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Sources · SPARK Senior Health · Investment Book · Stage 2 · 2025–2026
SPARK Senior Health · Proprietary & Confidential · All Rights Reserved
Model Development
Clinic Design · Clinical Model · Staffing · AI & Technology
4 Sections · Fixed-Clinic Design · NP-Led Clinical Model · Staffing & Compensation · AI & Technology · Investment Book 2025–2026
2.1
Clinic Design
~2,200 sq ft ADA-compliant buildout · CapEx envelope · zone layout
→
2.2
Clinical Model
NP-led care · CCM/APCM/RPM · AWV · billing architecture
→
2.3
Staffing Model
NP + LPN + driver per clinic · compensation · GA NP law
→
2.4
AI & Technology
EHR · RPM · AI documentation · telehealth · billing stack
→
Stage 2 · Model Development · Section 2.1
Clinic Design — External & Interior Layout
Fixed-location ADA-compliant clinic buildout — ~2,200 sq ft, leasehold improvement, and interior clinical zone layout. Every zone maps to a billable CPT code or compliance requirement.
§ 2.1SPARK Senior Health Investment Book · 2025–2026
Phase 1 · Launch
Fixed Leasehold Clinic
🏥
~$198K total CapEx (expansion) · ~$242K flagship
~2,200 sq ft commercial lease in county seat commercial corridor. ADA-compliant buildout with exam room, waiting area, lab/diagnostic zone, staff workspace, and intake station. Permanent presence builds community trust and enables full billable service delivery. Leasehold improvement amortized at 15-year useful life.
Activate: Launch Day 1 · All clinics from M1
Phase 2 · Expansion (Year 2)
Expanded Clinic Footprint
🏢
Same CapEx envelope · 2nd exam room addition
At 400+ enrolled members per clinic, a second NP and second exam room are added. This requires either a larger original lease space (preferred — select leases with expansion option) or buildout of an adjacent unit. Two-NP model doubles visit throughput and enables subspecialty telehealth consultations in dedicated room.
Activate: 650+ enrolled members · Two-NP hiring trigger
Phase 3 · Scale (Year 3+)
Full-Panel Clinic (10 sites)
🏛️
No new CapEx Y4/Y5 · all 10 built out by Y3 end
All 10 clinics operating at full panel capacity (up to 1,000 members each). Years 4–5 are steady-state with zero new clinic CapEx. Focus shifts to member panel deepening, PMPM optimization through APCM/CCM maturation, and operational efficiency across the 10-site network.
Steady state: Y4–Y5 · No new clinic CapEx
Interior Clinical Zones — ~2,200 sq ft Fixed Clinic
Six zones · each mapped to a billable CPT code or compliance function
Zone 1 · Intake / Registration
AI Check-In Station + Waiting Area
Front-desk check-in with Klara patient messaging, EHR intake, insurance verification, and care gap flag display. Waiting area with accessibility seating. Delivers structured pre-visit note to NP before exam room opens.
Zone 2 · Exam Room(s)
Adjustable Table · Vitals Station · EHR
ADA-accessible exam table, Vital Signs Station (BP multi-cuff, SpO2, weight scale, temperature), 12-lead ECG, EHR workstation, sink. Primary revenue driver — AWV, E&M, chronic disease visits, acute episodic. Two rooms at 550+ members.
Zone 3 · Lab & Diagnostics
i-STAT POC · CLIA-Waived · Ultrasound
Abbott i-STAT Alinity POC (BMP, HbA1c, INR, glucose, lactate), 10-parameter urinalysis reader, Butterfly iQ+ POCUS (M6), portable spirometer (M6), wound care station (M6), vision screening kit. Results in the visit — eliminates most referral delays.
Zone 4 · Telehealth Room
HIPAA-Compliant AV · Specialist Consult
Dedicated privacy-compliant room, Doxy.me Pro + Zoom for Healthcare link, specialist consult capability via NGHS referral network. The specialist comes to the patient. Doubles as NP-patient telehealth room when the NP is remote.
