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

Prognos Helps Uncover Risk and Improve Quality Scores

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

Prognos offers historical and ongoing clinical insights in near real-time (NRT) to optimize risk adjustment and better manage members. We utilize over 1000 algorithms to interpret and identify conditions from your existing and newly enrolled members.

Care Alerts

Identifying and tracking health conditions and disease in your member population

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

Improve HEDIS Scores Earlier in the Cycle

Prognos accelerates the improvement of HEDIS scores through generation of supplemental data qualifier feeds. We target and locate hard-to-find member lab test results and test dates to fulfill HCC reporting requirements 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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Webinar: A More Rounded Approach to Managing Risk: How a top payer uncovered member risk and improved ROI

July 30, 2019 1:30pm EST

Webinar: A More Rounded Approach to Managing Risk: How a top payer uncovered member risk and improved ROI

Register Today!

A data-driven risk adjustment approach is a no brainer. Payers can elevate their program to another level by utilizing clinical lab analytics with disease severity in addition to traditional data sets, like claims or Rx. . We’ll also discuss the potential of AI in improving risk adjustment programs. .By including a front-end AI prediction on the confidence factor that an HCC will exist in chart increases the effectiveness of the program. With the demand for value-based care, clinical lab results with its clinical specificity should be leveraged by both payers and clinicians for optimal risk adjustment. Hear from Dean Ratzlaff, Managing Actuary, Optima Health and Frank Jackson, EVP, Payer Solutions, Prognos Health on how utilizing clinical lab results can help find 15% more HCC’s than claim-based methods and how effectively identifying risk requires disease severity which is reflected in clinical data.

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