Operational OS for senior-care clinics that turns abnormal memory screens into triaged workups, referrals, and trial-ready patients.

1. Earlier cognitive tests can flag risk before conventional tools, which increases the volume of patients who need organized follow-up rather than ad hoc referral handling.
2. Deployment across more than 30 clinics shows the category is already entering live care settings, so downstream workflow pain exists now rather than in a hypothetical future.
3. Funding aimed at datasets and regulatory work suggests screening tools are moving toward broader clinical standardization, raising the value of workflow software that can scale with adoption.
4. Cambridge-origin research gives providers more confidence to operationalize earlier screening, which increases demand for software that can safely manage what happens after a positive result.

Catalyst. Prema's clinic deployment and funding for datasets plus regulatory work show that earlier dementia screening is becoming operationally real, which creates immediate demand for infrastructure after the screen.

The product sits downstream of any digital cognitive test or clinician-entered screen and converts an abnormal result into a structured next-step workflow. It captures caregiver and symptom history, pulls required chart context from the EHR, ranks urgency based on clinic rules, and routes each patient to the right follow-up path such as repeat testing, neurology referral, imaging workup, or research coordinator review. Operations leaders get dashboards for referral leakage, waitlist aging, and clinic-by-clinic conversion from abnormal screen to completed workup. Research teams can optionally receive consented, pre-qualified patients whose screening and follow-up data are already assembled. The first use case is simple: turn abnormal memory screens into scheduled memory-pathway actions within days instead of weeks.

What's different. Most cognitive-testing startups focus on the screen itself, while generic referral software misses the clinical nuance of dementia workups, caregiver intake, and research handoff. This company deliberately sits after any screening tool, making it easier to sell into clinics that do not want to swap vendors but do need follow-up discipline. Over time, it can build a proprietary dataset on which abnormal screens convert into completed diagnostics, specialist visits, and study enrollment, creating workflow and data defensibility.

Jobs to be done

flowchart LR
  Buyer[Senior care operations leader] --> Pain[Abnormal memory screens create manual referral backlog]
  Pain --> Product[Memory pathway orchestrator]
  Product --> Outcome[Faster workups lower leakage and produce trial-ready patients]

Executive takeaways

• The operational bottleneck is shifting from running a memory screen to completing the next step after a concerning result.
• Medicare already creates workflow and reimbursement hooks for cognitive follow-up, but clinics still need lightweight execution software to close loops quickly.
• Competition is strongest among assessment vendors; the cleaner wedge is a vendor-agnostic abnormal-screen orchestration layer rather than another test.

Market definition

Workflow software that converts an abnormal or concerning cognitive screen into a scheduled diagnostic, care-management, or research next step for older adults.

Customer and buyer

Initial users are operations leaders, medical directors, and referral managers inside U.S. senior-focused primary care groups and multi-site memory programs; the buying center includes clinical operations, physician leadership, and IT because success depends on referral conversion, documentation quality, and integration fit.

Buying triggers

• Rolling out digital cognitive assessment in primary care quickly creates a queue of positive or borderline cases that need triage, documentation, and human follow-up. [9][20]
• Medicare already requires cognitive assessment inside annual wellness workflows and covers separate care-planning visits, making follow-up operations a reimbursable workflow rather than a purely optional add-on. [2][3][4]
• Dementia-navigation and caregiver-support models such as GUIDE increase pressure to coordinate next steps, support caregivers, and reduce leakage after diagnosis concerns surface. [5][21]

Willingness to pay

There is a plausible budget owner because cognitive follow-up already touches reimbursable assessment and care-planning work and CMS is funding dementia-care navigation; buyers will still expect the software to prove fewer dropped referrals, less staff time, and cleaner documentation before paying meaningful subscription dollars. [2][4][5]

Category dynamics

Growth signal 1.9% CAGR in U.S. Alzheimer's prevalence from 6.9M to 13.8M older adults by 2060

Validation signals

• Prema says its PREMAZ tool is already deployed in more than 30 clinics across the UK and the US, indicating the upstream screening category is operationally real.
• A 7-clinic primary care implementation generated 447 referrals for further assessment from 1,808 completed digital cognitive screens.
• The TabCAT-BHA implementation increased PCP cognitive diagnoses and was adopted by 95% of participating providers.
• BrainCheck says it now serves more than 500 healthcare organizations and added more than 150 new practices in 2025.
• CMS has already created a dementia-care payment model that depends on navigation and caregiver support, validating the need for operational infrastructure.