Zone 5 · Medication & Supply
Locked Cabinet · Vaccine Fridge · Safe
Medical-grade vaccine refrigerator with data logger, locked medication cabinet, DEA-compliant controlled substance safe, PPE and supply storage, sharps/biohazard system. Vaccine revenue (flu, pneumococcal, shingles) — highest-margin per-visit ancillary line.
Zone 6 · Provider Workspace
Fiber + LTE Failover · EHR · Billing
Fiber primary + cellular LTE failover (sub-30-second). EHR workstations × 4, Commure Ambient AI documentation, HIPAA-isolated clinical network, MDM-enrolled devices via Rippling. Clean claims submitted same day via Commure RCM → Novitas J-6.
Per-Clinic CapEx — Lease vs Own
Expansion (C2–C10) baseline · Flagship adds $39K legal · Own = 20% down · 7% · 20-yr mortgage
Category
Lease
Own
Building (20% down + 3% closing)
—
$78,400
Leasehold improvements
$98,500
$98,500
Furniture & fixtures
$12,500
$12,500
Clinical equipment (D1→M9)
~$34,300
~$34,300
Tech & networking
$10,500
$10,500
Vehicles + wrap
$38,500
$38,500
Software (expansion)
$3,500
$3,500
Legal & formation (C1 only)
$39,000
$39,000
Total expansion (C2–C10)
~$198K
~$276K
Total flagship (C1 incl. legal)
~$242K
~$320K
Annual Building Carrying Cost
Rent / Mortgage payments
$30,000
$26,052
Property tax
—
$4,500
Property insurance
—
$6,000
Maintenance reserve
—
$7,500
Annual total
$30,000
$44,052
+$14,052/yr vs lease · Building $350K · Loan $280K · $2,171/mo · 39-yr MACRS · equity builds over 20 years
ADA & External Requirements
Mandatory before first patient · Medicare enrollment prerequisite
✓ADA entry ramp — 1:12 max slope; van-accessible parking minimum 1 space
ConnectivityFiber primary ($400/clinic/mo, incl. install lead time 4–8 weeks). Cellular LTE failover — sub-30-second automatic switchover. Offline EHR mode for outage resilience. Clinical VLAN isolated from guest WiFi.
HVAC & PowerMedical-grade climate control — vaccine cold chain maintenance. Dedicated UPS for EHR and critical clinical devices. Generator backup recommended for RPM alert continuity during power outages.
BiohazardSharps disposal unit, bloodborne pathogen compliance per OSHA 29 CFR 1910.1030. Licensed hauler contract (Stericycle or Sharps Compliance) — $90/month per clinic.
SecurityManaged firewall with intrusion detection. All devices MDM-enrolled via Rippling. "No Cash On Hand" signage. Video monitoring system recommended.
Stage 2 · Model Development · Section 2.2
Clinical Model & Care Protocols
Scope of services, CCM/APCM/RPM enrollment protocols, and the visit-first clinical philosophy. Increasing visits and managing chronic conditions is the entire economic engine.
§ 2.2SPARK Senior Health Investment Book · 2025–2026
Scope of Services
What we do · what we refer · built to maximize visits and chronic care maintenance
Core Services (fixed clinic)
Annual Wellness Visit — attribution anchor
Well + preventive + screening visits
Chronic disease management (HTN, DM, COPD, CHF)
CLIA-waived POC labs (i-STAT Alinity)
Vaccines: flu, pneumococcal, shingles, COVID
Acute episodic (within LPN/NP scope)
CCM enrollment + monthly 20-min protocol
APCM (G0556/G0557/G0558) monthly billing
RPM device setup + monthly data review
Transition of Care (7-day call, 30-day visit)
FFS-Duals Care Coordination
LTSS navigation for Medicaid-covered services (non-billing)
SDOH screening + follow-up
NEMT coordination for transport-dependent members
Dental / vision referral pathway
Telehealth-Supported (NP remote)
Specialist consult via Zone 4 telehealth room
Complex Dx/Rx — NP via Doxy.me (GA SB 128 compliant)
APCM advantage: No monthly time tracking required. Billing-friendly — especially on visit months when CCM time is harder to document separately. Mutual exclusion with CCM in same month for same patient.
