How it works

A plain-English walkthrough of what this is, why it exists, and how the test is set up. The technical detail lives on the Architecture page.

What this is

Most people who work with AI today reach for one general-purpose model (ChatGPT, Claude, Gemini) and ask it complicated, multi-domain questions. That works surprisingly well, but it has two costs: the data leaves your machine, and the model is a generalist — strong everywhere, a specialist nowhere.

This project tests an alternative: a small council of four specialized models running entirely on a laptop. One model leads the conversation; three others — fine-tuned on healthcare, law, and finance respectively — contribute their domain expertise. Then we put the council's answer side-by-side with what frontier Claude (Opus 4.7) produces on its own.

Why fine-tunes matter

A useful analogy: you have a complicated business question that touches medicine, law, and money. You can call one extremely smart generalist, or you can convene three actual specialists plus a chair who synthesizes their input.

The generalist will give you a good answer fast. But the specialists will use precise jurisdictional vocabulary, name the right regulatory bodies, distinguish standard of care from emerging practice, and call out where the analysis depends on assumptions vs facts. Those are properties of training data, not of intelligence.

This experiment asks: do small specialist fine-tunes — running on your own machine — capture enough of that domain texture to be worth the operational complexity?

How the test works

The same question runs through five pipelines simultaneously — three baseline pipelines and two later additions that test a different model architecture (Mixture-of-Experts) without leaving the laptop:

For a plain-English explanation of what Mixture-of-Experts is and why it's worth a separate comparison surface, see the Architecture page's MoE section. In short: MoE models trade memory for compute by storing more total knowledge but only activating a fraction of it per token — a genuinely different architectural category from the dense transformers in the existing cabinet.

The five test cases — design and cutoff alignment

The case battery is intentionally divergent: each prompt stresses a different way the council can go wrong. Three of the five cases also sit at or past the local cabinet's training cutoffs in load-bearing ways, which matters because the cutoffs aren't uniform — Saul anchors to ~Aug 2023, Med42 to Dec 2023, Phi-4 to Jun 2024, and only Qwen-Finance reaches into 2025 (see the Architecture page cabinet table). Today is mid-2026, so each case sits 14–32 months past the relevant backbone.

For each case below: what failure mode it's designed to provoke, why it was structured that way, the specific knowledge each domain needs to surface, and a frank assessment of whether that knowledge lives inside the local cabinet's training window or has drifted past it.

Case 1 — AI clinical decision support rollout

Failure mode tested: synthesis under competing recommendations.

Rationale. The most legible three-domain case. A 12-hospital health system is rolling out a sepsis-risk CDS tool via per-seat annual subscription. Each specialist has well-established doctrine to draw on (alert-fatigue tolerance, FDA SaMD classification, subscription-vs-usage pricing). The case tests whether the Lead can integrate three legible specialist contributions into a coherent v1 design — not whether any individual seat can dig up obscure knowledge.

Knowledge needed First-relevant date Cutoff risk
Alert-fatigue literature, sepsis-scoring debates (Epic critique 2021) Pre-2023 None
FDA SaMD framework, Class II classification doctrine 2017 guidance, stable None
Subscription / per-encounter / outcomes-based pricing structure Cutoff-insensitive None

Verdict — ✅ Within boundaries. No load-bearing dependency on post-2024 rulemaking. Even Saul's Aug 2023 corpus covers FDA SaMD doctrine fully. The case stresses synthesis, not recency. A correct local-council answer is fully achievable in principle; if it fails, the failure points at the architecture (or the Lead's integration), not at stale training data.

Case 2 — Cross-border digital therapeutic launch (US / UK / DE)

Failure mode tested: jurisdictional vocabulary discipline.

Rationale. A US-cleared prescription SaMD launching in the UK and Germany is the textbook case for keeping multiple regulatory regimes distinct (FDA vs MHRA vs BfArM; UK GDPR vs EU GDPR post-Brexit; UK MDR 2002 vs EU MDR 2017/745; DiGA reimbursement vs NHS commissioning vs US payer billing). Models that conflate these — or that treat FDA clearance as carrying any direct regulatory weight in the EU — fail visibly. The case is designed to reward jurisdictional precision and penalize translation-layer shortcuts.

