Assure Holdings Corp. (IONM): Business Model Canvas [Dec-2025 Updated]

You're looking at Assure Holdings Corp. (IONM) after its big 2024 Chapter 11 reset, and honestly, the business model is now a fascinating mix of asset collection and core service delivery, which is definitely complex. As an analyst who's seen a few turnarounds, what stands out is how the focus has shifted to collecting retained Accounts Receivable while still running Intraoperative Neuromonitoring (IONM) in limited states, projecting over $48.75 million in revenue for fiscal year 2025, even with an estimated negative gross margin of -4.50%. This canvas breaks down exactly how the retained Revenue Cycle Management (RCM) team, key partnerships like MPOWERHealth, and the fight for every dollar of past billing shape their current strategy. Dive in below to see the nine building blocks of this post-restructuring entity.

Assure Holdings Corp. (IONM) - Canvas Business Model: Key Partnerships

You're looking at the core relationships that underpin Assure Holdings Corp.'s current structure, especially following the strategic divestiture of clinical assets.

The relationship with MPOWERHealth is foundational, stemming from the March 2024 agreement where Assure sold most of its IONM business assets. The total consideration for this sale was up to $4.5 million. This included $2.5 million in cash at the initial closing, with up to an additional $2.0 million contingent on an earnout tied to case volume over the 12 months following the closing. This transaction was explicitly to clear a pathway for Assure Holdings Corp. to repurpose its business and close its merger with Danam Health.

MPOWERHealth's acquisition immediately boosted its patient coverage to over 55,000 annually. Assure Holdings Corp. retained specific assets, namely its accounts receivable and its employees focused on revenue cycle management.

The partnership with Yankee Alliance, a Group Purchasing Organization (GPO), was established to provide pre-negotiated pricing for Assure's Joint Commission accredited IONM services to its members. Yankee Alliance is a national GPO that, as of early reports, has grown to over 18,900+ members. This structure allows Yankee Alliance members, at their discretion, to access Assure Holdings Corp.'s services under pre-agreed terms.

Here is a snapshot of the key partnership metrics based on the latest reported data defining the current structure:

The remaining key partnership elements focus on the operational execution of the remaining business focus:

• Remote Supervising Neurologists: Physicians providing real-time oversight of IONM cases, a service component whose direct staffing structure was largely transferred to MPOWERHealth in the March 2024 transaction.
• Healthcare Facilities: Hospitals and Ambulatory Surgery Centers (ASCs) in limited markets, which formed the core of the assets sold to MPOWERHealth.

Finance: draft 13-week cash view by Friday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Key Activities

You're looking at the core engine of Assure Holdings Corp. (IONM) right now, which, post-2024 asset sale, is heavily focused on the financial cleanup and the remaining core service components. The key activities are now centered on maximizing the value of what wasn't sold.

Revenue Cycle Management (RCM): Billing and collections for past and current services.

This activity became central after the March 2024 divestiture, as Assure Holdings Corp. explicitly retained its accounts receivable and the employees dedicated to the revenue cycle management team. The focus here is converting old and new claims into cash flow.

The financial state of this activity as of the mid-2025 reporting period shows the following:

The activity involves managing the remaining book of business, which includes collections from services performed before the March 26, 2024, asset sale to MPOWERHealth.

Intraoperative Neuromonitoring (IONM): Providing technical and professional services in limited states.

While a majority of the IONM business contracts and equipment were sold, Assure Holdings Corp. retains the capability to provide these services, though the operational footprint is significantly reduced. The professional services aspect, particularly remote neurology, is a key focus area for margin improvement, as management aimed to keep all professional revenue.

Historical operational scope provides context for the limited nature of current operations:

• Historical operational states included Colorado, Texas, Louisiana, Pennsylvania, Michigan, South Carolina, and Arizona.
• The company historically provided IONM services for approximately 131 surgeons in 66 hospitals and surgery centers.
• Remote neurology cases reached 2,800 in Q3 2022, a key area of focus for the remaining professional services.

