Multi-State Payer Modeling and Milestone Runway for Digital Health

Use Level observations as cross-trade context. Other cards are planning scenarios, not measured industry percentiles. Match your business model, period and cost definition before comparing.

Time to First $ by State: Planning inputs to test, not measured industry percentiles: Illustrative stress case; replace with actual licensing, credentialing and payer-contract dates.

Payment-Rate Difference Sensitivity: Planning inputs to test, not measured industry percentiles: A 30-200% relative rate-difference sensitivity, not a published reimbursement distribution. State the base payer rate and compare the same service, location and collection basis.

Telemedicine Conversion: Planning inputs to test, not measured industry percentiles: Independent 12-25% web-visit-to-consult sensitivities and a 10% investigation level. Define visits, eligible prospects and completed paid consultations before diagnosing the funnel.

Burn Multiple Target: Planning inputs to test, not measured industry percentiles: Under 2.0x is a planning sensitivity, not a Series A requirement. Net cash spent / net new annual recurring revenue (ARR) needs matched periods and positive net new ARR; clinical milestones require a separate cash schedule.

Runway Horizon to Stress-Test: Planning inputs to test, not measured industry percentiles: Stress-test 24-30 months against actual regulatory, clinical, hiring and collection milestones. This is a planning horizon, not an investor-wide requirement.

Treasury Yield: Planning inputs to test, not measured industry percentiles: Fictional yield sensitivity; not a current provider quote. Match liquid reserves and clinical milestone funding before investing.

We build your revenue ramp from actual state go-live dates and reimbursement lags so your runway forecast reflects reality. A 6-12 month delay is an illustrative stress case, not a measured healthcare-startup median. Distinguish readiness to deliver care, eligibility to bill, accepted reimbursement and cash receipt in the runway model.

We model unit economics by payer and state so you can answer investor diligence questions with hard numbers. A missing payer-by-state model can leave reimbursement timing and contribution questions unanswered during investor diligence.

We map your burn rate directly against FDA, IRB, and commercial launch gates so your board sees every trade-off clearly. Map the actual investor plan to clinical and regulatory milestones as well as operating costs.

For a defined period, compare revenue minus included clinical costs with matched clinical hours. Before product revenue exists, review engineering cost per milestone rather than calling it gross profit. Level works from approved books, payroll and de-identified or aggregate clinical/billing exports, or supported connections within the agreed permissions. Our team reviews the cost allocations and assumptions. Any patient-level handling requires a separately agreed scope and permissions.

Account for credentialing lag, reimbursement timing, and payer-specific rate differences. Financial models built from documented assumptions so diligence questions can be traced to the records.

We map next Food and Drug Administration (FDA) review milestone, next institutional review board (IRB) approval, next pilot completion against burn so the board sees what trade-offs delay each gate.

Routine EHR configuration or implementation is not automatically research. Review funded-research terms, group eligibility, gross receipts and the five-tax-year history before a payroll-tax election; evaluate the actual work rather than treating every healthtech project as eligible.

Define each measure’s period and eligible records so the investor can follow the calculation.

A digital-health company is not automatically QSBS-eligible. Section 1202 excludes certain service businesses, including the practice of health; qualifying technology operations require a separate facts-based review. Original issuance, asset tests, eligible ownership and holding period also matter. We coordinate legal and tax review of the actual business before treating stock as eligible, alongside an 83(b) election (a choice to recognize income on qualifying nonvested property at transfer, filed no later than 30 days after the property transfer), incentive stock options (ISO), alternative minimum tax (AMT) and residency planning. Your legal and tax advisers decide whether these rules apply.

A 4.5-5% yield is a fictional sensitivity, not a current quote from Mercury, Ramp or Rho. At illustrative $5M invested for a full year at 4.8%, gross interest is $240K before fees and taxes; changing balances or rates changes the result. A $10M balance at 4.5-5% would yield $450K-500K on the same assumptions. Check current terms and access before moving cash; income is not a guaranteed engagement payback.