Healthcare's most persistent failures have been documented for thirty years. Preventable admissions. Avoidable readmissions. Undertreated complexity. The clinical knowledge to close these gaps has always existed. The data architecture has not.
Your risk-adjusted revenue is only as accurate as your documentation. HPDM™ identifies the gap between what your population’s clinical complexity actually is and what your claims reflect — without PHI, without integration, in 60–90 days.
Value-based contracts require clinical intelligence your EHR was not built to produce. HPDM™ gives your physicians the documentation specificity to close the gap between the care you deliver and the complexity that care reflects.
Downside risk changes everything. HPDM™ identifies which patients drive your shared savings risk, where your documentation understates clinical complexity, and what your care teams should prioritize this quarter.
Rural populations carry the highest chronic disease burden and the lowest documentation infrastructure. HPDM™ closes both gaps — connecting clinical complexity to the documentation accuracy and care access that federal and state programs require.
Medical Necessity Gap
Your population’s clinical complexity is higher than your documentation reflects. Not because of billing errors — because rural and community providers manage high-complexity patients without the documentation infrastructure that academic medical centers take for granted.
HPDM™ identifies the gap at the condition level, generates the clinical evidence for accurate documentation, and produces a priority queue your care teams can act on within 30 days.
HEDIS & Stars Gap
Rural populations underperform national quality benchmarks by 15–35 points on key HEDIS measures — not because care quality is inferior, but because access barriers, care coordination failures, and SDOH factors prevent the right care from reaching the right patient.
HPDM™ identifies which patients are closest to quality gap closure, what care team action closes that specific gap, and which payer infrastructure funds the intervention.
Structural Access Gap
Access barriers are not solved by telehealth alone. They are solved by knowing which patients have which barriers — which are near-immutable (geography, housing, transportation) versus modifiable (scheduling, literacy, engagement) — and which intervention removes the barrier for that specific patient.
HPDM™ maps access barriers through its four-shell architecture at the patient level — not the zip code level. Shell 1 and Shell 2 together produce an access barrier profile that no claims-based system can generate.
These are not projections or estimates. They are published findings from federal agencies and peer-reviewed research — the documented cost of an architectural problem that incremental improvements have not solved.
In 2001, the Institute of Medicine published Crossing the Quality Chasm — the most cited document in modern American healthcare policy. Its finding was not a lack of clinical knowledge or capable technology.
Its finding was structural: the delivery system was not designed to deliver the care that clinical science had already made possible.
A decade later, the IOM's Best Care at Lower Cost (2012) documented that the conditions from 2001 had not fundamentally changed — estimating $760 billion to $935 billion (JAMA 2019) in annual healthcare waste attributable to fragmentation, inefficiency, and missed prevention.
The Medicare Payment Advisory Commission has documented in multiple annual March Reports that Medicare Advantage plans systematically underpay for their highest-complexity members — the precise population where additive risk scoring fails most severely.
The HCC v28 model assigns risk scores additively — each condition weighted independently, as if the others do not exist. This methodology is appropriate for its designed purpose: actuarial population-level payment adjustment.
It was never designed as a clinical intelligence tool. It was never intended to capture how conditions interact. And it cannot be patched to do so — the limitation is architectural, not algorithmic.
A better algorithm running on the wrong architecture produces better predictions of the wrong thing. The problem is not the algorithm. The problem is the organizing unit — the billing code instead of the person.
Conditions are scored independently. Each diagnosis receives a risk weight. The patient's total score is the sum of those weights.
Social determinants are not captured. Behavioral factors are not in the model. Functional status is not a variable. Comorbidity interactions are not computed.
The patient is not the organizing unit. The billing code is.
The patient is placed at the center. All data — clinical, social, behavioral, biological — is organized as an attribute of that whole person, classified by mutability.
Condition interactions are computed multiplicatively across 65 validated comorbidity pairs, drawn from a pairwise interaction space of 24,310.
The score reflects the patient's actual clinical reality — not an administrative approximation of it.
HPDM organizes every data element about a patient as an attribute of that patient — classified by how mutable it is and what domain of their life it reflects. Four shells. Three scoring axes. One whole-person clinical profile.
HPDM is architecturally designed to receive and unify every data source that touches a patient — EHR, Claims, Encounter, ADT feeds, HIE networks, and State All-Payer Claims Databases where accessible. These sources are not merged into a flat file. They are organized as attributes of a whole person, classified by shell. The act of federating these sources is itself the first deliverable of a Tier Two engagement — before a single gap is identified, your organization has a unified clinical view of your population that no single system currently provides.
