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Your strategy office. Always working.

Every company in your market sees the same data. We read it against your strategy.

A retained strategy office for integrated health system leadership teams. AI agents built around your plan work on your growth, payer contracts, health plan and capital every day. Two former healthcare executives, with strategy consulting roots at Accenture and BCG and years in operating roles, direct that work and turn it into decisions.

An AI-powered strategy office for the cost of one senior hire.

The strategy graph for Harrow Valley Health, the illustrative system: its hospitals, health plan, service lines, payers, competitors and the assumptions its plan rests on.

The two people you work with

Coactivator is the two of us: former big firm strategy consultants who went on to run healthcare businesses. Our agents do the reading. We do the judgment.

Sanjay Cherian

Sanjay CherianA decade at Accenture as a strategy consultant specializing in health and life sciences, advising Merck, Pfizer and AstraZeneca on launches and marketing investment. Then an operator: Chief Product Officer at Telus Health and Global Head of Generative AI at Nike.

Hans Oh

Hans OhHans Oh is a former BCG Digital Health Expert and Team Lead who has advised pharma, providers, and payers, and served as a vice president at ZappRx and Omnicell. He founded Innoveron Group and co-founded Tenuto Labs.

More about us

How it works

Every engagement runs on two kinds of agents, built around your plan. Watch agents read public sources every day. Office agents do the work a strategy team does with what the watch agents find. Then the two of us take over: we test their work against your plan and our own experience, add the context the data does not carry, and decide what it means for you.

  1. 1

    Public sources

    FDA, CMS, payers, trial registries, state filings, bond disclosures, company filings, congresses

  2. 2

    Watch agents

    Read every day and flag what touches your plan

  3. 3

    Your strategy model

    Your assumptions and decisions, versioned

  4. 4

    Office agents

    Analysis, scenarios, options and packs

  5. 5

    Your leadership team

    Briefs, dashboards and board packs

Hans and Sanjay

Test the findings, add context from experience, and shape the recommendation

Your decisions update the model.

The agents do the reading and the first draft. We bring the judgment: which findings matter, what they mean for your plan, and what you should do next.

We use a proprietary, ontology-driven method to model your company's strategy. The ontology is a formal map of the entities in your business (hospitals, service lines, physician groups, payers, your health plan, competitors) and how they relate to each other. Everything else runs on that map.

Your strategy model. From your plans, board materials and leadership conversations, we build a versioned model of what you're betting on and what those bets assume. When an assumption changes, the model records what changed it and when. It also records the questions your leadership team and board ask, so each cycle starts from what they will want to know next.

Two kinds of agents. Watch agents read external sources continuously, with one set for each decision: CMS rules and rate notices, Star Ratings, certificate-of-need filings, payer policies and price transparency files, bond disclosures and competitor announcements. Office agents do the work a strategy team does with what the watch agents find: market research, scenarios and options, execution tracking, and board and leadership packs. Each one works from frameworks built for health systems.

A lens for every decision. Every finding passes through the lens for the decision it bears on: growth, contracting, health plan, capacity, capital or board. Each lens has the same structure: what happened, which part of your plan it touches, what else depends on that, what it means, the questions you will be asked, your options, our recommendation, and the sources. Each asks its own questions; the health plan lens, for example, asks about quality bonus exposure and benefit design. Because the structure never changes, you can compare this quarter's findings with last quarter's, and so can your board.

Sourced and reviewed. Every statement carries its source and the date we retrieved it. Nothing reaches your leadership team until one of us has reviewed it. You receive briefs and recommendations, and we run the system behind them.

See the agents

Agent tags

  • Biopharma
  • Healthcare
  • No tag: used for both

Tagged agents are illustrative of what we build for each kind of client.

Watch agents

Read public sources continuously, one set for each decision.

  • Launch Demand Watch

    Tracks demand against your forecast, from the data you already license and public prescriber data.

