About Prizm
We built the firm we wished existed
when we were on the plan side.
Prizm Advisory Consultants was founded on a straightforward premise: the organizations doing the hardest work in value-based care, closing risk gaps, moving quality metrics, managing utilization at scale, deserve consultants who have actually done that work.
Our Mission
Transform healthcare data into actionable performance improvement.
Healthcare organizations generate enormous amounts of data, claims, clinical, pharmacy, lab. Most of that data is used reactively, to report on performance after the fact. We help organizations use it prospectively, to change performance before it's too late to act.
That requires deep domain expertise, not generalist consulting frameworks applied to healthcare. Our practice is narrow by design. Risk adjustment, quality, and utilization are interconnected enough that true expertise in all three produces better outcomes than treating them as separate disciplines.
Expertise over volume
We take fewer engagements than we could. Each one gets the full attention of senior practitioners, not a team of associates with a partner on call.
Operational over advisory
We build programs. The measure of an engagement is not the quality of our analysis. It is whether your organization performs differently after we leave.
Direct over diplomatic
We tell you what we see. If your documentation program has a structural flaw, we say so, and explain how to fix it.
Durability over quick wins
RAF improvements that don't hold up under RADV. Star gains that erode next measurement year. We build for durability, not the next reconciliation cycle.
Our Expertise
Built on experience that spans the full value-based care ecosystem.
Risk Adjustment
HCC prospective & retrospective programs, RADV audit defense, RAF benchmarking, coding accuracy, clinician education
Quality / HEDIS
HEDIS gap closure, hybrid record retrieval, Star rating strategy, provider engagement, supplemental data pipelines
Utilization Management
UM program design, InterQual / MCG criteria, prior authorization workflow, P2P & appeals, CMS / NCQA compliance
Regulatory Affairs
MA bid strategy, CMS audit response, state DOI requirements, NCQA accreditation preparation
Let's talk about what you're trying to build.
We work best when we understand the full picture, not just the immediate problem.