Regulatory & technical constraints

• The product should avoid blanket asymptomatic-screening claims and instead support clinician-led follow-up after a concern or abnormal result, given USPSTF's evidence stance.
• CPT 99483 workflows require detailed history, functional review, caregiver involvement, and documented care-plan elements, so software must support documentation quality rather than bypass it.
• GUIDE-aligned deployments need caregiver support, care navigation, and coordination with community resources, which raises implementation scope but also validates the workflow.
• Interoperability expectations now favor USCDI, standardized APIs, and SMART/FHIR-style app access for production deployments.

Most commercial energy is still concentrated in detection, assessment, or care-plan generation rather than cross-vendor conversion of abnormal screens into completed next actions. Manual EHR tasks, referral faxing, and call-center outreach remain the dominant substitute, while assessment vendors are gradually extending toward adjacent workflow features.

Why incumbents do not win by default

• EHR platforms. Standardized APIs and data-sharing rules make integration more feasible, but generic records systems do not solve dementia-specific prioritization, caregiver intake, or memory-pathway sequencing by default.
• Screening vendors. Assessment companies increasingly add reports and care-plan features, but most remain anchored to their own test modality rather than acting as a neutral orchestration layer across whichever screen a clinic already uses.
• Specialty memory clinics. Specialists own downstream workup expertise, but referral-delay evidence and workforce strain mean they do not automatically solve upstream leakage from primary care.
• Collaborative care organizations. Service-heavy dementia-care models validate the need for coordination, yet they rely on staffing and standardized workflows that software can productize and scale.

The company should start as a vendor-agnostic workflow layer for U.S. senior-focused primary care groups that already run cognitive screening but still lose patients between an abnormal result and the next diagnostic or care-planning step. The first customer is a 10-50 clinic value-based senior care group with centralized referral operations, because abnormal screens, caregiver outreach, and specialty bottlenecks all sit under one operator with budget accountability. The wedge is deliberately narrow: ingest an abnormal or concerning screen, collect missing caregiver and symptom history, assemble the chart packet, prioritize urgency, and book the next best step without asking the clinic to replace its screening vendor. This is a faster proof point than building another digital assessment because the researched market already shows screening deployment, Medicare follow-up hooks, and coordination pain, while substitutes remain mostly manual. Go-to-market, pricing, and product scope should stay coupled around that same workflow, starting with a paid pilot priced against reduced leakage and faster time to scheduled workup in a small clinic cluster. The strongest long-term asset is a cross-vendor dataset showing which screen-positive patients convert into completed diagnostics, care plans, specialist visits, and research-ready referrals under specific workflow interventions. The company should explicitly avoid standalone diagnostic claims and position as workflow enablement, because the research shows regulatory and clinician-trust constraints around broad asymptomatic screening. Evidence for the wedge is credible but still incomplete on exact reimbursement capture, baseline leakage rates, and implementation burden at target accounts, so the first 12 months must produce customer-owned funnel and cycle-time data before the company broadens into memory clinics, payer pathways, or research monetization.

Problem

• Abnormal cognitive screens still turn into nurse callbacks, referral faxes, spreadsheet waitlists, and incomplete chart packets, so patients disappear before a workup is scheduled.
• Value-based senior care groups and memory programs feel the pain in both care quality and operations: delayed follow-up weakens CPT 99483 and GUIDE-aligned workflows, burdens caregivers, and leaves specialists and research teams with poorly prepared referrals.

Solution

• Build a workflow layer that receives abnormal-screen output or manual clinician concern, captures caregiver history and required documentation, applies site-specific routing rules, and drives the patient to a scheduled next step within days.
• Give operations leaders dashboards on leakage, aging, and conversion from abnormal screen to completed workup, then expand only after proof into research-ready referral packaging and specialty memory-clinic coordination.