    Launch lens

    Biopharma

  • Market Access and Formulary Watch

    Reads payer policies, formularies and CMS notices for anything that changes your coverage.

    Access lens

    Biopharma

  • Supply Resilience Watch

    Follows FDA inspections, warning letters and import alerts at your CDMOs and API suppliers.

    Supply lens

    Biopharma

  • Competitor Registry and Catalyst Watch

    Tracks competitor trials, label changes and PDUFA dates in your indication.

    Competitive lens

    Biopharma

  • Congress Readout Delta

    Compares what a congress abstract says with what the company said before.

    Competitive lens

    Biopharma

  • AI Drug Information Monitor

    Checks how AI assistants describe your therapy against the alternatives.

    Competitive lens

    Biopharma

  • Global Asset Scout and Diligence First Pass

    Screens in-licensing candidates and comparable deals, with a first diligence note on each.

    Capital lens

    Biopharma

  • Market Sentinel

    Reads certificate-of-need filings, licensing notices and competitor openings in your service areas.

    Growth lens

    Healthcare

  • Payer Policy and Rate Watch

    Reads commercial payers' medical and site-of-care policies, and the rates in hospital and payer price transparency files.

    Contracting lens

    Healthcare

  • CMS Rule Watch

    Reads proposed and final payment rules for hospital outpatient, inpatient and physician services, and sizes each one against your plan.

    Contracting lens

    Healthcare

  • Medicare Advantage Market Benchmarker

    Reads CMS enrollment, Star Ratings and plan landscape files for every plan in your counties.

    Health plan lens

    Healthcare

  • Workforce Market Watch

    Reads competitor job postings, wage announcements and state licensure data.

    Capacity lens

    Healthcare

  • Bond and Affiliation Watch

    Reads municipal bond disclosures, rating agency actions and affiliation announcements in your region.

    Capital lens

    Healthcare

Office agents

Turn what the watch agents find into analysis, options and packs, which we then test and finish.

  • Strategy Execution Tracker

    Tracks the plan's commitments and flags slippage before the quarterly review.

  • Indication and Policy Sequencer

    Orders launches and indications against IRA timing and MFN pricing.

    Access lens

    Biopharma

  • Scenario and Options

    Builds the options and scenarios when an assumption moves.

  • Readout Scenario Book

    Prepares your response to each possible outcome before a competitor readout.

    Competitive lens

    Biopharma

  • Portfolio Value Refresh

    Updates the value of each asset when one of its inputs changes.

    Capital lens

    Biopharma

  • Market Research

    Answers specific questions about your category from published sources.

  • Strategic Planning

    Keeps the long-range plan and the assumptions behind it current.

  • Strategy Dashboard

    Keeps the decision and assumption views for the CEO, COO and board current.

  • Board and Leadership Pack Builder

    Drafts board packs and leadership pre-reads for us to review and finish.

  • Service Line Market Assessor

    Builds the fact base behind each grow, hold or exit decision by service line.

    Growth lens

    Healthcare

  • Rate Position Analyst

    Shows where your negotiated rates sit against competitors, payer by payer.

    Contracting lens

    Healthcare

  • Bid and Stars Scenario Builder

    Models what a Star Rating or benchmark change does to benefits, membership and margin.

    Health plan lens

    Healthcare

Here is what that looks like for one company.

Choose the one closest to yours.

Harrow Valley Health is a fictional integrated system in a realistic market: its hospitals, its health plan and the competitors around it are invented, while the CMS programs, public filings and rules its agents read are real.

Between board meetings, CMS publishes a payment rule, a competitor files a certificate of need, your largest commercial payer changes a site-of-care policy, and a neighboring hospital's bond disclosure signals trouble. All of it is public, and most of it doesn't matter to you. The few items that do matter tend to reach your leadership team late, through a trade newsletter or a forwarded email.

This week, 38 CMS actions, 14 state filings, 22 payer policy changes, 6 competitor disclosures. 3 touched your plan.

