Who We Help
We work with organizations
that carry real financial risk.
Value-based care creates financial exposure tied to risk scores, quality ratings, and utilization outcomes. Our clients are the organizations responsible for that performance, and for explaining it to payers, regulators, and boards.
Provider Groups
Physician groups, IPAs & ACOs
Your value-based contract performance depends on metrics your billing and care teams don't always control together. We help you build the programs that close that gap, risk documentation, quality compliance, and appropriate utilization.
- Medicare Advantage & ACO REACH programs
- Shared savings & full-risk contracts
- Physician group quality improvement
- IPA risk adjustment program design
Health Plans
Managed care & Medicare Advantage plans
Plan performance at scale requires operational infrastructure that most internal teams don't have the bandwidth to build and maintain simultaneously. We augment your team with subject-matter expertise across risk, quality, and UM, without adding headcount.
- Medicare Advantage Star ratings
- Risk adjustment program management
- UM program design & compliance
- HEDIS gap closure at scale
Why Prizm
What sets a Prizm engagement apart.
Deep subject matter expertise
Our consultants come from health plans, provider groups, and regulatory bodies, not general management consulting. We know what the work actually requires.
Operational, not just strategic
We build programs, not decks. Every engagement ends with working infrastructure your team can operate, not a roadmap left on a shelf.
Integrated perspective
Risk, quality, and utilization interact. We manage all three from a unified practice, which means our recommendations don't create downstream problems.
Regulatory fluency
CMS, NCQA, URAC, state DOI, we stay current on the requirements so you don't have to. Our programs are built to hold up under scrutiny.