CCM Protocol — 2026 CMS Rates
Chronic Care Management · 45% of panel · 82% billing success · Chronic Care IQ auto-logs time
99490 · 20 min non-complex/month
55% of CCM panel · clinical staff time
~$56/mo
99439 · each add'l 20 min
No monthly limit on additional units
~$43/mo
99487 · complex CCM, 60 min
35% of CCM panel · multiple chronic, complex plan
~$123/mo
99489 · complex add-on 30 min
10% of CCM panel add-on
~$66/mo
CCM eligibility: ~45% of panel — 2+ chronic conditions, documented 20 min/month non-face-to-face care management. Chronic Care IQ auto-populates time logs. Top OIG audit risk — EHR-integrated documentation is non-negotiable.
The Visit-to-Revenue Chain
Rural NE Georgia FFS seniors average only 1.4 PCP visits/year vs 3.2 nationally. Every visit we generate drives the entire downstream revenue chain: AWV establishes attribution → CCM/APCM enrollment ($13–$91/mo recurring) → RPM enrollment (net ~$27/mo after device COGS) → chronic disease management improves → ER visits drop → CMS saves → CMMI funds us. Visits are the root metric. Everything else follows. Transportation to the clinic removes the last barrier — a van comes to pick you up.
1.4
Current PCP visits/yr rural NE GA FFS
→ 4.0–6.5
Our Y1→Y2 target ramp
~$239
Blended PMPM at full enrollment (base scenario)
Runs every month between visits
60%+
Of steady-state revenue from non-visit programs
Visit enables enrollment; enrollment pays monthly
Stage 2 · Model Development · Section 2.3
Staffing Model — Stage-Driven Clinic + MSO
Per-clinic staffing scales with member count through five stages. MSO staffing grows annually with 5 named Y1 hires ramping to 16 by Y3. Georgia scope-of-practice analysis and compensation benchmarks included.
§ 2.3SPARK Senior Health Investment Book · 2025–2026
Per-Clinic Clinical Staffing Roles
Stage-driven hiring · GA scope of practice · 25% benefits load on all roles
NP / APRN — Primary Clinician
NP conducts all clinical assessments — diagnoses, prescribes (including Schedule II under 2024 GA law expansion), orders labs, manages chronic disease, supervises field team. Telehealth or in-clinic. Must sign Nurse Protocol Agreement with Medical Director before any clinical activity. NPI triggers PECOS enrollment clock — hire first.
NP base: $125,000 · Loaded ×1.25: $156,250/yr
Medical Director / MD — Supervising Physician
Signs Nurse Protocol Agreement. Available via audio/video during all clinical hours (GA requirement). Handles escalated complex cases, incident-to billing NPI optimization, co-signature requirements. Does NOT require physical presence. Billing: E&M/AWV/TOC billed under MD NPI for 100% rate + 10% HPSA bonus.
MD retainer: $30K–$54K/yr (launch → full panel) · Part-time/fractional
LPN — Field Clinical Support
Conducts intake vitals (Vital Signs Station), POC testing, vaccination administration, CCM/RPM enrollment support, specimen collection, basic wound care. GA law permits LPN to draw blood — phlebotomy training required, no separate phlebotomist needed at launch. Works under NP supervision. Adds Part-Time Care Coordinator at Stage 2 (200–400 members).
LPN base: $52,000 · Loaded ×1.25: $65,000/yr
Care Coordinator — Remote
Manages CCM panel (300–600 active members per FTE), RPM alert monitoring (Tenovi dashboard), TOC outreach cadence, specialty referral tracking. For FFS-Duals: LTSS navigation, SDOH screening follow-up, NEMT coordination. Critical for CCM revenue — each missed 20-min monthly contact is lost billing. Time logged in Chronic Care IQ (auto-populates from activity).