Knowledge needed First-relevant date Cutoff risk
FDA SaMD pathway 2017+ None
DiGA framework + §139e SGB V (BfArM listing) 2019/2020 None — well inside all cutoffs
UK GDPR vs EU GDPR post-Brexit divergence 2021 None
EU MDR 2017/745 (replaces MDD) In force May 2021 None
EU AI Act high-risk classification for medical SaMD (Annex III × MDR) Entered into force Aug 2024 Past Healthcare (Dec 2023) and Legal (Aug 2023) cutoffs
UK Data Protection and Digital Information Act 2024 Past Legal cutoff

Verdict — ⚠️ Edge. The core framework (DiGA, GDPR, MDR) is all well within cutoffs and answerable accurately. The new wrinkle is the EU AI Act × MDR intersection: an adaptive ML smoking-cessation DTx triggers high-risk AI Act obligations on top of MDR conformity assessment, and that intersection only became operative in late 2024 — past both Healthcare and Legal seat backbones. opus-council surfaces it explicitly; the local council cannot.

Case 3 — Capitated Medicare Advantage risk contract

Failure mode tested: quantitative framework discipline.

Rationale. A 40-physician primary-care group is being offered a $1,180 PMPM full-risk capitated contract for a 25,000-member panel. The case tests whether each seat can do (and show) actual quantitative work — actuarial reserves, breakeven utilization, stop-loss layering — rather than hand-wave with adjectives. It's also the case most exposed to currently-evolving CMS rulemaking, which makes it the case where stale training data can produce confidently wrong numbers most easily.

Knowledge needed First-relevant date Cutoff risk
Stark Law / Anti-Kickback Statute structure Decades-stable None
HEDIS measure set specifics (year-over-year drift) Annually refreshed Med42 has HEDIS 2023 at best
CMS-HCC V28 risk-adjustment model transition Phased 2024–2026 (33% / 67% / 100% V28) Saul + Med42 anchored to V24 weights
MA quality reporting / Star Ratings methodology changes Annual 2024–2026 Past Healthcare / Legal cutoffs
CMS-4201-F (MA Final Rule restricting AI/algorithm in prior authorization) April 2024 Past Legal cutoff
2025/2026 MA payment rates (Rate Announcements) Apr 2024 / Apr 2025 Only Finance + Lead know

Verdict — ⚠️ Problematic. The V28 risk-adjustment transition is the operational reality for any current MA capitated contract — actuarial reserves built on V24 weights will be wrong by single-digit-percent margins that matter at scale. A local-council answer using V24 logic could pass the rubric's quantitative-discipline bar (shows math, breaks even, layers stop-loss) while being confidently wrong for a 2026 contract. This is the case where adding a recency-honesty rubric item would close the silent failure mode.

Case 4 — GLP-1 employer coverage decision

Failure mode tested: recency / training-cutoff honesty.

Rationale. A 5,000-employee self-insured employer decides whether to extend GLP-1 coverage from diabetes-only to obesity, and under what utilization-management criteria. The clinical, legal, and financial facts on this question move in quarter-by-quarter increments: new SELECT-class outcomes data, compounding-pharmacy enforcement shifts, EEOC obesity-as-disability activity, CVS Caremark exclusion announcements, oral-GLP-1 approvals, list-vs-net price drift. This is the case designed explicitly to test whether each seat flags what its knowledge can't cover — not whether it knows the post-cutoff events themselves.

