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M31 Capital · System Architecture · February 2026

The New Architecture

Eight interlocking layers — from patient data sovereignty to outcomes-based funding. No single layer works alone. Their value is emergent and combinatorial.

Layer 1 — Foundation
The Patient Graph
A continuously updated health record organized as a systems map — not by encounter or specialty. Graph database capturing symptoms, biomarkers, genetics, exposures, lifestyle, microbiome, hormones, and nervous system metrics with mapped relationships. AI pattern recognition flags cross-system clusters. Patient-owned. Decentralized.
Data Sovereignty
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Layer 2 — Intelligence
AI-Assisted Systems Physician
Primary care inverted: a deeply trained generalist as synthesizer, not gatekeeper. AI augments across three functions — continuous pattern surveillance, differential diagnosis with devil's advocacy, treatment interaction mapping across the full therapeutic spectrum. AI handles computation. Human handles judgment, empathy, wisdom.
Pearl Health Infrastructure
Layer 3 — Prevention
Prevention as Default
Not a separate activity — the default operating mode. Health coaches, movement specialists, nutritional therapists, stress physiology practitioners as core care team. Population-level environmental monitoring, continuous biomarker surveillance, lifestyle medicine as first-line intervention. Fully funded because the system makes prevention profitable.
70–80% of chronic disease is preventable
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Layer 4 — Therapeutics
Tiered Evidence Framework
Three tiers: strong clinical evidence → emerging with plausible mechanisms → traditional/experiential. Every Tier 2 and 3 encounter generates structured outcome data, turning the system into a continuous pragmatic trial. Interventions rise or fall based on observed outcomes, not on who can afford a clinical trial. Rigorous and epistemologically humble.
The System Becomes a Learning System
Layer 5 — Community
Community Intelligence
Patient communities as load-bearing infrastructure — not a support group bolted on. Structured data from patient-reported outcomes, symptom triangulation, treatment responses, comorbidity mapping across thousands of real cases. A parallel pattern-recognition engine alongside AI, specializing in lived-experience data that clinical trials cannot capture at speed or scale.
The Patient Graph meets the Community Graph
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Layer 6 — Verification
On-Chain Standards Body
Independent, decentralized standards organization on blockchain. Supplement testing, device validation, practitioner credentialing, protocol development, vendor approval. All records immutable and transparent. Staffed by functional medicine doctors, researchers, pharmacologists, patient advocates. Standards evolve on evidence, not politics or industry capture.
Garner Health Quality Intelligence
Layer 7 — Sovereignty
Blockchain Data Sovereignty
Self-sovereign health identity. Encrypted with granular, programmable, time-limited consent. When anonymized data contributes to research or AI training, the individual is directly compensated. No single institution controls the data layer. Open, blockchain-verified global registry of therapeutic protocols with standardized evidence tiers and decentralized peer review.
Oscar Health Platform Infrastructure
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Layer 8 — Incentives
Outcomes-Based Funding
Four funding layers: universal capitated base, expanded therapeutic access via health savings, data dividends for participation, outcome-linked pharmaceutical pricing. Complex patients carry higher capitation — making the hardest cases the most financially rewarding to serve well. Behavioral incentives as rewards for engagement, not penalties for outcomes.
Pay for Health, Not Activity
How Data Flows

The system is bidirectional — knowledge flows up from practice into research, not just down from research into practice

Patient Graph
Individual's complete health record as systems map — symptoms, biomarkers, genetics, lifestyle, wearables
→Feeds
AI Synthesis Engine
Cross-specialty pattern recognition, differential diagnosis, treatment interaction mapping at superhuman scale
→Generates
Personalized Protocol
Multi-modal treatment plan spanning physical, mental, emotional health — approved by systems physician
↕ Continuous Feedback Loop ↕
Upward Flow
Practice → Research
Every therapeutic encounter generates structured outcome data. AI continuously analyzes for emerging patterns — unexpected efficacy signals, adverse combinations, population-specific responses, novel comorbidity clusters. When patterns reach statistical significance, they are automatically flagged for formal investigation. Community intelligence feeds directly into this layer.
Downward Flow
Research → Practice
Evidence tiers update in real-time based on accumulated data. Interventions move between tiers based on observed outcomes. Protocol recommendations auto-adjust. The entire system is a continuous, massive, real-world pragmatic trial that generates hypotheses at speed and scale impossible in the current research architecture.
M31 Capital · The Architecture · Before Consensus Forms