Built around the decisions you already make

A health system leadership team comes back to the same six decisions every quarter. We build a set of agents and a lens for each one, and they report to us.

Growth and service lines

Where should the system grow, and is the ambulatory plan still the right bet?

The part of Harrow Valley's strategy graph behind the decision: Growth and service lines

Growth lens

  • Market Sentinel, Watch agents
  • Service Line Market Assessor, Office agents

One example

  1. Northgate Health files a certificate of need for an ambulatory surgery center four miles from Harrow Valley's planned south campus

  2. Two new surgery centers open in the south service area by Q3 2027Holding to Watch

  3. What it means: the board vote on ambulatory phase 2 gets a competitive analysis first, and a decision on whether to comment before the filing's deadline

We read every filing and opening in your service areas against the sites and service lines your plan depends on.

What the agents read

  • State certificate-of-need filings and licensing notices
  • Competitor openings, acquisitions and physician group moves
  • Medicare claims and Census data on demand by service line

What they produce

  • Share by service line in each service area
  • A brief whenever a filing touches a site or service line in your plan
  • The fact base behind each grow, hold or exit decision

Payer contracts and rates

Are you paid what you should be, and what will next year's contracts look like?

The part of Harrow Valley's strategy graph behind the decision: Payer contracts and rates

Contracting lens

  • Payer Policy and Rate Watch, Watch agents
  • CMS Rule Watch, Watch agents
  • Rate Position Analyst, Office agents

One example

  1. Your largest commercial payer publishes a site-of-care policy that moves outpatient MRI and CT to freestanding centers from July 2027

  2. Outpatient imaging stays in hospital departments under commercial policyHolding to Watch

  3. What it means: imaging is on the table in the 2027 renewal, and the growth plan gets a freestanding imaging option to compare

We read payer policies, price transparency files and CMS payment rules against your rates and your volume.

What the agents read

  • Commercial payers' medical and site-of-care policies
  • Hospital and payer price transparency files
  • CMS rules for hospital outpatient, inpatient and physician payment

What they produce

  • Your rate position against competitors, by payer and service
  • A negotiation brief before each contract renewal
  • The effect of each payment rule on your outpatient revenue

Health plan performance

Will the plan earn its quality bonus, and what does the next bid look like?

The part of Harrow Valley's strategy graph behind the decision: Health plan performance

Health plan lens

  • Medicare Advantage Market Benchmarker, Watch agents
  • Bid and Stars Scenario Builder, Office agents

One example

  1. CMS releases the 2027 Star Ratings: Harrow Valley Health Plan drops from 4 stars to 3.5

  2. Health plan stays at 4 stars or aboveHolding to At risk

    Health plan margin funds $40 million a year of the ambulatory planHolding to At risk

  3. What it means: it is the worked example further down this page

We read Star Ratings, enrollment and rate notices for every plan in your counties against your plan's membership and margin.

What the agents read

  • CMS Star Ratings and cut points, by measure
  • Medicare Advantage enrollment and plan landscape files, by county
  • The annual Advance Notice and Rate Announcement

What they produce

  • Your Star Ratings by measure against every plan in your counties
  • Bid and benefit scenarios before each June deadline
  • A membership forecast tied to the benefits competitors will offer

Capacity and workforce

Do you have the beds, staff and sites the plan assumes?

The part of Harrow Valley's strategy graph behind the decision: Capacity and workforce

Capacity lens

  • Workforce Market Watch, Watch agents
  • Strategy Execution Tracker, Office agents

One example

  1. Northgate Health raises starting nurse pay 9% across the metro

  2. Nurse vacancy rate below 8% by mid-2027Holding to Watch

  3. What it means: the 2027 workforce budget gets a wage scenario before the finance committee meets

We read the labor market and your competitors' moves against your staffing and capacity plan.

