Third Horizon is a Chicago-based 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 behavioral health, care delivery design, and payment.
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.
David Smith launched as a solo practitioner, advising health systems, states, and associations on payment reform, behavioral health integration, and delivery system transformation.
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.
The pivotal shift came when Third Horizon recognized that qualitative analysis and subject matter expertise would eventually be commoditized. The company broke ground on data systems and analytic infrastructure, resulting in Starset Analytics — an industrial-grade platform capable of processing billions of data elements.
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. The company refers to this as a System Architecture services model.
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.
We connect the data, context, and signals others assess in isolation to uncover what matters most.
We pinpoint where targeted action can create outsized impact across the system.
We go beyond recommendations to design the tools and structures that turn insight into execution and change into real results.
Third Horizon focuses on three structural fracture points that hold the potential to move the entire health care system.
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.
When chronic disease takes hold, the system’s response is fragmented and nearly impossible to navigate. Hospitals must be remanded to their proper role, more deeply integrated with lower-cost care modalities.
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.
Third Horizon's culture is built around principles that prioritize autonomy, accessibility, and purpose.
Professionals are treated as self-directed adults. Staff do not have managers but leaders who hold stewardship for enabling peak performance.
The firm de-emphasizes hierarchical titles in favor of describing what people do. Contribution matters more than position.
Any team member can reach any leader directly. The CEO regularly holds one-on-ones with every member of the team regardless of role or seniority.
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