high high likelihood
R-001: Medicare reimbursement and coding dependency
The model appears materially dependent on Medicare navigation-related reimbursement and billing workflows; CMS coding, consent, supervision, documentation, denial, audit or clawback changes could impair revenue.
Diligence request: Review claims files, coding policies, physician-supervision arrangements, consent templates, denial rates, CMS/OIG guidance analysis and audit history.
high medium likelihood
R-002: Valuation support and financial-quality opacity
Public information supports financing milestones but not revenue, gross margin, burn, cash runway, retention, CAC, contribution margin, cap table or liquidation preferences.
Diligence request: Request audited/management financials, revenue recognition memo, KPI deck, cohort economics, cash runway and full financing history.
high medium likelihood
R-003: Payer and reimbursement concentration
Public evidence emphasizes Medicare, Medicare Advantage and payer partnerships, but customer-level revenue concentration and plan-specific economics are private.
Diligence request: Request payer mix, claims by plan, top customer concentration, contract terms, termination rights and denied-claim economics.
high medium likelihood
R-004: HIPAA, PHI and cybersecurity controls
Solace handles PHI through referrals, patient support and platform workflows; public HIPAA statements do not prove controls, BAAs, subprocessors, audit logs or breach history.
Diligence request: Request HIPAA risk assessment, SOC 2/HITRUST, pen tests, incident/breach logs, subprocessors, BAAs and privacy-policy change history.
high medium likelihood
R-005: Advocate network quality, scope and labor classification
A services marketplace using healthcare advocates and 1099 RN roles must manage quality, credentialing, supervision, state licensure, scope-of-practice, malpractice and contractor-classification risks.
Diligence request: Review advocate credentialing, training, QA, malpractice coverage, classification analysis, state licensure matrix and escalation protocols.
high medium likelihood
R-010: Referral, payer and billing compliance
Provider referrals, payer partnerships, Medicare billing and advocate compensation require careful AKS/CMP, HIPAA marketing, billing and documentation compliance.
Diligence request: Have healthcare regulatory counsel review referral sources, payer contracts, marketing materials, billing workflows and compensation arrangements.
medium high likelihood
R-006: Outcome and satisfaction claims not independently validated
Patient-improvement and growth claims are public but appear company-provided; lack of independent methodology could weaken payer sales and create marketing-risk exposure.
Diligence request: Request cohort definitions, raw survey data, independent evaluation reports, complaint logs, NPS/CSAT, and outcome methodology.
medium high likelihood
R-007: Crowded navigation and advocacy competition
Established care-navigation and advocacy companies compete for employers, health plans and members; adjacent Medicare and older-adult support products could pressure differentiation and distribution.
Diligence request: Request win/loss data, pricing comparisons, customer references, differentiation proof and plan/employer pipeline conversion by competitor.