PRISM is all about Process Efficiency through Process Discipline and Collaboration
 

A CASE STUDY: TRANSFORMATION WITH PRISM

BEFORE PRISM

Acme Health (MCO) uses tools/spreadsheets.

AFTER PRISM

Acme has implemented PRISM.

See How An MCO Transformed Itself
PRISM OVERVIEW
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FINANCIAL
MANAGEMENT
PROCESS-FLOW
ACTION-ORIENTED
DASHBOARDS
PROCESS-FLOW
SUPPLEMENTAL DATA
MANAGEMENT
PROCESS-FLOW
DENTAL FRAUD
MANAGEMENT
PROCESS-FLOW
Healthcare business is low-margin, compliance intensive, and data sensitive with increasing demands for population specific quality improvement. Pay-for-Performance model necessitates a more flexible business platform.

HEALTHCARE PAINS

Executives feel Medical Loss Ratio (MLR) and Admin Loss Ratio (ALR) are unmanageable
Leadership constantly finds itself working with inconsistent data; decision making could be better
Financial team is usually operating without scenario planning or any significant risks analysis
Operations team is too tied up with compliance issues
Teams are overworking to address unscheduled random data requests (ad-hoc)
Quality and Medical Management teams are struggling to demonstrate enhanced quality of care
Provider contracts are a mess …
 

… and SYMPTOMS

Excel sheets are the standard working tools
Lack of automation and high process inefficiencies
High IP, ER, Rx, and Mental Health PMPM Costs
Compliance takes up most of the time; audit is a nightmare
Chasing ad-hoc queries demands too many extra hours
Data is outdated and all over the place, duplication is rampant, inaccuracy persists
Impossible to deliver population specific quality care
Prescription costs are out of control
Business seems to lack any strategy …
CONSEQUENTLY: quality of care is low, margins thinner, and investment risk is very high

PRISM – THE SOLUTION PLATFORM

PRISM Solution Platform offers:

Risk-Based Capital (RBC) Management
Medical Loss Ratio (MLR) Management
Admin Loss Ratio (ALR) Management
Full PMPM Control – Revenue, MLR, and ALR
Intelligent Process Automation
Workflows for methodical operations
Single Source Truth and Action-Oriented Data
Full Compliance Enablement
Detailed Quality Management
AI/ML Aided Care Management
Active Wellness Management
Proactive Member Risk Profile
Specific Population Quality Management
Provider Management
Active Fraud Management
Scenario Planning for CFOs

PRISM DIFFERENTIATION

PRISM Solution is a flexible and extensible business platform. Any set of integrated modules can be developed over PRISM platform. It's not just a tool or just one system but an integrated set of systems which automate Healthcare business processes.

It is crafted specifically for Healthcare . Hence, it addresses improving both Operational Efficiency and Operating Margin for Healthcare business.

Other solutions are often tweaked to 'fit' Healthcare requirements and may result in minimal efficiency improvements and no increase in margins. For example, they may just address some aspects of compliance processes.

PRISM allows customization to your specific needs.
The core philosophy of PRISM is automating processes, connecting tasks with team members thus increasing accountability, and enabling more informed decision making.

TECHNOLOGY

PRISM is a platform, built for the business of Healthcare – and – the solution architecture has been designed and implemented keeping specific business domain requirements for integrated automation, high performance, full scalability, and security.

Architected for business
Web and Mobile Friendly
On Cloud
PHP
SQL Server
End-to-End Security
API Integration
Agile implementation
Utilizing machine learning and artificial intelligence

See Brochure

Healthcare business is low-margin, compliance intensive, and data sensitive with increasing demands for qualify improvement using detailed member profiles.

See Brochure

Prism Team

With over 100 years of combined healthcare experience, PRISM Team brings you a unique and unmatched solution to transform your Healthcare business like you have been thinking. We have been helping healthcare clients for more than a decade. Our team members have been at the forefront of taking clients' difficult compliance situations or operation levels and have successfully turned things around where the clients ended up becoming the poster child of compliance, audit, or operations in Healthcare area.

PRISM team is always in constant consultation with C-level executives and top government consulting leaders to understand the latest on Healthcare direction and to keep the product in line with the most demanding scenarios for businesses.

We also provide:

Healthcare specific operations support
Building reports in legacy systems using tools like SSRS, Tableau, and PowerBI etc.
Developing systems that meet client specific needs like managing special children's needs
24 X 7 support, weekends/holidays included
Agile Methodology implementation of PRISM
 

Manaw Modi

MD/CEO, Karma Strategies

Jay Weinberg

President, The JAY Group

Mike Bonamassa

CEO, PLADcloud

Contact Us

With over 100 years of combined healthcare experience, Karma brings you a unique and unmatched solution to transform your Healthcare business like you have been thinking.

Address

444 N Wells Chicago, IL 60654

Phone Number

440-385-6804

Email

info@healthplanprism.com

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