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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>
99 lines
4.5 KiB
Markdown
99 lines
4.5 KiB
Markdown
# Signal CGM — Master Summary
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### Strategic Analysis Package | STTIL Solutions LLC | April 2026
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---
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## What This Package Contains
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| File | Description |
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|------|-------------|
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| Analysis/signal-cgm-segment-scoring-v1.md | Three-model scoring: SaaS ICP, Asset Sale, Pilot Validation across 7 segments |
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| Analysis/signal-cgm-re-scored-composite-v2.md | Composite re-score (50/30/20 weights) with MA + Medicaid payer scope applied |
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| Analysis/signal-cgm-final-ranking-leverage-v3.md | Final four-segment ranking, denial quantification, six leverage points |
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| Assets/signal-cgm-pitch-v1-plain.md | Leave-behind: plain language / social media (6th grade reading level) |
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| Assets/signal-cgm-pitch-v2-professional.md | Leave-behind: professional (mid-size and larger billing organizations) |
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---
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## Final Composite Rankings (MA + Medicaid Scope · Asset Sale Primary)
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| Rank | Segment | Composite Score | Primary Use |
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|------|---------|----------------|-------------|
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| #1 | Billing company / DME RCM outsourcer | **7.61** | Pilot partner + asset buyer |
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| #2 | NikoHealth-type platform vendor | **7.34** | Primary asset sale target |
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| #3 | VGM Group / MSO | **5.72** | Follow-on distribution post-sale |
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| #4 | Mid-size independent supplier | **5.36** | SaaS ICP if pivot away from asset sale |
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**Weights:** Asset sale 50% · Pilot 30% · SaaS 20%
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---
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## Key Metrics (All Sources: CMS 2024 / OIG 2025 / KFF 2024)
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| Metric | Value |
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|--------|-------|
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| CGM improper payment rate (Medicare) | 25.2% |
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| Projected annual CGM improper payments | $278.5M |
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| Share from documentation failures | 94.2% |
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| Net revenue loss after appeals (per supplier) | ~20% of gross CGM billing |
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| Permanently written off (not recovered) | ~63% of denied claim value |
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| Recovered through L1+L2 appeals | ~28% of denied claim value |
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| MA DMEPOS appeal success rate (L2) | 63.9% |
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| MA prior auth denial rate | 7.7% of PA requests |
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| Traditional HME supplier locations (2024) | ~8,005 (−38% from 2013) |
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---
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## Leverage Priority Stack (Workflow Intervention Points)
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1. **Prior Authorization** (9.2/10) — Only denial type with zero recovery path
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2. **Refill Tracking / Coverage Clock** (8.8/10) — Enabling infrastructure for everything
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3. **6-Month Visit Compliance** (8.1/10) — Highest-frequency daily queue driver
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4. **PECOS Validation at Each Refill** (7.4/10) — Hard write-off prevention
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5. **Intake Validation** (6.5/10) — Front-door pipeline defense
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6. **Audit Defense Log** (5.8/10) — Compliance record as system byproduct
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---
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## Sequencing Recommendation
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```
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Week 1–2: Identify 2–3 billing company targets with CGM-active client books
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Week 2–4: Approach with Version 1 or 2 leave-behind; propose 60-day pilot
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Week 4–8: Execute pilot on live MA + Medicaid CGM data under BAA
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Week 8: Deliver denial risk exposure report (before/after)
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Week 9–12: Use pilot evidence to open NikoHealth asset sale conversation
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at higher valuation than current $45K–$65K ask
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Week 12+: Parallel VGM vendor partner program conversation for distribution
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```
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---
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## Validated Hypotheses Status (as of April 2026)
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| Hypothesis | Status | Method |
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|-----------|--------|--------|
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| H1: Denials are documentation-fixable | **Confirmed by CMS data** — 94.2% doc failures | Desk research (OIG + CMS 2024) |
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| H2: April 13 PA expansion is live and unpatched | **Likely confirmed** — no incumbent updated | Requires 2–3 discovery calls to verify |
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| H3: CB 2028 deadline drives active buying urgency | **Untested** | Requires 5 discovery calls with owner-operators |
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---
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## Next-Steps Prompt for Next Claude Code Session
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> Continue Signal CGM go-to-market execution. All strategic analysis is
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> in CGM-Denial-Prevention/01-Claude-Outputs/. The asset sale target ranking
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> is: #1 Billing company (pilot first), #2 NikoHealth (asset sale after pilot
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> evidence). Payer scope: Medicare Advantage and Medicaid as first
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> proof-of-concept. Pilot offer: 60 days, no cost, on live client data under
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> BAA. Asset ask: $45K–$65K acquisition or $75/client/month licensing.
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> Next priority: identify 3 billing company targets (suggest starting with
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> Florida-based DME RCM firms given existing FAHCS research) and prepare
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> outreach sequence using Assets/signal-cgm-pitch-v2-professional.md.
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> Hypothesis H2 (April 13 PA gap) and H3 (CB urgency) still require
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> discovery call validation per validation-hypotheses.md in Obsidian vault.
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---
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*Generated: April 2026 | STTIL Solutions LLC | Signal CGM*
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*All figures from CMS, OIG, KFF primary sources — see individual files for citations*
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