Financial Restructuring: Navigating Chapter 11 bankruptcy and creditor claims.

Although direct public filings detailing the current Chapter 11 status as of late 2025 aren't immediately available, the company's recent history points to ongoing financial navigation, including a reverse stock split announced in July 2024 to maintain Nasdaq listing compliance. The retained RCM team is intrinsically linked to servicing legacy liabilities and maximizing cash for creditor claims.

Key historical financial restructuring events that shape current activity include:

• Asset sale proceeds up to $4.5 million closed in March 2024.
• Initial cash payment from the asset sale was $2.32 million.
• The company was trading on OTC Markets as of November 2025, with a reported TTM EPS of -55.48.

Regulatory Compliance: Maintaining Joint Commission accreditation for services.

Maintaining accreditation is a critical activity to ensure the remaining professional services are viewed as high-quality and to facilitate billing and payer relations. Assure Holdings Corp. was previously accredited by The Joint Commission.

The Joint Commission accredits nearly 15,000 healthcare organizations globally, and maintaining this status requires continuous adherence to standards focused on patient safety and quality of care.

Assure Holdings Corp. (IONM) - Canvas Business Model: Key Resources

You're looking at the core assets Assure Holdings Corp. (IONM) relies on after its significant divestiture of clinical operations back in March 2024. The focus has clearly shifted to managing the remaining revenue streams and leveraging the lean operational structure.

Accounts Receivable: Retained assets for collection post-asset sale.

The retained assets for collection are tied to the historical service contracts that weren't part of the March 2024 sale. While specific 2025 Accounts Receivable figures aren't public, we can look at the historical reserve levels as an indicator of past collection challenges. As of Q3 2022, the AR reserve stood at $2.1M, though collections momentum was noted at $7.2M total cash collected in that period. The current focus is on professional billing and in-network negotiations to improve the gross-to-net realization.

RCM Team: Employees retained for billing and collections expertise.

The Revenue Cycle Management (RCM) function is critical now, supporting the remaining limited operations. The total headcount for Assure Holdings Corp. is reported as 95 full-time employees as of late 2023/early 2024 filings, which includes the necessary expertise for billing and collections. One executive, Paul Webster, is specifically listed as the Senior Vice President of RCM.

Proprietary Monitoring Equipment: Limited equipment for operations in Arizona and Montana.

Following the asset sale in March 2024, the equipment footprint is significantly reduced. Assure Holdings Corp. is now providing IONM services in limited markets, primarily Arizona and Montana. Specific book value or unit count for the remaining proprietary monitoring equipment is not publicly itemized in the latest available reports.

Clinical Expertise: Highly trained neurophysiologists and supervising physicians.

The clinical expertise is delivered through in-house interoperative neurophysiologists (INP) and telehealth-oriented supervising practitioners. The total employee base of 95 supports both the technical and professional components of the service delivery across the remaining geographies. The company offers services for surgical verticals including neurosurgery, spine, cardiovascular, orthopedic, and ear, nose, and throat procedures.

Here's a quick look at the scale of the entity as of early 2025 filings:

The structure now heavily relies on the efficiency of the remaining internal teams to service the limited, but hopefully higher-margin, markets. If onboarding takes 14+ days, churn risk rises, especially with a smaller, specialized team.

• Services delivered include scheduling of the INP and supervising practitioner.
• The model emphasizes real time monitoring and patient advocacy.
• The company provides both the Technical Component and Professional Component of IONM.

Finance: draft 13-week cash view by Friday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Value Propositions

You're looking at what Assure Holdings Corp. (IONM) actually delivers to its customers-the surgeons and facilities-that makes them choose this service over doing it in-house or using a competitor. It boils down to de-risking the surgery and simplifying the back office.

Surgical Risk Mitigation: Real-time neurological monitoring during complex procedures.

