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.
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 $750 billion 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 and 29,403 Z-axis interaction paths.
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.
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.
We do not ask for trust before we earn it. 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.
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