What the agents read

  • Competitor job postings and wage announcements
  • State nursing licensure and workforce data
  • Beds and occupancy from Medicare cost reports

What they produce

  • Your vacancy and wage position against the market
  • A capacity forecast by campus
  • A staffing scenario before each budget cycle

Capital, affiliations and partnerships

What can you afford, and who might you partner with or acquire?

The part of Harrow Valley's strategy graph behind the decision: Capital, affiliations and partnerships

Capital lens

  • Bond and Affiliation Watch, Watch agents
  • Scenario and Options, Office agents

One example

  1. St. Brennan Community Hospital, the independent hospital in the north service area, discloses that it missed its debt service coverage covenant

  2. No competitor affiliation in the north service area before 2028Holding to Watch

  3. What it means: the affiliation decision comes forward, with options ready before another system approaches St. Brennan's board

We read bond disclosures and deal announcements across your region against your capital plan and your rating.

What the agents read

  • Municipal bond disclosures for every hospital in your region
  • Rating agency actions and published medians
  • Affiliation and acquisition announcements

What they produce

  • A financial health view of every hospital in your region
  • An affiliation shortlist, each with a first note
  • Your capital plan tested against your covenants and your rating

Board and bondholders

The questions your board, finance committee and rating analysts will ask, including the ones they have not thought of yet, and the pack that answers them.

The part of Harrow Valley's strategy graph behind the decision: Board and bondholders

Board lens

  • Board and Leadership Pack Builder, Office agents
  • Strategy Dashboard, Office agents
  • Strategic Planning, Office agents

One example

  1. The Q1 2027 board pack opens with the two assumptions that moved this quarter

  2. Health plan stays at 4 stars or aboveHolding to At risk

    Health plan margin funds $40 million a year of the ambulatory planHolding to At risk

  3. What it means: it leads with the question a director is most likely to ask: whether ambulatory phase 2 still works without the quality bonus

What the agents read

  • Everything the other five lenses produce
  • Rating agency medians and peer disclosures
  • The questions raised on peers' bondholder calls

What they produce

  • A board and finance committee pack drafted with you each quarter
  • The questions directors and rating analysts are likely to ask, each with an answer and a source
  • The Decision Log entries behind every recommendation

One finding, start to finish

Every brief we send follows the same lens, so your leadership team knows where to look.

The 2027 Star Ratings result for Harrow Valley Health Plan, linked to the health plan assumptions and the ambulatory decision it affects.

Health plan lens. Harrow Valley Health. October 9, 2026.

A health plan lens brief

CMS released the 2027 Medicare Advantage Star Ratings. Harrow Valley Health Plan dropped from 4 stars to 3.5. The two national carriers with the most members in its counties both rated 4.5.

The 2027 ratings set quality bonus payments for 2028. At 3.5 stars, the plan loses the 5% quality bonus for 2028, and its rebate share stays at 65%. At 4.5 stars, both national carriers keep the bonus and a 70% rebate share, so they can fund richer 2028 benefits in the same counties. Two measures drove the drop: medication adherence for diabetes and a member experience measure.

What happened.

CMS 2027 Star Ratings: Harrow Valley Health Plan drops to 3.5 starsHarrow Valley Health Plan (Medicare Advantage, 68,000 members)

Which part of your plan it touches.

  1. Health plan stays at 4 stars or aboveAt risk
  2. Health plan margin funds $40 million a year of the ambulatory planAt risk
  3. Membership reaches 75,000 by January 2028Watch

What else depends on it.

  1. 2028 Medicare Advantage bid and benefits
  2. Ambulatory phase 2 (two surgery centers)

Health plan stays at 4 stars or above moves from holding to at risk. Health plan margin funds $40 million a year of the ambulatory plan moves from holding to at risk. Membership reaches 75,000 by January 2028 moves to watch.

The 2028 bid, due the first Monday in June, and the board's Q1 vote on ambulatory phase 2: two surgery centers that the plan's margin was meant to fund.

