3 of the Top 5 health plans trust Prognos for their risk management needs.

Prognos Delivers Higher Value, Actionable Information

At Prognos, we work closely with health plans to deliver the most rounded member information available on the market – when you need it most – early in the process. That’s because our AI-based solutions leverage member lab test results on a weekly basis. The information on members goes back as far as two years, even before they became a member of your plan, and allows you to recoup losses in RAF reimbursement on existing members.

Prognos is not just another healthcare analytics or AI company. Our technology ingests, harmonizes and standardizes lab data from industry leading testing companies including Quest Diagnostics, LabCorp, and BioReference, into the largest and continuously updated repository of clinical diagnostic information – 200 million unique patients strong and growing. No other company has done this at the scale that Prognos has. In addition, our patient data is agnostic; meaning it’s easily enriched with other member data including prescription and medical claims. You receive the latest actionable information in the form of weekly alerts, and most importantly, in a way that makes it easy and clear on which members pose the most risk and opportunity for cost savings.

Risk Alerts

Finding health risk in your member populations Payers are challenged to identify health conditions in their members especially newly enrolled lives. Claims are an incomplete source of clinical conditions and payers need new timely clinical data sources. Prognos offers historic and ongoing near real-time clinical insights to optimize risk adjustment and better manage members. Prognos utilizes over 1000 algorithms to interpret and identify conditions including newly enrolled members.

Care Alerts

Identifying and tracking health conditions and disease in your member population

Payers are responsible for measuring and improving clinical quality of it’s members. Managing clinical quality requires timely and  clinically specific insights to inform member and provider outreach. Most payers rely on claims but it lacks timeliness and clinical insights. Prognos Care Alerts offers a historic and ongoing disease profile along with disease trajectory to clinically inform quality programs. Early detection of disease can improve HEDIS and Star scores significantly while facilitating better care and reducing medical costs.

Care Gaps

Finding health risk in your member populations

Payers strive to improve quality outcomes and member health. Payers require key documentation to close high value HEDIS / STARS gaps, however this documentation is often missing or inaccessible and not available in time to meet HEDIS reporting cutoff timelines.

The Prognos Care Gaps product is specifically designed accelerate the improvement of a Payer’s HEDIS scores through streamlined generation of supplemental data qualifier feeds. The product targets & locates hard to find member Lab Test Results and Test Dates to fulfill HEDIS Care Gap reporting requirements well in advance of HEDIS deadlines.

Prognos has achieved HITRUST CSF® Certification for its payer product portfolio.

Upcoming Conferences


RISE Risk Adjustment Forum

June 9-11

Attending The Risk Adjustment Forum on June 9-11 in Chicago? Contact Asher Gendelman for a quick meet up! Email him: agendelman@prognos.ai 

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