How KEEP keeps the limb.
A plain, step-by-step tour of the benefit manager built for the chronic wound. The problem it answers, the model in five steps, what a health plan actually gets, and the one number it reports back.
We keep limbs. We keep people whole. At home.
Six minutes. Every outside number is cited at the bottom.
A wound is a human countdown, riding on a market that broke.
There are two problems at once. One is a person who may lose a limb. The other is a category of spend that ran away and has no dedicated manager. KEEP exists because both are true.
The wound is the start of a countdown
Five years after a major diabetic-foot amputation, more than half of patients are gone. That is worse than breast, prostate, and colorectal cancer and the all-cancer average4. And it falls unevenly: Black patients are amputated at two to four times the rate of white patients5. Chronic wounds already cost Medicare more than $28 billion a year across 8.2 million people, roughly one in seven6.
Spend ran away, then got half-fixed
Medicare Part B skin-substitute spend grew about 40x from 2019 to 2024 while the patient count only roughly doubled1. In January 2026 CMS capped the price at a flat $127.14 per square centimeter, a roughly 90% cut2. But CMS fixed the price, not the coverage. The seven coverage rules that would have governed which product and which wound were withdrawn December 24, 20253. No regulator has stepped in to close that gap.
One managed pathway, from the open wound to the kept limb.
KEEP manages the episode, not the product. The skin substitute is the trigger, not the prize. Here is the path a single wound travels, and what KEEP does at each turn. Follow the spine down.
An open wound enters the benefit
A diabetic foot ulcer is flagged. Instead of a graft order routed straight to payment, the episode opens inside KEEP. The clock starts on a closure-or-escalation endpoint, not on a product line.
Episode beginsHome nursing takes the wound
A credentialed home-wound provider is assigned the case under tele-wound MD/NP supervision. The Tuesday visit that catches an infection early is the actual mechanism of keeping a limb, and it happens where the patient already is. Home care is the spine, not a feature.
Home-care networkThe vascular gate: no graft without blood supply
Before any advanced product is approved, the limb gets a vascular workup — ABI and studies. No graft goes on a limb with no blood supply to heal it. This single gate is where the over-grafting that drove the 40x gets stopped, and where a limb is most often saved.
Vascular before productThe right care, escalated up or stepped down
Offloading, the correct antibiotics, glycemic and nutrition support, an evidence formulary, and the right level of care: escalate to vascular, surgery, or HBOT the moment the limb is threatened; step down to home maintenance as the wound closes. Levels of care are the lever; limbs kept is the result.
Acuity managementEvery wound is measured — the closure registry
Photographic, measurement-based documentation is a contracting requirement, so KEEP builds the record claims data can't see: a closure-rate registry by product and by provider. That record steers the next patient to what actually works, and it is what lets KEEP bear real risk.
Closure registry · the moatWhat a health plan sees when it hands KEEP the wound benefit.
A plan does not buy a product list. It hands over one disease and gets back a managed pathway, a record claims can't produce, and a risk structure it can climb at its own pace.
A managed episode, end to end
Home nursing, the vascular gate, offloading, medications, escalation and step-down — the services the wound touches, run inside one pathway with an evidence formulary at its center. The plan stops paying for a loose product and starts paying for an outcome.
The record claims can't see
A closure-rate registry segmented by product, provider, and wound type — the data a UM rule doesn't produce. It steers volume to what works, and it is the proof the plan needs before it ever puts a dollar at risk.
A risk ladder it climbs at its pace
Start with an admin fee for formulary, evidence-aligned prior auth, and the diagnostic. Move to performance guarantees on closure and limb-preservation. Reach a capitated wound carve-out once the registry proves the outcome moves, the same structure UnitedHealth used for a DME carve-out in 20267.
What KEEP reports back is limbs kept.
Not dollars saved. A limb preserved. A wound closed. A person kept whole, at home. The order is deliberate.
Limbs kept
The north-star metric, and the name. Limb-preservation rate is what every level of care is orchestrated toward.
Wound closure
The clinical proof underneath the limb — captured in the registry, by product and by provider.
Cost, last
The savings are real. They are the quiet consequence of adding the right care and removing the wasteful care — never the thing we open with.
A managed wound benefit adds the right care up — more nursing, the vascular gate, offloading — and removes the wasteful care down. That is what makes "lead with limb preservation, savings follow" true, and not a slogan.
See your own wound exposure.
The diagnostic builds your plan's own 40x chart from public and plan-shareable data, and it leads with the limbs at risk. No network required to produce it.
We open with limb preservation. We close with limbs kept. The savings come last.