What it means.

By our estimate from the plan's 2027 bid, losing the bonus takes about $35 million out of 2028 plan revenue, close to the full amount the ambulatory plan expects from the health plan each year. The larger exposure is competitive: the national carriers will go into 2028 enrollment with better benefits, and a smaller plan means less margin in 2029 as well.

What you'll be asked.

  • Directors will ask whether ambulatory phase 2 still works without the quality bonus, and what it costs to wait a year.
  • Rating analysts will ask how much of the system's margin depends on the health plan.

Options.

  1. Build the 2028 bid without the bonus now, and decide which supplemental benefits to hold and which to trim.
  2. Put a recovery plan on the two measures that drove the drop, aimed at the next measurement year.
  3. Phase the ambulatory plan: open one surgery center in 2027 and take the second to a joint venture with an orthopedic group, which shares the capital.
  4. Fund phase 2 in full from the system balance sheet and accept fewer days cash on hand.

Our recommendation.

Rebuild the bid on a no-bonus basis now, and start the recovery plan this month. Take a phased ambulatory plan to the Q1 board: one center funded as planned, and a joint-venture option for the second. It protects the growth plan without asking the balance sheet to cover the lost bonus.

Sources. CMS 2027 Medicare Advantage Star Ratings, released October 8, 2026, retrieved October 8, 2026. CMS 2028 rebate percentages by star level. Harrow Valley Health Plan 2027 bid (internal). Ambulatory capital plan, phase 2 (internal).

What reaches you

The brief is one of three things your leadership team sees. The other two stay current every week.

Assumption Watch

An Assumption Watch excerpt

AssumptionStatusChangedWhy
Health plan stays at 4 stars or aboveCMS 2027 Star Ratings; see health plan lens briefAt riskOctober 8
Health plan margin funds $40 million a year of the ambulatory plan2028 quality bonus lostAt riskOctober 9
Membership reaches 75,000 by January 2028National carriers rated 4.5 in the same countiesWatchOctober 8
Two new surgery centers open in the south service area by Q3 2027Northgate certificate-of-need filing four miles from the south campusWatchSeptember 23
Days cash on hand stays above 200Confirmed at the October finance committeeHoldingOctober 6

Decision Log

A Decision Log entry

Ambulatory phase 2.

Held for a phased option, October 9, 2026.

Decided by the CEO with the CFO and the health plan president.

Revisit at the Q1 board meeting, or when the 2028 bid assumptions are final, whichever comes first.

Phase 2 assumed the health plan would keep its quality bonus and fund $40 million a year, and both moved this week.

Relies on:

  • the plan's star rating
  • plan margin
  • the south surgery center timeline
  • orthopedic share

Your dashboard

The same model, as your CEO, COO and board see it, updated as your market moves.

Harrow Valley Health decisions exposed, October 9, 2026

3 decisions need attention3 assumptions moved this week2 at risk

What moved this week

  • Health plan stays at 4 stars or above: Holding to At risk. CMS 2027 Star Ratings; see health plan lens brief.Touches Ambulatory phase 2 (two surgery centers); 2028 Medicare Advantage bid and benefits. Source: CMS 2027 Medicare Advantage Star Ratings, released October 8, 2026, retrieved October 8, 2026
  • Health plan margin funds $40 million a year of the ambulatory plan: Holding to At risk. Follows from the lost 2028 quality bonus.Touches Ambulatory phase 2 (two surgery centers). Source: Harrow Valley Health Plan 2027 bid (internal)
  • Membership reaches 75,000 by January 2028: Holding to Watch. National carriers rated 4.5 in the same counties.Touches 2028 Medicare Advantage bid and benefits. Source: CMS 2027 Medicare Advantage Star Ratings, released October 8, 2026, retrieved October 8, 2026
Open the health plan lens brief

Why two of us, and not a firm

The big strategy firms can bill a mid-size company millions of dollars a year in project fees. The partner who sold the work shows up for the steering committee. The analysis is done by associates a few years out of school. And when the project ends, everything the team learned about your business leaves with it.