Care Coordinator base: $55,000 · Loaded ×1.25: $68,750/yr · Added at Stage 2
Driver — Transportation & Logistics
Handles member transport (picks up members who cannot self-transport to the clinic), vehicle logistics, and route optimization. Does not provide clinical care. Routes planned prior afternoon via route optimization software. Breakdown response: rental standby contract within 2 hours. 1 driver per active clinic — every clinic, from Day 1.
Driver base: $45,000 · Loaded ×1.25: $56,250/yr · Every active clinic
Five-Stage Per-Clinic Staffing
Member-count triggered · each clinic runs its own stage clock independently
Stage
Members · Staff Added
Launch
0–200 members · Remote NP + LPN + Driver
Building
200–400 members · + Care Coord (0.5)
Steady State
400–650 members · + FT Care Coordinator + PT Admin
Two-NP
650–800 members · + 2nd NP + 2nd LPN
Full Clinic
800–1,000 members · Full team · Terminal PMPM
Georgia Scope of Practice — Key Rules
What each role can do in clinic · GA 2024 rules
NP in GA (2024):Diagnose, prescribe (Schedules II–V), order diagnostics under collaborative agreement. Supervision ratio 8:1. No physician physically on-site required — audio/video presence satisfies requirement.
LPN in GA:Administer medications (including injections/vaccines), collect specimens, draw blood, perform ECG. Cannot independently diagnose or prescribe. Works under NP supervision at all times.
Telehealth (GA SB 128):NP may prescribe via telehealth without in-person prior visit for most conditions. Audio-video required; audio-only limited to specific circumstances. Hub-and-spoke model fully compliant.
Escalation Protocol:Field LPN → remote NP → supervising MD → 911/ER. Decision tree by condition type must be documented before first patient. LPN cannot independently manage uncontrolled acute conditions.
Staffing Cost — MSO & Per-Clinic Clinical
MSO: loaded ×1.25 · Clinic Staff: base salaries + driver · portfolio total · from Financial Model P&L
MSO — 3-Year Build
Y1 (Startup Team)$1,400,000
Y2 (+CFO, VP, Legal, Comm, Billing 2)$2,382,188
Y3 (+Ops Coord, Sr Billing)$2,991,079
Y4/Y5 steady state$2,991,079
Clinic Staff Build
Y1 · 1→3 clinics opening$709,000
Y2 · 3→6 active clinics$2,518,000
Y3 · 7→10 clinics opening$4,655,000
Y4/Y5 · all 10 steady state~$5.9M
Stage 2 · Model Development · Section 2.4
AI & Technology Integration
The finalized technology stack — EHR, CCM platform, AI documentation, RCM, RPM, telehealth, connectivity, and operations. Technology serves the clinician; every vendor selection maps to a specific billing or compliance function.
§ 2.4SPARK Senior Health Investment Book · 2025–2026
Morning huddle (7:30 AM): LPN + NP teleconference. Day's schedule, overnight RPM threshold breaches, care gap alerts surfaced from EHR. Patient context delivered before clinic opens.
2
Check-in (Klara + EHR): Patient SMS check-in via Klara ($300/clinic/mo flat). Insurance verification, last-visit summary, care gaps (missing AWV, overdue A1c, lapsed CCM) flagged in EHR before exam room opens.
3
Vitals (Vital Signs Station): LPN captures BP, weight, SpO2, temperature. i-STAT POC lab if ordered. All values auto-integrate into Commure pre-visit structured note delivered to NP via Doxy.me or in-clinic.
4
Encounter (Commure Ambient): AI ambient scribing during exam. CPT coding suggestions validated by NP. CCM time auto-logged in Chronic Care IQ from coordinator activity. Documentation complete before patient exits.
5
Checkout + claims (5:00 PM): Next visit scheduled, RPM reading confirmed, CCM follow-up queued. Clean claim submitted same day: Commure RCM → Novitas J-6. QMB status verified before submission. Target: $0 next-day unbilled encounters.
AI capacity multiplier: Commure Ambient enables one NP to supervise 8–12 encounters/day vs 4–6 in a traditional non-AI model — a 2–3× throughput improvement. Critical for the per-clinic unit economics.