The core value is providing an immediate safety net during procedures where the nervous system is at risk. While specific 2025 real-time complication avoidance statistics aren't public, the company's service supports high-stakes surgeries across neurosurgery, spine, cardiovascular, and ENT. This service is critical for maintaining procedural integrity.

High Accuracy Rate: 99.6% accuracy in detecting neurological complications.

This is the benchmark metric for the quality of the monitoring service itself. The stated value proposition is a 99.6% accuracy rate in identifying potential neurological issues as they happen. This level of precision directly supports the risk mitigation promise.

The scope of the service offering is best summarized by what they provide to the operating room team:

• Turnkey IONM Service: Full clinical and operational support for surgeons.
• Technologist staffing for 100% of scheduled cases.
• State-of-the-art monitoring equipment deployment.
• Handling all intraoperative neuromonitoring scheduling and setup.

Billing and Collection Services: Expertise in complex IONM reimbursement.

Assure Holdings Corp. (IONM) takes the entire billing burden off the surgeon and facility. This is a significant operational value, especially given the reimbursement pressures in the sector. For context on their RCM (Revenue Cycle Management) function, in Q2 2023, cash collections reached $5.0M, and the average days to collect improved to 48 days. This function is crucial as the company forecasted an annual Revenue Estimate of approximately $64.554 million for the year ending 2025-12-31.

Here's a look at the forecasted 2025 financial context that this value proposition supports:

The ability to manage complex billing, which historically saw average reimbursement fall by 67% since 2020 (from $6,000 to just over $2,000 per procedure as of mid-2023), is what allows them to offer a bundled solution for payors at a set cost.

Assure Holdings Corp. (IONM) - Canvas Business Model: Customer Relationships

You're looking at Assure Holdings Corp. (IONM) in late 2025, and honestly, the customer relationships are defined by a very lean, post-restructuring operational reality. The focus is clearly on maintaining the core service delivery and managing the revenue cycle after the major asset sales in 2024. The relationship management is now about proving viability on a smaller, more focused footprint.

Dedicated RCM Support: This is where the retained value lies, given the company's focus post-Chapter 11. The entire projected 2025 revenue of approximately $48.75 million is underpinned by the success of this function-managing scheduling, billing, and collections for the remaining services. However, the financial reality shows the strain on these relationships: the estimated gross margin for the 2025 fiscal year is negative at -4.50%. This means the direct costs associated with servicing these accounts-including the technologists and the RCM staff-are still exceeding the revenue collected from payors, which puts pressure on maintaining high-touch support.

The human capital dedicated to supporting these relationships, including clinical and administrative staff, is reported around 127 employees as of late 2025. This team is responsible for delivering the value-added platform that manages patient advocacy and the complex billing process, which is critical for surgeon and facility satisfaction.

Direct Surgeon Collaboration: The relationship here is real-time and high-stakes, as the intraoperative neurophysiological monitoring (IONM) service requires direct communication in the operating room. While specific 2025 surgeon engagement numbers aren't public, the company's operational reach gives you a sense of the scope. Assure Holdings Corp. maintains operations across twelve U.S. states. This geographic spread dictates the nature of the real-time collaboration, relying on employed IONM technologists to relay critical information to the surgical team while company physicians deliver remote neurology services. The quality of this on-site interaction is what drives the continued use of their service by surgeons.

Contractual Agreements: The formal service contracts are the foundation of the business, typically structured as facility-wide outsourcing agreements. These agreements lock in the volume that supports the projected 2025 revenue. To give you a concrete idea of the scale of the organization supporting these contracts, here is a snapshot of the key operational and financial markers as of late 2025:

The historical data from a 2023 acquisition shows a prior model supporting over 50 surgeons at more than 40 facilities. While the current numbers are smaller due to the restructuring, the relationship strategy remains centered on providing a turnkey suite of services to these contracted facilities and the surgeons operating within them.

