CertaGrid Health
Healthcare research and forensic analytics
Structural analysis of consolidation in American healthcare delivery
CertaGrid Health is a healthcare research and forensic analytics firm focused on the structural reality of consolidation in American healthcare delivery.
The firm operates across three pillars: a weekly analytical publication examining the architecture of healthcare consolidation arrangements; a research series presenting the firm's structural and operational verification methodology in instrument form; and analytical services for healthcare attorneys, institutional investors, health systems, and journalism that require document-level structural analysis where public disclosure does not reach.
The firm's analytical posture is forensic rather than evaluative. The methodology characterizes what consolidation arrangements operationally do, distinguishing representational language from operational reality, and surfaces the structural questions that document-level review must address.
The Healthcare Structural Review
The Healthcare Structural Review is published weekly on LinkedIn. Recent editions have examined the disclosure architecture of payer-owned ambulatory surgery center platforms, the document-level structure of value-based care partnerships between investor-backed platforms and physician groups, and the gap between representational language at IPO and operational reality across multi-year disclosure cycles.
Read the current edition and archive on LinkedIn.
The research series
The firm's research series is now available: four volumes across two companion sets, presenting CertaGrid's structural and operational verification methodology in instrument form for application by counsel, investors, and operators evaluating consolidation arrangements at the document level. Each set pairs a structural volume, which reads how an arrangement is built, with an operational volume, which verifies how it actually runs. Each volume is available on its own, each set as a pair, or all four together as the complete library, with one year of structural updates included.
Set One — Ambulatory Surgery Center Consolidation
Both volumes as a set, $400Buy the set
Inside the ASC set
Two volumes, 342 and 328 pages, 670 in all, with a template for every instrument and a worked application to a composite ASC.
Volume One — nine platform profiles
- Surgery Partners NASDAQ: SGRY
- Tenet Healthcare / USPI NYSE: THC
- SCA Health / Optum / UnitedHealth NYSE: UNH
- AmSurg / Envision Healthcare
- U.S. Orthopaedic Partners USOP
- SurgCenter Development SCD
- Compass Surgical Partners
- Regent Surgical Health
- and additional operators
Each profile is read against the platform's SEC filings and public disclosures.
Volume Two — the seven instruments
- 1The Control-Allocation Matrix. Authority read across six dimensions of control: equity, governance, operational authority, economic participation, clinical autonomy, and exit and leverage.
- 2The Risk and Vulnerability Matrix. Five categories of risk exposure against two dimensions of vulnerability.
- 3The Reserved-Powers Risk Checklist. The reserved-powers landscape that board composition alone does not reveal.
- 4The Partnership-Reality-Gap Audit. The disciplined comparison that establishes the gap between the public readings and operative reality.
- 5The Autonomy-Preservation Protocol. Where clinical autonomy is retained in form and shaped in operation.
- 6The Discovery-Roadmap Tool. What to ask for, and where the operative evidence is reached.
- 7The Composite Verification Engagement. The instruments integrated into a single engagement, end to end.
Look inside — no registration
Read a complete profile in full: Surgery Partners, Inc. (NASDAQ: SGRY), the reading performed against the company's own filings.
Read the full profile (PDF)Set Two — MSO and DSO Arrangements
Both volumes as a set, $400Buy the set
Inside the MSO/DSO set
Two volumes, 134 and 126 pages, with a template for every instrument and a worked application to composite dental and physician arrangements.
Volume One — the anatomy, by structural question
The structural volume reads by dimension, each opening with the question it turns on, worked through both professions, dental and physician.
- 1Control. Who holds the reserved powers.
- 2Economics. Where the value goes.
- 3Governance. How the powers are allocated.
- 4Exit. The transfer power.
- 5Payer Ownership. When the payer and the provider are one enterprise.
Volume Two — the instruments
- 1The Control-Allocation Matrix and the Entity Control Map. Authority mapped across the dimensions of control, and the arrangement drawn across its entities.
- 2The Risk and Vulnerability Matrix. Exposure read against the points at which the arrangement is vulnerable.
- 3The Reserved-Powers Risk Checklist. The reserved-powers landscape that board composition alone does not reveal.
- 4The Representation-Reality-Gap Audit. The disciplined comparison of what the documents represent against what the arrangement operatively does.
- 5The Autonomy-Preservation Protocol and the Disclosure Drift Timeline. Where clinical autonomy is kept in form and shaped in operation, and how the representations drift across the operating term.