Why we win

• The product sits after any screening tool rather than replacing it, which matches how buyers already operate and creates a cleaner sales motion than competing head-on with assessment vendors.
• Each deployment compounds proprietary routing, caregiver-intake, and conversion data on what actually moves screen-positive patients to completed follow-up, which generic EHR workflows and services firms do not capture systematically.

Milestones

flowchart LR
  Wedge[Abnormal-screen workflow wedge] --> MVP[Routing intake and scheduling MVP]
  MVP --> Proof[Cycle-time and leakage proof points]
  Proof --> Expansion[Multi-clinic rollout and research modules]

Founding team

Experiment roadmap

Risk assessment

What must be true

• A 3-5 clinic pilot must reduce median days from abnormal screen to scheduled next step by at least 30% within 120 days.
• At least 50% of paid pilots must convert to production within 6 months of pilot completion.
• The first implementation pattern must support 2 upstream screening inputs plus manual entry without custom work that drives gross margin below target.
• Buyers must accept per-clinic plus usage-based pricing at levels consistent with six-figure annual contracts for multi-clinic groups.
• The company must show that vendor-neutral follow-up orchestration wins even when assessment vendors already offer basic care-plan or reporting features.

Open diligence questions

• What percentage of abnormal cognitive screens in the target ICP currently fail to convert into a scheduled next step within 30 days?
• Which screening vendors and EHR stacks dominate the first 20 target accounts, and how reusable is the integration pattern?
• Does the economic buyer fund this from operations, quality, or innovation budget, and what ROI threshold unlocks production rollout?
• How much caregiver outreach and chart assembly can be automated before clinical teams feel safety or trust concerns?
• In live evaluations, why does a buyer choose this layer over BrainCheck, Linus Health, internal referral teams, or existing EHR task workflows?

Model sanity

• Revenue engine. Base-case Y3 revenue comes from 12 live clinic groups paying roughly $11K-$12.2K monthly after pilots convert into multi-clinic production contracts.
• Must go right. Pilot-to-production conversion needs to stay near the plan's 50%+ target by M12-M18 or the revenue ramp will lag the fixed implementation-heavy cost base.
• Model breaks if. If sales cycles slip by a quarter or gross margin stalls below 66%, downside cash turns negative before the company reaches a seed-ready proof point.
• Next-round proof. A seed raise is justified once the company shows 9 live clinic groups, one repeatable integration pattern, and a channel-ready ROI story by the end of Y2.

Scenarios

Sensitivity

flowchart LR
  AbnormalScreens[Abnormal screens] --> ManagedPathways[Managed pathways]
  ClinicSubscriptions[Clinic subscriptions] --> Revenue
  ManagedPathways --> UsageFees[Usage fees]
  ManagedPathways --> ClinicSubscriptions
  UsageFees --> Revenue
  Revenue --> GrossProfit
  GrossProfit --> Cash

Flags: The model assumes all three paid pilots land by M9 and at least one converts to production economics by M12; a one-quarter slip materially pressures cash. · Revenue per FTE stays below a typical SaaS benchmark because healthcare implementation, caregiver-workflow design, and customer proof still require a meaningful services component. · Gross margin only reaches the business-plan target in Y3, so deeper-than-modeled EHR customization or support intensity would likely delay the next round.

• Clinical validation dependency. If digital cognitive screens do not gain broader clinical trust, downstream workflow demand could stay niche. Mitigation: Start with customers already deploying screening and position the product as vendor-agnostic infrastructure rather than a new diagnostic claim.
• Slow healthcare integrations. EHR and referral-system integration can stretch sales cycles and delay time to value. Mitigation: Launch with lightweight intake, scheduling, and document-generation workflows first, then deepen integrations after measurable conversion gains.
• Unclear reimbursement owner. Clinics may agree the workflow pain is real but hesitate if savings or revenue capture are not obvious to one budget holder. Mitigation: Sell first into value-based senior-care groups and research programs where reduced leakage and increased trial throughput have a visible economic owner.