Lead physician
Owns the longitudinal care plan, chairs interdisciplinary conferences, and aligns clinical priorities to quality outcomes.
Physician-led medical group ยท Senior value-based care
Accountable care, delivered at home.
Sphere Health Partners brings the Sphere Senior model into a medical group structure: in-home care for high-needs Medicare beneficiaries, powered by directly employed Care Pods and Sphere-built clinical infrastructure.
Medical group practice
Physician-led clinical structure
Care Pods
Interdisciplinary in-home operating model
24/7/365
Clinician coverage and escalation model
Value-based
Aligned around outcomes, prevention, and total cost of care
Sphere Senior model
Whole-team senior care, directly accountable.
Sphere Health Partners organizes care around Medicare seniors who need proactive, longitudinal support at home. The operating premise is simple: the team must be complete, employed, and accountable to the same clinical and economic outcomes.
Geriatric NP or PA
Delivers in-home visits, transitions-of-care support, and urgent clinical follow-through when the beneficiary needs it.
RN care manager
Runs triage, complex case management, medication reconciliation, and daily execution against the care plan.
Clinical pharmacist
Conducts polypharmacy and Beers-criteria reviews, with special focus on complex and frailty-tier beneficiaries.
Behavioral health
Provides embedded collaborative care, depression and anxiety workflows, and caregiver-burden interventions.
Community support
Community health workers, social work, and palliative specialists address SDOH, benefits, language access, and goals of care.
Beneficiary access
Care where the beneficiary lives.
The Sphere Senior model treats access as a clinical intervention. In-home primary care, same-day urgent dispatch, audio-only access, language match, and specialty coordination reduce preventable emergency department use and avoidable fragmentation.
- Primary modality
- In-home visits for routine, urgent, and complex care.
- Transitions
- Post-discharge contact within 24 hours and in-home visit within 7 days.
- After-hours
- Clinician coverage at all times, with escalation into the Care Pod workflow.
- Equity
- PRAPARE-informed social-needs routing, language access, and caregiver support.
Prevention and coordination
Prevention becomes daily work.
Annual wellness visits, vaccinations, medication reconciliation, falls assessments, advance care planning, behavioral health screening, and chronic-condition pathways are built into the workflow instead of tracked as side projects.
Risk tiers
Stable, rising-risk, complex, and frailty or serious illness tiers drive visit cadence, team composition, and escalation.
Care pathways
Heart failure, COPD, diabetes, CKD, dementia, falls, depression, and polypharmacy workflows include standing orders and follow-up cadence.
Pod scorecards
Preventive measures, coordination measures, avoidable ED use, readmissions, and total cost of care are tracked at pod level.
Data and health IT
Built for accountable care execution.
The model is built around Sphere EHR and Sphere OS: an in-house, FHIR-native clinical and operating layer for care delivery, population health, analytics, quality improvement, and standards-based exchange.
Claims and clinical ingestion
CCLF, Parts A/B/D claims, EHR data, biometric signals, pharmacy fills, PROs, and SDOH assessments feed a longitudinal view.
FHIR-native exchange
FHIR R4, USCDI v3+, Bulk Data Access, SMART on FHIR, OAuth 2.0, OIDC, HL7 v2, and X12 capabilities support portability.
Risk stratification
Sphere OS turns utilization, clinical, pharmacy, biometric, and social-risk data into prioritized Care Pod work queues.
Secure transfer
Zero-trust design, AES-256 encryption at rest, TLS in transit, audit logging, Direct Secure Messaging, and least-privilege access protect PHI.
Value-based operations
Built for durable accountable care.
Sphere Health Partners is structured as a medical group with the operating discipline required for value-based care: physician leadership, aligned providers, prevention-first workflows, beneficiary access, data exchange, and privacy controls.
- Provider alignment Directly employed Care Pod staffing and performance incentives align clinical behavior with outcomes.
- Clinical governance Physician-led clinical oversight with defined quality review, escalation standards, and accountable-care operating discipline.
- Economic discipline The model is organized around prevention, avoidable-utilization reduction, post-acute coordination, and total cost of care.
- Compliance orientation Beneficiary communications, privacy, audit trails, and secure data-sharing controls are designed around healthcare compliance expectations.