Coactivator costs about what you would pay one senior strategy hire. For that, two ex-BCG and Accenture strategy consultants who have also run healthcare businesses work on every piece of your strategy, with AI agents reading your market every day against your plan. Nothing waits for a statement of work, and nothing ends when a deck is delivered.

A big strategy firmCoactivator
Who does the workA partner sells it; analysts and associates deliver itThe two of us, on every piece of work
When it happensA project, with a start date and an end dateContinuously, often before you ask
What it knows about youWhat each new team learns in its first weeksYour strategy model, kept current from week one
What it costsProject fees that can reach millions a yearAbout the cost of one senior strategy hire

On call, not on a calendar. When something material happens in your market, you hear from us that day, with what it puts at risk and what we would do first. And most of the work starts before anyone asks. We know your plan and the calendar it runs on, so the scenarios are drafted before the readout, the rate notice or the board meeting.

Illustrative: ahead of the 2028 Medicare Advantage rate notice at Harrow Valley Health

  1. 8 weeks out

    The Medicare Advantage Market Benchmarker sets the expected Advance Notice against the 2028 bid assumptions, now without the quality bonus.

  2. 6 weeks out

    The Bid and Stars Scenario Builder models three benchmark outcomes and what each does to benefits, membership and ambulatory funding.

  3. 3 weeks out

    We take the CEO, the CFO and the health plan president through all three, with the questions the finance committee will ask.

  4. Notice day

    Whichever way it goes, the bid team starts from a prepared position and the Assumption Watch moves that day.

How it starts. In the first two weeks we build your strategy model from your plans, board materials, forecasts and operating reviews, and set up the agents around it. Alongside, we learn how your leadership team decides. By the end of the first month the work arrives in your formats, and you have two partners on call. Engagements run for at least six months.

Who we are

Sanjay Cherian

Sanjay spent a decade at Accenture as a strategy consultant specializing in health and life sciences, advising pharmaceutical companies including Merck, Pfizer and AstraZeneca. His work there covered market entry strategy, product launches, and the econometric and portfolio analysis that tells a commercial team where its next marketing dollar earns the most. He then took operating roles: he led digital innovation for retail pharmacy at Shoppers Drug Mart across roughly 2,000 stores, built North America's first two-sided digital health marketplace as Chief Product Officer at Telus Health, and was Global Head of Generative AI and Enterprise Data at Nike. He founded Tenuto Labs, which builds the ontology-driven AI systems Coactivator runs on. Based in Austin.

Hans Oh

Hans has spent more than two decades advising and running healthcare and life sciences businesses. He began inside a large hospital system, reporting to its COO on process re-engineering and cost analysis. As a strategy consultant at Accenture and then BCG, where he was a Digital Health Expert and Team Lead, he advised pharma companies, providers and payers. He led a five-year benchmarking study of IT spending across 16 major biopharma companies, and worked on a provider cost-reduction program that delivered $18 million in net savings within two years. He then took operating roles as a vice president at ZappRx and Omnicell. At ZappRx he negotiated the company's first biopharma commercial agreement, which became the template for three more, and led the deal effort for its sale to Allscripts. He founded Innoveron Group, a healthcare strategy consultancy, and co-founded Tenuto Labs. Based in New York.

Tell us what's in front of you

Write to us with the decision you're facing, a competitor event coming up, or the plan you're working to. Within 48 hours we'll send you a short brief built from public sources, so you can judge the work before we talk.

coactivatorai@tenutolabs.com

Some starting points:

  • A decision you're facing: a two-page decision brief.

  • A competitor filing or CMS rule coming up: an event brief before it lands, and a follow-up after.

  • Your plan: a first Assumption Watch for your company, built from public filings and federal data.