Underwrite the health risk you already take.
For organizations paid a fixed amount per patient — outcome-aligned programs, value-based contracts, at-risk chronic care. Ledger records what every care action cost and what it produced, then turns those rows into a number you can act on: with our analysis tools on top of your own history, estimate what the next patient, cohort or contract costs to serve — before you commit to it.
Tell us how you reach patients. We come back with your first rows and a first estimate of what an outcome costs you.
You're already an insurer. You just don't have the book.
A fixed payment per patient is a risk transfer. The payer set the price; you took on everything it costs to reach the outcome — the calls, the devices, the shipping, the nurse hours, and the AI that may or may not have moved anything.
An underwriter pricing that risk would start with a loss history: what each attempt costs, how often it works, which patients run hot. Almost nobody carrying this risk has one. Costs sit in a payroll system and a stack of vendor invoices, results sit in the chart, and nothing joins them at the level of a single care action.
So the margin on every contract you sign is a guess, and the first time you learn it was wrong is at reconciliation.
One row for every attempt to move a patient.
Ledger sits between the tools you already use to reach patients and the place you bill. Each attempt writes one row: what the action was, what it cost, what followed, and what that was worth.
| The action | What it cost | What followed | What it was worth |
|---|---|---|---|
| Outbound call, 6 min | Staff minutes at a loaded rate | Patient activated the app | Track opens, care can be delivered |
| BP cuff shipped | Device + shipping | Reading landed, in range | The measurement the payment depends on |
| AI check-in, 3 messages | Model + platform cost | Nothing | $0 |
| Medication change | Clinician time | Follow-up visit happened | The visit, billed |
Cheap to write while the work is happening. Impossible to reconstruct a year later, which is the whole reason to start now.
Writing the rows is the first half. The second is what our tools do with them: once the history is deep enough, the same ledger stops only reporting what a patient did cost and starts estimating what a patient like this one will — per action, per cohort, per contract.
Cost per landed result — and what the next one will cost.
- Which action actually produced the result — the call, the nudge, the device, the clinician hour — and what it cost to get there.
- An estimate before you spend it. Our tools read your rows and put a number on what it will take to land the outcome for a patient like this one, so the care plan is priced going in.
- The patients running hot, early. The panel's cost curve while there is still time to change the plan, not after the period closes.
- A next-time answer. The cheapest action that still lands the event, instead of doing all of them to be safe.
- AI actions priced like every other action. Model spend lands in the same unit as nurse minutes, so the two can be compared at all.
A loss history you can underwrite from.
- Cost to serve, per patient and per cohort, set against the payment you actually receive for them.
- Which patients you can afford to take. The distribution, not the average — the average is what makes a book look fine until it isn't.
- Price a contract before you sign it. Put a proposed rate and a proposed population through your own history and see the estimated cost to serve, and the margin, in advance.
- An evidence file for the payer conversation: the same rows, assembled as proof the intervention did something worth paying for.
- A defensible number for the next contract. An estimate you can show your work on, from your own history instead of last year's spreadsheet.
See your first rows, from your own work.
Tell us how you reach patients today and what a completed patient pays you. We'll come back with what the first rows look like, and the first estimate they'd already support — cost to serve one patient, against what you get paid for them.