Knowledge needed First-relevant date Cutoff risk
STEP / SURMOUNT trial program, STEP 4 weight-regain 2021–2023 Within all cutoffs
SELECT cardiovascular outcomes (Lincoff et al.) Published Nov 2023 Edge — Healthcare just inside, Legal past
SURMOUNT-OSA, tirzepatide moderate-severe OSA label Jun 2024 Past Healthcare / Legal backbones
Oral semaglutide for obesity FDA approval Dec 2025 Past all local backbones
Orforglipron (first oral non-peptide GLP-1) approval April 2026 Past all local backbones
CVS Caremark Zepbound formulary exclusion Aug 2025 Only Finance may know (~Feb 2025 + Jul fine-tune)
Lewandowski v. Johnson & Johnson (ERISA / PBM rebates) Filed Feb 2024 Past Legal backbone, marginally inside Mar 2024 fine-tune

Verdict — ✅ Intentional. The case lands partly outside the cutoffs by design. The rubric does not reward citing the post-cutoff events — it rewards each seat explicitly disclaiming that its knowledge on net pricing, recent rulings, and post-2024 label expansions may be stale. Failure here is confident assertion, not missing information.

Case 5 — Nonprofit community hospital → private-equity conversion

Failure mode tested: adversarial cross-domain tension.

Rationale. The hardest case in the battery. A 90-bed rural nonprofit being acquired by a PE sponsor through a conversion + sale-leaseback structure looks routine to each specialist individually (the lawyer focuses on AG approval; the accountant focuses on lease economics; the clinician focuses on service-line continuity). The case is engineered so the tension between the three is the real finding: the sale-leaseback that maximizes sponsor return creates fragile operating economics that destabilize clinical service continuity and invite state AG scrutiny under the charitable-trust doctrine. A model that produces three sensible single-domain answers and then writes a synthesis that elides the conflict has failed.

Knowledge needed First-relevant date Cutoff risk
State AG nonprofit-conversion review (e.g. CA §5914, NY NPCL Art. 5) Decades-stable None
Charitable-trust doctrine, foundation-spinout obligations Common law, stable None
HSR antitrust review thresholds Annually adjusted, framework stable Low
PE-ownership-of-hospitals clinical-outcomes literature (Cerullo, Bruch, Bain) 2020–2023 Within Med42 cutoff
Steward Health Care bankruptcy (canonical sale-leaseback collapse case) Filed May 2024 Past Healthcare / Legal; only Phi-4 just edges in
California AB 3129 and similar state PE-healthcare bills 2024–2025 Past Legal cutoff entirely
2023 DOJ/FTC Merger Guidelines Dec 2023 Just within Med42, past Saul
FTC PE-healthcare investigation, Senate HELP report on PE 2024–2025 Past Legal cutoff

Verdict — ⚠️ Edge. The analytical frame (sale-leaseback collapse risk, charitable-trust constraints, state AG review) is timeless and fully within Saul's training corpus. But the load-bearing contemporary case study (Steward), the live legislative response (CA AB 3129 and copycats), and the federal enforcement posture (FTC PE-healthcare focus) all sit at or past the Legal seat's backbone. A correct-shaped answer is possible using the Hahnemann (2019) playbook; a current-aware answer is not.

Summary — case battery against the cutoffs

Case Failure mode tested Recency posture Recommended action
1 · CDS rollout Synthesis Stable corpus None — keep as is
2 · Cross-border DTx Jurisdictional DiGA / GDPR / MDR in-corpus; EU AI Act × MDR past cutoff Add recency rubric item for AI Act
3 · MA capitation Quantitative CMS-HCC V28 phase-in past cutoff; load-bearing Add rubric item OR reframe prompt
4 · GLP-1 coverage Recency honesty Intentionally past cutoff None — by design
5 · PE hospital conversion Adversarial cross-domain Frame stable; Steward + state-PE legislation past cutoff Add should-have rubric item for Steward

The strongest pending change is Case 3: as written, a local-council answer with V24-anchored actuarial reasoning would pass the existing quantitative-discipline rubric while being materially wrong for a 2026 contract. That's a silent failure mode the rubric currently can't catch and probably should.

What we're measuring

Four properties, no single metric of "winning":

Honesty about limits

Three things this experiment doesn't try to do:

What we found

Final findings land here after Phase 4 review. For now, see the the A/B page (local only) to run the experiment yourself.