Building What Health Care Needs but Doesn’t Have

Some problems in U.S. health care persist because no one has built what it takes to solve them, including unenforced parity laws, fragmented safety nets, payment models that reward the wrong work, and more. The Foundry exists to address those problems. Third Horizon finds the structural failures the market has left undone, aligns the mission-driven partners willing to take them on and builds what the work requires: measurement tools, payment models, coalition infrastructure, and first-of-their-kind platforms. The Foundry is where Third Horizon does its most ambitious work.

A diverse group of health care and policy leaders reviewing a framework document and data together at a table

Key Initiatives

Printed policy measurement charts and parity-score data reviewed at close range

Mental Health Parity Index (MHPI)

The Mental Health Parity Act promised equal access to behavioral health care. For over fifteen years it has been effectively unenforceable because no mechanism existed to measure parity. The MHPI changes that, making quantitative parity measurement possible for the first time.

Measures behavioral health vs. physical health reimbursement levels and provider access parity in a geography
Transforms price transparency disclosures into validated, plan-specific parity scores
Co-developed with The Kennedy Forum, the American Medical Association, American Psychological Foundation and The Ballmer Group
Piloted in Illinois with an open-source data visualization application; national deployment in April 2026

Safety Net Moonshot Initiative

America's urban safety nets serve the most vulnerable through institutions never designed to function as a system. The Safety Net Moonshot provides a comprehensive framework for restructuring fragmented systems into coordinated, financially sustainable infrastructure — so communities that depend on the safety net can actually rely on it.

Developed through the Chicago Safety Net Moonshot Initiative — a state-level effort restructuring how safety-net hospitals serving low-income, Medicaid, and uninsured communities are funded and operated; designed as a replicable national blueprint
Transformation framework including asset reallocation, sustainable payment design, and capital formation strategies
Coordinates public, nonprofit, and private stakeholders around shared infrastructure rather than competition for scarce resources
Designed for measurable impact: better access, fewer coverage gaps, and earlier connection to the right care before crisis demands costlier intervention

Addiction Recovery Medical Home APM

Fee-for-service reimbursement treats addiction as an acute event. The ARMH-APM is the first bundled payment model designed to align financial incentives with sustained recovery, not episodic billing — recognizing that addiction is a chronic condition requiring years of coordinated support.

Multi-year episode-based payment replacing fragmented billing with a single, accountable framework for sustained recovery
Quality metrics tied to recovery milestones, not service volume, so providers are rewarded for outcomes that matter
Integrated Treatment and Recovery Network (ITRN) connecting peer recovery coaches, care coordinators, primary care physicians, and addiction specialists
Built through an 18-month collaboration with the Alliance for Addiction Payment Reform, including AHA, HFMA, Duke Margolis, and 30+ organizations
Released as a public good; principles deployed by Indiana, Oregon, New York, and private market payers and treatment centers

See how the Mental Health Parity Index uses real-time payer data to reveal where access breaks down — and where action drives improvement.

Explore the Index

How the Foundry Lab Puts It to Work

Putting it to work

A diverse group of health care and policy leaders reviewing a framework diagram together on a digital display

Measurement tool developmentBuild the quantitative instruments — benchmark indices, scores, risk metrics that make a standard measurable for the first time

Cross-sector coalition buildingAlign payers, providers, policymakers, and community organizations who each hold part of the solution but no shared mechanism to act on it together

Payment model designStructure reimbursement around the outcomes that matter — sustained recovery, coordinated care, financial sustainability

Public utility data platformsRelease the resulting tools as open, public infrastructure — not proprietary products locked behind a paywall — so the whole field can use them

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If you are building a coalition, a measurement tool, or a payment model the market hasn't built yet, the Foundry exists to build it with you.

Leadership

David Smith

Foundry LAB Leadership

Founder and Chief Executive Officer

Health care strategist and coalition builder with 16 years of experience in payment reform, behavioral health transformation, and systems innovation. He leads the firm’s national consulting and strategy initiatives and hosts The Cost of Care podcast. Prior to founding Third Horizon, David was Chief Development Officer at Leavitt Partners.

Greg Williams

Foundry LAB Leadership

President

Behavioral Health finance strategist, policy expert, and documentary filmmaker with more than 20 years of experience advancing addiction recovery and mental health system transformation. Leads client strategy and national coalition initiatives focused on payment reform, policy, and systems change. Prior to joining Third Horizon, Greg was the Executive Vice President at Facing Addiction.