Keep the limb.
Keep the person whole.
KEEP is the first benefit manager built for the chronic wound. A home-care spine, an evidence formulary, and the one record claims can't see: whether the wound closed.
We keep limbs. We keep people whole. At home.
North-star metric: limbs kept. Not dollars. The dollars follow.
A wound is not a billing line. For too many patients it is the start of a countdown.
Five years after a major diabetic-foot amputation, more than half of patients are gone. That mortality is worse than breast, prostate, and colorectal cancer and the all-cancer average6. And the people losing limbs are not chosen at random: Black patients are amputated at two to four times the rate of white patients7. Chronic wounds already cost Medicare more than $28 billion a year across 8.2 million beneficiaries, roughly one in seven8. KEEP exists to bend that countdown the other way.
A market broke, got fraudulent, and was half-fixed in the same eighteen months.
Skin-substitute spend ran away, the courts caught a billion-dollar scheme, and CMS slammed the price. Each one alone would matter. Together they open the door for a manager.
About 40x in five years
Medicare Part B skin-substitute spend went from $256M in 2019 to over $10B in 2024 while the patient count only roughly doubled1. Dollars outran people by 20 to 1.
Adjudicated, not alleged
An Arizona wound-graft scheme drew guilty pleas and 15.5- and 14-year sentences, plus $309M in civil recovery5. The money was real. So was the harm.
Dollars outran patients, 2019–2024
Medicare Part B skin-substitute spend, plotted against the patient count it was meant to track.1
CMS fixed the price. It did not fix the coverage.
The new rate caps dollars per square centimeter. It says nothing about which product, which wound, how many applications, or how large a graft. And on December 24, 2025, the seven MAC coverage rules that would have answered those questions were withdrawn4.
What is now capped
- Dollars per square centimeter, flat at $127.142
- Same rate in office and hospital outpatient
- Paid as an incident-to supply, not a marked-up product
What is still unguarded
- Which product, of 361 on the list
- Which wound, which indication, medical necessity
- How many applications, how large a graft — a flat per-cm² rate even rewards larger grafts
CMS capped the dollars-per-unit and walked away from medical necessity. No regulator is coming to fix the other side. That is the benefit manager's job.
KEEP manages the episode, not a product.
The skin substitute is the trigger, not the prize. KEEP runs the whole wound episode — every service the wound touches — inside one managed pathway. The formulary and the closure registry sit inside it, not beside it.
A manager that touches only the formulary manages the loud ten percent and leaves the real money — and the real outcomes — untouched. So KEEP owns one disease, vertically, all the way down: home nursing, medications, labs and the vascular gate, offloading, and the right level of care escalated up or stepped down as the wound moves. One disease. Not all of healthcare.
The wound episode, escalated up and stepped down
One managed pathway across levels of care. Ancillary services are the levers; the formulary and registry sit inside; everything is orchestrated to one number.
kept
The right care
- More home-nurse monitoring — the visit that catches infection early
- The vascular gate before any advanced product is approved
- Offloading, correct antibiotics, glycemic and nutrition support
- Escalation to vascular, surgery, or HBOT the moment the limb is threatened
The wasteful care
- Over-grafting — product applied where it cannot help
- Grafts on limbs with no blood supply to heal them
- Applications beyond evidence, larger grafts the flat rate rewards
- Wound-center utilization the patient could get safely at home
Managing the right care up and the wasteful care down is what makes lead with limb preservation, savings follow true — not a slogan. The savings are the consequence of better care, never the goal we open with.
The risk ladder
KEEP climbs from administrative fees toward a capitated wound carve-out. You can only take a capitated rate if you can move the outcome — and only the registry lets you prove it.
Admin / PMPM management fee
Formulary, evidence-aligned prior auth, network access, and the wound-spend diagnostic.
Performance guarantees
Closure-rate and limb-preservation targets put fees at risk against real outcomes.
Capitated wound carve-out
A per-member rate for the wound population, keeping the spread it saves. Precedent that payers will capitate a young vendor: Synapse Health / UnitedHealth, DME, 2026.
What KEEP reports back is limbs kept.
Not dollars saved. A limb preserved. A wound closed. A person kept whole, at home.
The metric is limb-preservation rate, supported by closure rate, and only then by cost. Run the toggle: when a wound benefit is managed, the outcomes move first. The savings are the quiet consequence, and they come last.
A wound population, unmanaged vs. managed
Every payer. We start where the dollars are most exposed.
The genuinely unmanaged spend sits in commercial and Medicaid, where there is no CMS rate to cap it and no public dataset even sizing it. Medicare Advantage already manages this. We meet each payer where it actually stands.
Commercial
Same clinical wound burden, no CMS rate to cap it, weak medical policy in many plans. The most exposed dollars, and the clearest first meeting.
Medicaid MCOs
FFS segments and weak-policy states carry the same risk with no public number sizing it. A regional MCO without internal wound capability is the wedge buyer.
Medicare Advantage
Already self-manages this through prior auth — only ~7% of FFS skin-sub spend despite over half the lives9. Pitched as managed services, the home spine, and the registry. Not a rescue.
Medicare FFS
Got the price fix but still carries coverage-side risk — larger grafts, more applications. A managed pathway still has a job through the coverage gap.
THE OPERATOR
Joe Nalley
Staff Vice President of Carelon Growth (Elevance Health)
Built by someone who has carried wound patients and built the businesses around them.
Joe Nalley is Staff Vice President of Carelon Growth (Elevance Health), where he works inside the machinery of payer growth at national scale.
He founded and sold ClearBill, which returned $9.2M to payers in its first six months. He built and exited GetWell, a 13-location behavioral-health and substance-use provider that served more than 30,000 patients.
Across a career in care delivery and payer growth, he has been responsible for more than 200,000 lifetime patients served. KEEP is the benefit manager that work has been pointing toward.
Book the wound-spend diagnostic.
One condition, the diabetic foot ulcer. One artifact: your own 40x chart, built from public and plan-shareable data, so your plan sees its own exposure. No network required to produce it.
We open with limb preservation. We close with limbs kept. The savings are real, and they come last.