A4M is a Seattle-based, intelligence (AI) company, building algorithms and clinical decision support tools for medicine’s quadruplet aims: Access, Quality, Cost, & Experiences.


Dr. Robert Highley

Founder, CEO, Chief Medical Officer

Dr. Robert Highley is a cardiologist and MPH who wrote the interactive textbook, the diagnostic matrix, the drug sequencing algorithm, and developed the Hypertension application.

Sam Chughtai

Co-Founder, CTO

Mr. Chughtai is technologolist with expertise in digital innovation and cybersecurity. He served as a U.S. State Department Advisor and was recipient of the Microsoft Military Affairs Award for Veterans Recruitment. He served as an Adjunct Professor for UW Bothell School of Business and the Seattle University School of Law. His prior professional experiences includes IBM, Microsoft, KPMG, and Accenture.

Randall Highley

Chief Financial Officer

Randall Highley is a CPA, MBA and COO with an MBA from the Kellogg School of business at Northwestern University in Chicago. He has over 35 years of experience managing the business and legal issues at a large privately held corporation.

Eric Abbott

Chief Innovation Officer, CPO

Eric Abbott is a Product Management and Product Marketing business executive with over 20 years of digital transformation and innovation experience in digital health, 5G, IoT, cybersecurity, and enterprise mobility. He has launched over 30 products throughout his career and received multiple patents. He is also Adjunct Professor at Northwestern University, instructing the Consumer Digital Health and American Healthcare graduate courses.

Michael Lawrence

Chief Strategy and Investment Officer

Strategic executive with a track record of delivering over $1.6B in portfolio investments for clients.

Board Advisors

General Stephen Lanza(Retired)

U.S. Army General Officer with over 20 years of service in command and leadership assignments with extensive global operations and leadership experience. Documented ability to provide senior management experience leading large complex organizations ranging in size from 600 to 156,000 in peace and combat operations. Providing intellectual and organizational leadership to accomplish clear and concise strategies and direction in dynamic complex and ambiguous environments. Highly skilled in Public Speaking, Organizational Leadership, Strategic Planning, Strategic Communications, Assessing Strategic Risk and Leadership Development. Key advisor to senior leaders on critical communications issues. Experienced panelist, presenter and expert on global issues.


The Hypertension CDST is a SaaS application. Six-month minimum contract, volume related per member per month fee. This includes video and in person training seminars with case studies on how to better manage HTN and how to utilize the CDST.

The A4M program uses peak diurnal home BP monitoring to better classify hypertension excluding white coat HTN (20-30% of cases) and detecting masked HTN (20%). Missing masked HTN will affect your present baseline rate of control. We aim to exceed the Healthy People 2020 control rate goal of 62% with less provider time, improving access and quality while reducing cost. Projected ROI is > 20:1 based on the AHA estimated cardiovascular cost savings of $1,048 per controlled hypertensive/year. The application also provides performance monitoring, comparing rates of control, disease distribution, relative drug costs, time management and outcomes among providers and across delivery systems. Data useful in HEDIS reporting and quality improvement.


Software to run a Hypertension Clinic

  • A Diagnostic Matrix for the differential diagnosis of HTN
  • Drug sequencing algorithm
  • Templated virtual visits
  • Billing analytics

Performance tracking

  • Efficacy- by Provider and by Institution
  • Relative Drug costs- by Provider by clinic and other institutions
  • Time management analytics

Event tracking

  • Outcomes for clinical trials
  • Adverse Effects

Frequently Asked Questions

  • Why do I have to measure my blood pressure twice a day?

    Blood pressure varies by time of day. The highest readings usually occur between 8:00 AM and noon and between 4:00 PM in 8:00 PM. If we control the highest readings of the day, then the rest of the readings will be under goal.

  • Using a Tuesday Thursday Sunday Tuesday Thursday schedule or a Monday Wednesday Saturday's Monday Wednesday schedule makes it easier to calculate percentages based on 10 readings and it isimportant to give the medications time to work. It takes 10 or more days to equilibrate blood drug levels. So, a 10-to-20-day evaluation period is helpful before adjusting medications.

  • These are based on different risks. Patients with previous heart attack or stroke do better with blood pressures lower than 130/80. Females with aSystolic blood pressure reading between 110-119 have the same MI and heart failure risk as a male with a systolic blood pressure of 160. Your doctor will choose the appropriate blood pressure goal for your situation.

  • The two main problems are 1) Lifestyle issues like diet, exercise, street drugs, smoking and alcohol and 2) Compliance- meaning taking your medications regularly over long periods of time when you do not feel bad from the hypertension but may have side effects from the medication. You are trying to avoid the long-term effects of hypertension: stroke,heart attack, heart failure, renal failure, Atrial Fibrillation, and vascular dementia. For example, nearly 60% of heart failure in females could be eliminated, if BP is controlled, 17% of heart attacks could be avoided, roughly 50% of strokes would disappear.

  • Lifestyle issues can be important. You can lower your blood pressure by losing weight, exercising regularly, or doing meditation, yoga, etc. Avoid smoking, excess salt, street drugs and alcohol. Certain over-the-counter drugs like Motrin, Naproxen, Indomethacin, oral contraceptives, steroids, etc. can elevate your BP. So, let your doctor know if you are taking any over the counter medications or herbal remedies. Foods like blueberries, walnuts. asparaguscan help lower your BP.