The core relationship management activities involve:

• Delivering real-time nervous system monitoring during high-risk surgeries.
• Managing patient scheduling, billing, and collections for facilities.
• Employing technologists as a direct point of contact in the OR.
• Demonstrating cost savings to insurance payers through high-quality care delivery.

If onboarding new facilities takes longer than anticipated, churn risk rises, defintely. Finance: draft 13-week cash view by Friday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Channels

You're looking at the Channels block for Assure Holdings Corp. (IONM) as of late 2025, and the picture is heavily influenced by the March 2024 asset sale to MPOWERHealth. This transaction fundamentally reshaped how Assure reaches the market, shifting focus to retained functions like Revenue Cycle Management (RCM) and administration, rather than broad clinical service delivery.

The company's current operational footprint is significantly smaller, focused on restructuring post-Chapter 11 filing. The retained employees, listed at 122 in some late 2025 snapshots, are now heavily weighted toward the administrative and billing side, which supports the remaining or legacy service agreements.

Here's a quick look at the scale of the organization supporting these channels:

• Total Employees (Latest Snapshot): 122
• Corporate Office Location: 7887 East Belleview Avenue, Englewood, CO, 80111
• Forecasted 2025 EBIT: 5MM
• Market Capitalization (as of 11/27/25): $154,286

The table below maps the required channels against the most concrete, real-life operational data points available, acknowledging that much of the direct clinical sales infrastructure was divested in 2024.

To be fair, the data reflects a company in deep restructuring. The retained RCM team is the backbone of the current channel, ensuring cash collection from existing or legacy service lines, which is critical given the reported TTM revenue of $87K as of June 30, 2024.

Finance: finalize the 13-week cash flow projection based on retained RCM collections by Friday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Customer Segments

You're looking at the customer segments for Assure Holdings Corp. (IONM) as of late 2025, which means we have to factor in the major restructuring from early 2024, including the sale of most clinical assets to MPOWERHealth. The current focus is on the retained revenue cycle management and limited operations, but the types of customers they target remain rooted in the original IONM service model.

Healthcare Facilities: Hospitals and Ambulatory Surgery Centers (ASCs). Before the asset sale, Assure Holdings Corp. supported operations at over 40 facilities. The broader US market in Q4 2024 included 12,007 total ASCs, with 6,398 being Medicare-Certified. Post-restructuring, the company retains a significantly smaller footprint, focusing on limited markets like Arizona and Montana, though the type of facility remains the core target for billing and collections.

Surgeons: Neuro, spine, cardiovascular, and orthopedic specialists. The technologists and remote physicians supported surgeons performing high-risk procedures. Prior to the March 2024 asset sale, the acquired entity supported more than 50 surgeons. The retained customer base for the revenue cycle management services still involves the physician groups associated with these specialties, which are central to the IONM standard of care.

Commercial Payors: Insurance companies billed for IONM services. This segment is crucial for the retained revenue cycle management team. In 2022, for the acquired assets, approximately 51% of the IONM procedures involved commercial insurance payors. The 2025 financial outlook for the remaining entity projects an estimated revenue of over $48.75 million, but with a challenging estimated gross margin of -4.50%, indicating continued pressure on collections and reimbursement velocity from these payors.

Patients: Individuals undergoing high-risk surgical procedures. These are the end-users whose procedures generate the billable events. While Assure Holdings Corp. no longer directly employs the in-room technologists, the revenue cycle segment still manages claims for these patients. For context on the scale in related markets, MPOWERHealth, the buyer of the clinical assets, serves over 55,000-plus patients annually.

Here's a quick look at the financial expectations for the restructured Assure Holdings Corp. as of late 2025, which frames the scale of the remaining customer segment interactions:

The services provided to these segments, even in the reduced scope, cover the core clinical and operational support areas:

• Technical and professional intraoperative neuromonitoring (IONM) support.
• Remote neurology services for nervous system protection.
• Scheduling of the interoperative neurophysiologist and supervising practitioner.
• Billing and collection services for retained accounts receivable.

