Hanging a Shingle
David Smith launched as a solo practitioner, advising health systems, states, and associations on payment reform, behavioral health integration, and delivery system transformation.
Est. 2018 — Chicago, IL
About Third Horizon
Third Horizon is a Chicago-headquartered health care intelligence firm that architects solutions to problems the market has not solved. Founded in 2018, the company operates at the intersection of strategic advisory and proprietary data assets, combining deep domain expertise in health and behavioral health strategy, payment design, and care delivery.
Our Story
A founding thesis about structural problems.
Third Horizon was founded by David Smith, a health care economist who spent eight years at Leavitt Partners working at the intersection of policy, strategy, and market transformation. The founding thesis: the most vexing problems in American health care are not technical problems waiting for better technology or clinical evidence. They are structural, sitting at the intersection of financial incentives and human sociology, and structural problems require architects and engineers.
Building a Boutique Consultancy
The firm expanded deliberately. Practice areas emerged in Community Health, Behavioral Health, Payment Design, and Market Analytics. Revenue grew across dozens of clients in multiple states.
Developing Platform Infrastructure
The pivotal shift came when Third Horizon recognized that building data systems and analytic infrastructure to pair with the advisory practice is a strategic imperative in an outcomes-based consulting environment. The company broke ground on data systems and analytic infrastructure, resulting in Starset Analytics — an industrial-grade platform capable of processing billions of health care data elements.
Shifting to Platform-Enabled Advisory
Third Horizon now has advisory depth that pure technology companies lack, technical infrastructure that traditional consultancies cannot match, and a growing portfolio of AI capabilities that amplify both. Machine deployment opens infinite ways to bring tailored solutions to clients, re-imagine the entire advisory experience, and build enduring client relationships.
The Model
Most Firms Advise. We Architect Solutions for the Real World.
Advice is easy. Execution is hard. Health care does not need more generic recommendations. It needs solutions designed for the real complexity of the system. That is what Third Horizon is designed to do, from immediate operational challenges to long-term system redesign.
See the whole system
Third Horizon connects the data, context, and signals others assess in isolation to uncover what matters most.
Find the leverage point
Third Horizon pinpoints where targeted action can create outsized impact across the system.
Build the mechanisms
Third Horizon goes beyond recommendations to design the tools and structures that turn insight into execution and change into real results.
Focus Areas
Three Structural Fracture Points
Third Horizon focuses on three structural fracture points that hold the potential to move the entire health care system.
Behavioral Health Architecture
Practitioners who address the upstream causes of chronic disease create enormous economic value, yet they are paid as if their work were extraneous. Building a behavioral health infrastructure worthy of the problem is foundational.
Care Delivery Architecture
When chronic disease takes hold, the system’s response is fragmented and nearly impossible to navigate. More coordinate care models with lower-cost care modalities are imperative to improve access, strengthen outcomes, and support quality at scale.
Economic Flow Architecture
The system must become incentivized to pay for health, not volume. This means transparency, navigation to high-quality and low-cost care, and incentives that derive economic benefit from better outcomes.
By the numbers
Company Snapshot
276Clients to Date
671Total Engagements
25Professionals
94%Staff Retention
The People Behind the Work
Meet the leaders, strategists, and technologists building solutions the market has not solved.
Meet the TeamOur Story
A founding thesis about structural problems.
Third Horizon was founded by David Smith, a health care economist who spent eight years at Leavitt Partners working at the intersection of policy, strategy, and market transformation. The founding thesis: the most vexing problems in American health care are not technical problems waiting for better technology or clinical evidence. They are structural, sitting at the intersection of financial incentives and human sociology, and structural problems require architects and engineers.
2018–2019
Hanging a Shingle
David Smith launched as a solo practitioner, advising health systems, states, and associations on payment reform, behavioral health integration, and delivery system transformation.
2019–2022
Building a Boutique Consultancy
The firm expanded deliberately. Practice areas emerged in Community Health, Behavioral Health, Payment Design, and Market Analytics. Revenue grew across dozens of clients in multiple states.
2022–2025
Developing Platform Infrastructure
The pivotal shift came when Third Horizon recognized that building data systems and analytic infrastructure to pair with the advisory practice is a strategic imperative in an outcomes-based consulting environment. The company broke ground on data systems and analytic infrastructure, resulting in Starset Analytics — an industrial-grade platform capable of processing billions of health care data elements.
2025–Present
Shifting to Platform-Enabled Advisory
Third Horizon now has advisory depth that pure technology companies lack, technical infrastructure that traditional consultancies cannot match, and a growing portfolio of AI capabilities that amplify both. Machine deployment opens infinite ways to bring tailored solutions to clients, re-imagine the entire advisory experience, and build enduring client relationships.
2018–2019
Hanging a Shingle
David Smith launched as a solo practitioner, advising health systems, states, and associations on payment reform, behavioral health integration, and delivery system transformation.
2019–2022
Building a Boutique Consultancy
The firm expanded deliberately. Practice areas emerged in Community Health, Behavioral Health, Payment Design, and Market Analytics. Revenue grew across dozens of clients in multiple states.
2022–2025
Developing Platform Infrastructure
The pivotal shift came when Third Horizon recognized that building data systems and analytic infrastructure to pair with the advisory practice is a strategic imperative in an outcomes-based consulting environment. The company broke ground on data systems and analytic infrastructure, resulting in Starset Analytics — an industrial-grade platform capable of processing billions of health care data elements.
2025–PRESENT
Shifting to Platform-Enabled Advisory
Third Horizon now has advisory depth that pure technology companies lack, technical infrastructure that traditional consultancies cannot match, and a growing portfolio of AI capabilities that amplify both. Machine deployment opens infinite ways to bring tailored solutions to clients, re-imagine the entire advisory experience, and build enduring client relationships.
The Model
Most Firms Advise. We Architect Solutions for the Real World.
Advice is easy. Execution is hard. Health care does not need more generic recommendations. It needs solutions designed for the real complexity of the system. That is what Third Horizon is designed to do, from immediate operational challenges to long-term system redesign.
See the whole system
Third Horizon connects the data, context, and signals others assess in isolation to uncover what matters most.
Find the leverage point
Third Horizon pinpoints where targeted action can create outsized impact across the system.
Build the mechanisms
Third Horizon goes beyond recommendations to design the tools and structures that turn insight into execution and change into real results.
Focus Areas
Three Structural Fracture Points
Third Horizon focuses on three structural fracture points that hold the potential to move the entire health care system.
01
Behavioral Health Architecture
Practitioners who address the upstream causes of chronic disease create enormous economic value, yet they are paid as if their work were extraneous. Building a behavioral health infrastructure worthy of the problem is foundational.
02
Care Delivery Architecture
When chronic disease takes hold, the system’s response is fragmented and nearly impossible to navigate. More coordinate care models with lower-cost care modalities are imperative to improve access, strengthen outcomes, and support quality at scale.
03
Economic Flow Architecture
The system must become incentivized to pay for health, not volume. This means transparency, navigation to high-quality and low-cost care, and incentives that derive economic benefit from better outcomes.
By the numbers
Company Snapshot
276Clients to Date
671Total Engagements
25Professionals
94% Staff Retention
The People Behind the Work
Meet the leaders, strategists, and technologists building solutions the market has not solved.
Meet the Team