Where HCC v28 adds condition weights independently, HPDM's Z-axis computes interaction effects between conditions — the same multiplicative compounding that clinical literature has documented for decades and that additive models structurally cannot capture.
A patient with diabetes, chronic kidney disease, and heart failure does not carry three independent risks. Each condition accelerates and modifies the progression of the others. A patient with 12 active conditions generates 66 pairwise interaction evaluations under HPDM's Z-axis — against 12 independent assessments in an additive model.
These are not projections. They are outcomes documented in peer-reviewed literature as achievable — and documented as persistently unachieved with current data architectures. HPDM is the architectural change that makes the difference.
A 60-day, fixed-fee engagement. Synthetic patient cohort calibrated to your population using only public Tier A data. No PHI. No EHR or claims integration. No long-term commitment. You walk away with documented, contract-ready findings — whether you continue with us or not.
Four-shell clinical intelligence profile across immutable biological, mutable clinical, social-environmental, and behavioral domains, with Z-axis interaction analysis. Calibrated to your geography, payer mix, and case complexity.
Specific coding opportunities the standard HCC v28 architecture misses — surfaced against your current population parameters and immediately actionable by your coding team without waiting for the next AEP cycle.
Prioritized intervention opportunities for care management, ranked by clinical impact and feasibility — including the social-determinant and behavioral exposures the current architecture ignores entirely.
Documentation completeness quantified per high-complexity member, and reported as the gap between what interaction scoring finds and what the additive instruments record. Computed on your population, with its derivation attached — defensible in payer contract negotiations because you can reproduce it.
A sequenced path through all six HPDM activation layers, scoped to your organization's readiness. You decide whether to run the next phase with us, internally, or not at all.
Coding teams get specific ICD opportunities. Care managers get prioritized lists. CFOs get defensible RAF documentation. Clinical leadership gets a population-level architecture view. No deliverable sits on a shelf.
60 days · Fixed fee · No integration required · No PHI leaves your environment · Standalone analytical deliverable, not a commitment to further engagement
See HPDM™ in action
→No login required. Explore the synthetic cohort dashboard.
We do not ask for trust before we earn it. You activate what you need. You pay for what you use. Nothing more. Tier Zero is a fixed-fee assessment against a synthetic patient cohort — no integration required, no PHI, no long-term commitment. You see what HPDM finds. You decide what to do next.
Every activation layer is independently valuable. Each closes a specific category of gap your organization is already carrying. You activate what you need. You see the value before committing to the next layer.
One finding reproduces across every synthetic cohort we have run — independently derived, calibrated to different populations, different payer mixes, different disease burdens. A material share of patients rank materially higher under interaction scoring than any additive instrument rates them.
Two systems look at the same patient and disagree about how sick they are. The additive model scores each condition independently and adds the weights. HPDM computes how the conditions act on each other. Where a patient carries interacting conditions — and most complex patients do — the two answers separate, and the additive one is lower.
That separation is the product. It is not a projection, not a benchmark, and not an estimate of savings. It is a per-patient comparison between two scoring methods run over the same record, and it can be recomputed by anyone holding both.
It is computed, not modelled. Each patient is scored twice and the difference is read off. There is no fitted parameter between the input and the finding.
It is reproducible. The same cohort scored again returns the same ranking, and cohorts derived independently of one another produce the same direction and the same shape.
It names the patients. A share is not the deliverable — the list is. Tier Zero returns which members rank higher, which interacting conditions drive each one, and what a care team or a coding team can do about it inside thirty days.
We are not going to tell you on a web page. The size of the gap depends on your population, your payer mix, and how completely your record already reflects your patients’ complexity — and a number quoted from somebody else’s cohort is not evidence about yours. Tier Zero produces the figure for your population, with its derivation attached, and you keep it whether or not you continue with us.
Before HPDM, David Nethaway spent twenty years inside healthcare operations — as a clinician, as a program manager, and as a strategic advisor to health plans and government programs. He has seen the data architecture problem from every angle.
Hypersphere Health was founded on a single premise: the architecture was wrong, and fixing it required starting over — with the person at the center.
Naya Advisory Services provides the consulting engagement vehicle. Hypersphere Health, Inc. is the platform company. The patent-pending HPDM architecture is the foundation of both.
Not to sell you something. To understand whether HPDM applies to your specific problem. Twenty minutes. No deck. No pitch.
Tier Zero assessments are available immediately · Fixed fee · No integration required · No PHI