- 6The Discovery-Roadmap Tool. What to ask for, and where the operative evidence is reached.
- 7The Composite Verification Engagement. The instruments integrated into a single engagement, end to end.
Look inside — no registration
Read a complete chapter in full: Payer Ownership, the reading applied to what happens when the payer itself owns the platform.
Read the chapter (PDF)The Complete Verification Library
All four volumes, both domains, with one year of structural updates included.
$750
Buy the complete libraryThe method, and what it surfaces
The research series is the firm's methodology, set down in full. Each volume documents its own analytical instruments — the matrices, checklists, and audits that read an arrangement's representations against its operative reality — so that a reading made with them can be examined and defended rather than merely asserted. The ASC set alone sets down seven such instruments, each with a template and a worked application. An engagement applies the same published method to a particular arrangement.
A specimen of the reading
Consider a representative arrangement. The management agreement reserves every clinical decision to the professional entity; the operating records show case-acceptance standards and staffing targets issued centrally, under the management company's name. The documents and the records do not describe the same arrangement. The analysis locates that divergence — what each instrument grants, where the operative record departs from it, and the evidence that establishes the departure — and stops there, short of pronouncing the gap lawful or unlawful, which is a question for counsel and the tribunal.
Stay informed
The quarterly brief
The Quarterly Healthcare Structural Intelligence Brief launches in Q3 2026 as the firm's institutional subscription product, delivering original structural analysis of healthcare consolidation arrangements on a quarterly cadence.
Independent engagements
Alongside the firm's published research, I take a small number of independent engagements. The work is structural verification of consolidation arrangements: examining whether an arrangement operates as its documents represent. Most parties to these arrangements cannot answer that question disinterestedly. Counsel drafts the structure and represents a side, operators carry the growth thesis, and advisers on both sides are paid for the transaction to close. The independent reading is the one no participant is positioned to give, and it is the only role I take.
The value of this work depends on its independence. I do not advise both sides of a transaction, sit on deal teams, or participate in negotiation, and I do not accept contingent or success-based fees; my compensation never depends on a transaction closing or on any particular finding. Engagements are confidential and accepted selectively. Each begins with a conflicts check and proceeds under a confidentiality protocol; where it is appropriate, the work is structured through counsel, so that the analysis is delivered as a privileged input rather than a freestanding report.
The work takes a few specific forms.
Independent transaction diligence. When an investor, acquirer, or health system is evaluating or recapitalizing an ASC, physician, or dental platform, or a hospital-physician partnership, I provide the structural read that no party with a stake in closing can: whether the control, economics, and governance operate as the transaction represents, and how the arrangement is likely to behave once the founding clinicians are paid out and the terms are tested. The work product is a written assessment of where representation and operational reality diverge, framed for a deal team to act on — the divergences that warrant a price adjustment, an escrow, a covenant, or a closer look — and scoped to the diligence timeline.
Pre-signing structural review. When counsel or a counterparty is finalizing an ASC, MSO, joint-venture, or value-based arrangement, I read the documents against the operational reality they produce, locating the specific points at which the reserved powers, compensation, exit, and cash-flow terms depart from what the agreement represents. The review is delivered before signature, while the terms can still change.
Independent analysis in disputes. When an arrangement is contested, and the question turns on whether control was real or merely papered, I provide independent structural analysis of the substance-over-form record for counsel, separate from the litigation and without a position in its outcome. Because the method is published and documented, the basis for each finding — what the record shows, and what is inferred from it — is set out to be examined rather than taken on the analyst’s word.
Standing structural research. When an institution needs to follow a sector rather than a single transaction, I provide retained structural research on consolidation arrangements and the enforcement landscape, including bespoke analysis of specific platforms or sub-sectors as questions arise.
This is independent structural analysis. It complements legal and financial counsel and is not legal advice, a legal opinion, or investment advice. A detailed overview of each engagement, including its process from intake to delivery, is available on request. Engagements are scoped individually, and inquiries may be directed to founder@certagridhealth.com.
About the founder
CertaGrid Health was founded by Scott C. Williams, who serves as President and Founder. Williams brings more than 20 years of healthcare strategy and operations experience, including leadership roles at Kaiser Permanente (Hawaii and Georgia Regions) and PeaceHealth. His analytical framework — what the firm refers to as structural ethnography — draws on training in anthropology and on extensive operational experience inside health systems and payer organizations. Williams is a former United States Marine Corps officer.
Contact