Healthcare Performance Consulting
Turning Challenges
into Breakthroughs.
In today's rapidly evolving healthcare landscape, transitioning to value-based care is no longer optional, it's essential. At Prizm Advisory Consultants, we specialize in helping healthcare organizations like yours navigate this shift with confidence, ensuring improved patient outcomes, reduced costs, and sustainable growth.
What We Do
Three service lines.
One integrated practice.
Every engagement draws on deep subject-matter expertise across risk, quality, and utilization, because performance on each dimension affects the others.
Risk Adjustment
HCC analytics, prospective programs, and retrospective review that close the gap between clinical complexity and documented risk, built to hold up under RADV scrutiny.
Learn moreQuality / HEDIS
Measure-level gap closure strategies, hybrid record retrieval, and Star rating programs that deliver points, not just dashboards.
Learn moreUtilization Management
UM program design, InterQual/MCG criteria application, and appeals support that balance clinical appropriateness with cost performance.
Learn moreWho We Help
Built for organizations
navigating value-based risk.
Our clients carry real financial exposure tied to risk scores, quality ratings, and utilization outcomes. We work with them, not around them, to build programs that are operationally durable, not just technically compliant.
Performance gaps have a cause. And a fix.
Let's look at where your program stands and what's driving the gap.
Insights
Perspectives from the practice
Understanding HCC Risk Scores: What Every Provider Group Needs to Know
Hierarchical Condition Category (HCC) risk adjustment is the financial foundation of value-based care. Here's how it works, where programs fail, and what high-performing groups do differently.
Quality & HEDISThe HEDIS Gap Closure Playbook: Moving from Measurement to Performance
Most organizations measure HEDIS well. Fewer close gaps at the rate that moves Star ratings. The difference is operational, not clinical.