Kisa 346a1fb58e feat: Signal CGM strategic analysis + asset sale package

Adds complete go-to-market analysis for Signal CGM asset sale:

Analysis/
  - signal-cgm-segment-scoring-v1.md   (3-model scoring across 7 segments)
  - signal-cgm-re-scored-composite-v2.md (50/30/20 composite, MA+Medicaid scope)
  - signal-cgm-final-ranking-leverage-v3.md (final 4-segment rank + leverage map)

Assets/
  - signal-cgm-pitch-v1-plain.md       (plain language leave-behind)
  - signal-cgm-pitch-v2-professional.md (professional leave-behind)
  - master-summary.md                   (rankings, metrics, next-steps prompt)

Key findings: 25.2% CGM improper payment rate; 20% net revenue loss;
63% of denied claims permanently written off; billing company #1 target
for pilot; NikoHealth #1 for asset sale.

Co-Authored-By: Claude Sonnet 4.6 <noreply@anthropic.com>

2026-04-19 20:37:18 -04:00

4.5 KiB

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Signal CGM — Master Summary

Strategic Analysis Package | STTIL Solutions LLC | April 2026

What This Package Contains

File	Description
Analysis/signal-cgm-segment-scoring-v1.md	Three-model scoring: SaaS ICP, Asset Sale, Pilot Validation across 7 segments
Analysis/signal-cgm-re-scored-composite-v2.md	Composite re-score (50/30/20 weights) with MA + Medicaid payer scope applied
Analysis/signal-cgm-final-ranking-leverage-v3.md	Final four-segment ranking, denial quantification, six leverage points
Assets/signal-cgm-pitch-v1-plain.md	Leave-behind: plain language / social media (6th grade reading level)
Assets/signal-cgm-pitch-v2-professional.md	Leave-behind: professional (mid-size and larger billing organizations)

Final Composite Rankings (MA + Medicaid Scope · Asset Sale Primary)

Rank	Segment	Composite Score	Primary Use
#1	Billing company / DME RCM outsourcer	7.61	Pilot partner + asset buyer
#2	NikoHealth-type platform vendor	7.34	Primary asset sale target
#3	VGM Group / MSO	5.72	Follow-on distribution post-sale
#4	Mid-size independent supplier	5.36	SaaS ICP if pivot away from asset sale

Weights: Asset sale 50% · Pilot 30% · SaaS 20%

Key Metrics (All Sources: CMS 2024 / OIG 2025 / KFF 2024)

Metric	Value
CGM improper payment rate (Medicare)	25.2%
Projected annual CGM improper payments	$278.5M
Share from documentation failures	94.2%
Net revenue loss after appeals (per supplier)	~20% of gross CGM billing
Permanently written off (not recovered)	~63% of denied claim value
Recovered through L1+L2 appeals	~28% of denied claim value
MA DMEPOS appeal success rate (L2)	63.9%
MA prior auth denial rate	7.7% of PA requests
Traditional HME supplier locations (2024)	~8,005 (−38% from 2013)

Leverage Priority Stack (Workflow Intervention Points)

Prior Authorization (9.2/10) — Only denial type with zero recovery path
Refill Tracking / Coverage Clock (8.8/10) — Enabling infrastructure for everything
6-Month Visit Compliance (8.1/10) — Highest-frequency daily queue driver
PECOS Validation at Each Refill (7.4/10) — Hard write-off prevention
Intake Validation (6.5/10) — Front-door pipeline defense
Audit Defense Log (5.8/10) — Compliance record as system byproduct

Sequencing Recommendation

Week 1–2:   Identify 2–3 billing company targets with CGM-active client books
Week 2–4:   Approach with Version 1 or 2 leave-behind; propose 60-day pilot
Week 4–8:   Execute pilot on live MA + Medicaid CGM data under BAA
Week 8:     Deliver denial risk exposure report (before/after)
Week 9–12:  Use pilot evidence to open NikoHealth asset sale conversation
            at higher valuation than current $45K–$65K ask
Week 12+:   Parallel VGM vendor partner program conversation for distribution

Validated Hypotheses Status (as of April 2026)

Hypothesis	Status	Method
H1: Denials are documentation-fixable	Confirmed by CMS data — 94.2% doc failures	Desk research (OIG + CMS 2024)
H2: April 13 PA expansion is live and unpatched	Likely confirmed — no incumbent updated	Requires 2–3 discovery calls to verify
H3: CB 2028 deadline drives active buying urgency	Untested	Requires 5 discovery calls with owner-operators

Next-Steps Prompt for Next Claude Code Session

Continue Signal CGM go-to-market execution. All strategic analysis is in CGM-Denial-Prevention/01-Claude-Outputs/. The asset sale target ranking is: #1 Billing company (pilot first), #2 NikoHealth (asset sale after pilot evidence). Payer scope: Medicare Advantage and Medicaid as first proof-of-concept. Pilot offer: 60 days, no cost, on live client data under BAA. Asset ask: $45K–$65K acquisition or $75/client/month licensing. Next priority: identify 3 billing company targets (suggest starting with Florida-based DME RCM firms given existing FAHCS research) and prepare outreach sequence using Assets/signal-cgm-pitch-v2-professional.md. Hypothesis H2 (April 13 PA gap) and H3 (CB urgency) still require discovery call validation per validation-hypotheses.md in Obsidian vault.

Generated: April 2026 | STTIL Solutions LLC | Signal CGM All figures from CMS, OIG, KFF primary sources — see individual files for citations

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