 2

Credentialed reviewers do the work

PharmD, MD, and clinical specialists with therapeutic expertise. Contracted panel, external to your plan. Minimum two independent reviewers per cycle for inter-rater reliability. Every determination is human, not algorithmic.
Step 3

You hold the artifact

Documented governance record with outcome distribution, influence rates, and the full audit trail. Yours to keep. Present it to your board, your stop-loss carrier, or your consultant. Your call.
Data security
BAA executed before any data transfer. HIPAA-compliant infrastructure. SOC 2 pathway in progress. All data encrypted at rest and in transit.
Advisory-only. No duty to act.
External reviewers, no denial authority, no utilization management action triggered. Your team decides what to do with the findings through existing channels.
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Joe Nalley
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Track Record

The work is the resume.

Joe Nalley

I built a health system from zero: behavioral health, SUD, MAT, primary care, a surgical center, a community hospital. Thirteen locations, thirty thousand patients. I took it through the acquisition and stayed on as CEO through the transition.

I built a billing verification platform and sold it. It returned $9.2 million to payers in its first six months of full deployment.

Published in Pharmacy Times. 65,234 patients across NIH-validated cohorts, a 29.1% flag rate across the 30,734 in the federal dataset.

Most recently, Staff Vice President of Carelon Growth at Elevance Health, running six specialty clinical risk books across $50B+ in spend: MSK, Oncology, CHF, Maternity, Autoimmune, and Dementia. Those books are where every gap in this portfolio became visible.

M.S. Applied Behavior Analysis, Northeastern · 30,000+ BH patients across 13 locations (2012–2025) · 80%+ residential completion across 3,400+ admissions · joe-nalley.com
Seven products and four tools. Every site, every price, every clinical standard, every line of code. I built all of it.
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Joe Nalley
09

I run 90-day pilots.
On your claims data. You keep the findings.

Every engagement starts the same way: your claims data, your baseline, your measurement. I build the scorecard before the pilot starts. Metrics are agreed, not discovered after the fact. At day 30, 60, and 90, you see what moved and what didn't.
There's no platform to install, no integration to build, no multi-year lock-in. If the numbers don't move, you walk away with the data and the analysis. The 90 days were worth it either way.
The 90-day pilot is how these products earn their first performance record on your data. You're not buying a platform. You're hiring a governed review of your claims, run by someone who has done it tens of thousands of times.
Skin in the game from day one.
Fee-at-risk where applicable. Gain-share earned in year two, not assumed in year one.
Subscription pricing. No setup fees.
Cadence $2–6 PMPM
Caliber $2–5 PEPM
Curated $4–7 PEPM
Waybright $8 / $6 / $4.50 PEPM
Waybright is tiered. Two or more products: portfolio discount. Compass, Covenant, and FORGE are free. Equipoise runs free on sample data; white-label priced separately.
Independence is structural.
I have no downstream interest in volume, no network to fill, no PBM to feed. The findings go to your team.
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Joe Nalley
10

Tell me your top cost category.
I'll build the pilot around your claims data.

I take two new pilot engagements a quarter. The methodology is published, the findings are yours, and the risk is mine.
showyourwork.health Cadence    verifythebill.com Caliber
curatedhealth.care Curated    waybright.health Waybright
joe-nalley.com Full portfolio
joenalley25@gmail.com