Prospect360 is a payer-provider collaboration platform that delivers real-time Complete Person Risk Scores and actionable insights for Medicare Advantage members. It enables coordinated care management, care gap closure, and improved risk performance through continuous risk score refreshing with every new claim.

How does Prospect360 improve care gap closure?

Prospect360 continuously refreshes member risk profiles throughout the year, identifying care gaps and documentation opportunities in real-time. By providing prioritized, provider-specific care gap lists, it allows healthcare teams to take timely, targeted action on high-impact conditions that affect quality scores and member outcomes.

What is a Complete Person Risk Score?

A Complete Person Risk Score is a continuously updated risk assessment for each Medicare Advantage member that combines RAF score calculations with care gap identification. It refreshes with every new claim to provide real-time insights on member risk status, documentation opportunities, and intervention priorities.

How does Prospect360 facilitate payer-provider collaboration?

Prospect360 bridges communication gaps between payers and providers by sharing continuously refreshed risk scores, care gap data, and documentation insights. It delivers stratified provider insights at the clinic and specialty level, enabling targeted collaboration and personalized intervention strategies for each provider's patient mix.

Member Risk Insights & Payer-Provider Collaboration

Payer-Focused Solution

Payer-Provider Collaboration Platform for High-Quality, Cost-Effective Care

Precise Health Risk Compass™ Prospect360 unites payers and providers to deliver exceptional care for Medicare Advantage and at-risk populations. The platform continuously calculates a Complete Person Risk Score for each member, refreshing with every new claim to surface care gaps, documentation opportunities, and actionable member risk insights in real time.

With deep visibility into member risk profiles, teams can navigate complex value-based care partnerships with confidence—taking timely, informed action while reducing administrative burdens and maximizing care quality. Explore our payer analytics solutions for comprehensive risk management.

Real-Time Risk Calculation

Complete Person Risk Scores updated with every claim for immediate actionability

Prioritized Care Gaps

Focus on high-impact conditions and documentation opportunities that matter most

Seamless Collaboration

Bridge communication gaps between payers and providers for better member outcomes

Key Capabilities

Transform Member Data into Performance-Driven Collaboration

From generating continuously refreshed Complete Person Risk Scores to identifying critical documentation gaps, this platform transforms member data into actionable member risk insights.

Generate Real-Time Complete Person Risk Scores

Continuously refresh member-level risk assessments with live claim updates for immediate actionability.

Identify High-Impact Care Gaps & Documentation

Target chronic conditions and documentation discrepancies that influence quality outcomes the most.

Deliver Stratified Provider Insights

Focus collaboration efforts on provider, clinic, and specialty-level performance patterns.

Seamlessly Integrate into Workflows

Minimize administrative burden while maximizing care coordination effectiveness.

Optimize Payer-Provider Alignment

Bridge communication gaps between plans and providers for better member outcomes.

Prioritize High-Value Interventions

Identify members requiring immediate attention based on risk dynamics and care gaps.

Platform Features

Comprehensive Insights from Real-Time Data

Surface actionable member risk insights from real-time claims data and member analytics with prospective risk analytics.

Real-Time Risk Scores

Continuously updated member risk profiles with live claim data.

Care Gap Analysis

Monthly reviews to prioritize unaddressed clinical needs.

Provider Performance

Documentation and care patterns across clinicians and specialties.

Chronic Condition Management

Risk-based recommendations for high-impact condition coordination.

Documentation Intelligence

Identify critical documentation opportunities and discrepancies.

Quality Measure Alignment

Connect care interventions with Star Ratings performance.

Advanced Analytics

Medicare Risk Stratification & Population Insights

Deliver targeted interventions with precision prospective risk analytics and risk stratification.

Medicare Risk Stratification

Map members across risk tiers for targeted outreach programs.

Member Risk Trend Tracking

Monitor fluctuations in member risk scores over time.

Population Health Analytics

Aggregate risk distribution insights across your entire population.

Strategic Collaboration

Payer-Provider Collaboration for Maximum Impact

Standard care coordination no longer works. Member management must be strategic and data-driven. Prospect360 supports this transformation with payer provider collaboration.

Provider-Specific Care Gap Prioritization

Align intervention strategies with each provider's patient mix
Focus on known high-risk conditions
Personalized recommendations for maximum effectiveness

High-Impact Condition Focus

Direct attention to conditions affecting quality scores
Improve member outcomes and financial performance
Evidence-based condition prioritization

Targeted Member Outreach

Avoid provider overload with smart filtering
Eliminate non-essential interventions
Reduce burden while improving impact

Proven Results

Measurable Impact in Months, Not Years

With focused implementation, Prospect360 users experience transformative results quickly.

85%

Improvement in Care Gap Closure

Realize meaningful gains in just 3 to 4 months through targeted member interventions

40%

Reduction in Administrative Burden

Less manual tracking, more automated insights, freeing teams to focus on care

5★

Stronger Quality Performance

Maintain care coordination that enhances Star Ratings and quality measures

100%

Enhanced Provider Satisfaction

Equip providers with precision-level recommendations based on real-time insights

Get Started with Prospect360 Today

Schedule a personalized demo to see how Precise Health Risk Compass™ Prospect360 fits into your organization's prospective risk adjustment strategy.

Schedule Your Prospect360 Demo

Real-Time Risk Insights for Payer–Provider Collaboration