Open Item — EHR SelectionAthelas AIR vs Athenahealth. Must demo CCM time tracking, offline mode, Novitas J-6 EDI compatibility, and Commure integration before deciding. EHR must be live before PECOS enrollment is finalized. $750/provider/month for either option.
Technology Stack — Core Clinical
Finalized vendors · pricing included in financial model · EHR selection is final open item
Category
Vendor
Pricing
EHR
Athelas AIR or Athenahealth (open item)
$750/provider/mo
CCM/APCM Platform
Chronic Care IQ — auto time-logs, care plan templates
Rippling — all devices MDM-enrolled, payroll unified
$12/employee/mo + $35 base
Business Email
Proton Business — HIPAA-compliant encrypted email
$9/user/mo
Knowledge Base
Notion — clinical protocols, SOP library
$13/user/mo
HIPAA Compliance
Compliancy Group — BAA management, audit readiness
$400/mo flat
Analytics
Looker Studio — PMPM, utilization, claims dashboards
$0 (free tier)
Architecture Principles
→EHR is the system of record. All other platforms connect via API. No manual dual-entry anywhere in the stack.
→Offline capability required. Rural dead zones in NE Georgia are real. EHR must function offline and sync on reconnection.
→Novitas J-6 MAC. All GA Medicare claims route through Novitas Solutions J-6. Clearinghouse EDI compatibility confirmed before first claim.
→Fiber lead time. 4–8 week installation. Initiate fiber order during clinic buildout — not after lease signing.
Stage 2 · Model Development · Summary
Stage 2 Key Decisions & Open Items
Model defined across clinic design, clinical protocols, staffing, and technology stack. One open flag remains before go-live. Proceed to Stage 3 — Financial Model.
SummarySPARK Senior Health Investment Book · 2025–2026
~2,200
Sq ft per fixed clinic · ADA-compliant · 6 clinical zones · leasehold ~$98.5K
6 Zones
Clinical zones mapped to billable CPT codes · intake → exam → lab → telehealth → meds → workspace
NP + LPN
Stage-driven hiring · MD retainer for supervision · driver at every active clinic from Day 1
~$239
Blended PMPM at full enrollment · base scenario · APCM + CCM + RPM + E&M + AWV
8–12
Visits per day per clinic · ~200/month · transport van brings non-driving members in
1 Open
EHR selection (Athelas AIR vs Athenahealth) — must resolve before PECOS enrollment
§2.1–2.2 · Clinic Design & Clinical
Fixed ~2,200 sq ft ADA-compliant clinic at ~$198K expansion CapEx. Six interior zones mapped directly to billable CPT codes. APCM (G0556/G0557/G0558), CCM (99490 series), and RPM (99454/99457) protocols at 2026 rates yield ~$239 blended PMPM. Escalation protocol (LPN → NP → MD → 911) documented before first patient. FFS-Duals LTSS navigation is care coordination, not a separate billing line.
§2.3–2.4 · Staffing & Technology
Stage-driven per-clinic staffing (Launch → Full Clinic, 5 stages by member count · ranges 0–200 through 800–1,000). MSO scales from 5 named Y1 hires to 16 by Y3. Finalized tech stack: Commure Ambient + RCM, Chronic Care IQ, Tenovi RPM, Klara, Doxy.me, Bamboo PatientPing, Samsara, Rippling. AI multiplier: 8–12 visits/day per NP vs 4–6 without AI. EHR selection is the final open item before PECOS enrollment.
⚠ Open Flag — EHR Selection
Must demo Athelas AIR vs Athenahealth before go-live. Requirements: CCM time tracking integration with Chronic Care IQ, offline mode, Novitas J-6 EDI, Commure API compatibility. EHR must be live before PECOS enrollment is finalized. Budget: $750/provider/month — both options are equivalent in cost.
Next Stage
Stage 3 — Financial Model
Revenue model · Reimbursement schedule · CCM/APCM/RPM PMPM detail · 5-year P&L · Capital structure · Investor ROI scenarios