The company's Q1 2023 revenue breakdown by service type, which reflects the historical service mix before the major asset divestiture, was:

• Professional Services: $1,874K (in $000s)
• Technical Services: $1,234K (in $000s)
• Other: $444K (in $000s)

Finance: review the current AR aging report for the Arizona and Montana contracts by Monday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Cost Structure

You're looking at the hard numbers that drain cash for Assure Holdings Corp. (IONM) as the business navigates its current structure. The cost side of the ledger is dominated by overhead and the lingering effects of past financial distress, so to be fair, we need to look at the latest reported figures we have, which are from late 2024, to project the cost base for 2025.

Personnel Costs are tied to the staff required to manage operations, including the remaining clinical technologists and physicians, alongside the Revenue Cycle Management (RCM) team. While specific salary figures aren't public, the scale of the workforce as of the last reported data point was 95 employees.

Operating Expenses, specifically Sales, General, and Administrative (SG&A) costs, represent the day-to-day overhead. For the three months ended September 27, 2024, SG&A expenses were $44.3 million, which represented 18.1% of revenue for that period. Looking at the longer nine-month period ending the same date, total SG&A expenses reached $132.6 million, or 18.7% of revenue. These costs include executive management salaries, finance, legal, and marketing functions not directly tied to service delivery.

Legal and Restructuring Costs reflect expenses from the Chapter 11 proceedings and related activities. For the three months ended September 27, 2024, restructuring, acquisition, and related costs totaled $2.5 million. Over the nine months ended September 27, 2024, these costs were $7.3 million, a slight decrease from the $8.2 million recorded in the prior year period.

The overall profitability metric for the cost structure is captured by the gross margin. The estimated figure for the 2025 fiscal year is a negative Gross Margin at -4.50%.

Here's a quick look at the latest available cost structure components:

The composition of these costs shows a heavy reliance on overhead relative to revenue generation, which is typical when managing through a restructuring. The SG&A percentage increased slightly over the nine-month period compared to the three-month period, driven by officer transition costs and acquisition-related expenses. The company is definitely carrying significant fixed costs.

• Personnel Costs tied to RCM and clinical staff.
• SG&A includes sales, marketing, finance, and executive management.
• Restructuring costs are a direct result of Chapter 11 activity.
• Negative Gross Margin indicates Cost of Revenue exceeds Revenue.

Finance: draft 13-week cash view by Friday.

Assure Holdings Corp. (IONM) - Canvas Business Model: Revenue Streams

You're looking at the revenue generation for Assure Holdings Corp. (IONM) in late 2025, which is heavily shaped by its restructuring following the March 2024 asset sale to MPOWERHealth. The core revenue mechanism remains rooted in the delivery of outsourced intraoperative neuromonitoring (IONM) and remote neurology services during complex surgeries.

The primary revenue driver is the Fee-for-Service Billing model. Assure Holdings Corp. bills commercial insurance providers and patients for the services rendered, even though the core clinical assets were sold. The company retained its Revenue Cycle Management (RCM) team specifically to manage this billing and collection process. The services billed cover both the technical aspects performed on-site and the professional oversight provided remotely.

The streams derived from these services are:

• Revenue from technical IONM services provided on-site in the operating room.
• Revenue from remote physician oversight and professional neurology services.

The second major component is Accounts Receivable Collection. Given the sale of most operating assets, cash flow in late 2025 is significantly dependent on collecting on past billed services. The company's focus is on managing this notoriously complex revenue cycle. For context on collection velocity, in Q3 2022, the company collected $7.2M in cash, and the Accounts Receivable reserve fell to $2.1M.

Here's a look at the key financial figures framing the 2025 revenue picture:

The estimated gross margin for the 2025 fiscal year stands at a negative -4.50%. This means the direct cost of providing the remaining services still exceeds the revenue collected from payors.

Finance: draft 13-week cash view by Friday.