Joe Nalley.

• Led product strategy across six integrated specialty risk portfolios. 45M+ total plan members; 30M managed lives across specialty medical spend covering six high-acuity specialty risk books.
• Directed a product team of directors, analysts, PMs, and product owners. Worked across Finance, Actuarial, Legal, Compliance, IT, and Provider Partnerships.
• Built Risk Playbook 2.0: defined the RACI, commercialization process, and phase-gating framework for bringing risk products to external market. Sole author, built from 50+ internal interviews into an interactive governance tool. Adopted as the operating standard for risk product commercialization across the subsidiary.
• Drove the MSK risk expansion business case — a three-year operating-gain model — and found the operating-model gaps blocking two additional programs from reaching market. Both moved into active remediation.
• Built the blueprint for a member-intelligence hub connecting clinical, claims, and risk data across all specialty books. One coordinated record instead of three separate programs for a member's orthopedic episode, chronic condition, and behavioral health needs.
• Role eliminated in a September 2026 enterprise restructuring.

• An independent studio for the governance layer after authorization: Cadence governs specialty pharmacy continuation, Caliber verifies high-cost claims before payment, Curated routes behavioral health episodes. Every line of it built as sole contributor. Full portfolio at joe-nalley.com.
• Authored the Cadence Governance Standard (CGS v1.1): 8-section clinical framework defining when, how, and by whom a continuation therapy gets reassessed. 7 required triggers. Open standard, published for industry adoption.
• Three locked cohorts totaling 65,234 patients. Flag rates of 25–29.1% converge across all three populations, anchored by the 30,734-patient NIH All of Us study. Modeled first-cycle savings value of $14.3M covering four drug classes.
• Built the platform architecture, pricing models, and every site. 11,000+ lines on Cadence alone, single-file, no framework. Pharmacy Times article published (April 2026). Manuscripts submitted to Health Affairs and AJMC.

• Built a real-time billing integrity platform that audits claims before they reach the payer. AI + human QA layer between clinical delivery and financial accountability. Catches errors, overcharges, and code mismatches at the source.
• Returned $9.2M to payers in its first six months of full deployment. B2C-to-B2B platform with payer PEPM revenue model. Acquired by a Fortune 50. Stayed on as CEO through integration.

• Founded Kentucky Mental Health Care (2012). Scaled to a 13-location health system across five states with 750+ employees and $30M+ in annual revenue at time of sale.
• Launched Kentucky Recovery (2018) and built four opioid treatment programs end to end — DEA, SAMHSA, and state licensure each time, including the contested La Grange siting we won. Statewide coverage, 15,000+ patients per year.
• Negotiated and held the MCO contracts myself — Medicaid, commercial, and Medicare — and lobbied Kentucky Medicaid to carve the IOP code back out of the NTP bundle so it paid on top instead of disappearing inside it.
• Established GetWell Health System, North Clark Community Hospital, and North Clark Medical Group (2021). Built a new regional hospital from the ground up with primary care, imaging, surgery, cardiology, neurology, and a full diagnostic lab.
• Led the full health system through acquisition (confidential). Stayed on as CEO for 3.5 years post-acquisition. Diligence, transition planning, and post-close integration. Full P&L responsibility. 200,000+ patients served combined at time of sale.

First company. Traditional Chinese herbal medicine: two retail locations and the e-commerce store that made most of the money — tinctures, blends, single-herb extracts. Built and ran the online storefront. Sold in 2012, the same year Kentucky Mental Health Care was founded.