SOURCE: CareFacets


September 12, 2016 08:07 ET

CareFacets Launches PRiSM™ to Support Improved Utilization Management

Proprietary Risk Scoring Algorithms for the Payer and Provider Communities

ATLANTA, GA--(Marketwired - Sep 12, 2016) - CareFacets announced today the launch of PRiSM™, a new platform that provides seamless and secure access to a library of risk scoring algorithms that can be integrated into any existing utilization management workflow. PRiSM was developed to deliver disease-specific risk scores to evaluate and advise providers on the authorization of medical tests and procedures in real-time. PRiSM also provides caregivers with critical patient information needed to improve outcomes and make the authorization process more efficient.

"We believe we can add significant value to the profound utilization management challenges that the payer and provider communities are facing. Healthcare data analytics have the potential to bring clarity and transparency to the healthcare industry. Our propriety tools are customized to help healthcare payers, systems and providers improve health outcomes, drive costs down and increase revenue," said Madan Moudgal, Founder of CareFacets.

CareFacets' PRiSM platform is designed to house multiple algorithm-based micro-services. The platform features a readily available, auto-scaling cloud infrastructure, and easy-to-use cloud-native technology, built to host other algorithm-based and non-algorithm-based services, as well as third-party services. PRiSM currently houses risk algorithms for several procedures, including obstructive sleep apnea, a suite of algorithms in oncology and a suite of algorithms in cardiovascular health. CareFacets continues to develop risk algorithms for new conditions and also builds custom algorithms based on pre-authorization needs.

Although there is a shift in care toward greater cost efficiency and more informed decision-making to improve utilization, many cases today still result in costly and unnecessary procedures in a number of clinical areas. For example, recent data show that among women who received screening for breast cancer using MRI, only 25% had a >20% lifetime risk of developing breast cancer, while 53% had <15% lifetime risk1.

CareFacets' risk-based strategies for procedure approvals, such as MRI-guided biopsies for prostate cancer or breast cancer MRI screenings, address these common inefficiencies, optimizing medical utilization and minimizing unnecessary testing. Similarly, CareFacets' high-specificity proprietary algorithms in OSA (obstructive sleep apnea), built to assess which patients should be tested at home versus in lab, impacted 30% of patients in question and yielded a total savings of over $5 million per year, when implemented with a health plan.

About CareFacets
CareFacets is a private company founded in 2013 and based in Sandy Springs, GA. CareFacets uses proprietary data analytics to bring clarity and transparency to the healthcare industry, facilitating clinically-validated decision making and improved risk assessment for its partners. Healthcare payers, systems and providers partner with CareFacets to create more precise measurements of outcomes and better predictability of future events. For more information, go to

1. Karen J. Wernli, Wendy B. DeMartini, et al. Patterns of Breast Magnetic Resonance Imaging Use in Community Practice. JAMA Intern Med. 2014 January 1; 174(1): 125-132.

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