ClearPrism Graph and AI-Powered Insights for Healthcare

Healthcare Performance Optimization Analytics
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Deeper Insights 

Powered by ClearPrism’s Vertedge Health patent-pending graph and AI-powered Network Dynamics Insights Engine, accountable care organizations (ACOs), other value-based care (VBC) provider systems, and integrated delivery networks can finally visualize and remediate hidden sources of high-impact cost and revenue leakage across patient journeys.

Make Visible What is Now Invisible Across Disparate Datasets

High-cost subnetworks of physicians and other providers (“communities”)

Physician outliers on cost and quality

Patient journeys most likely to become complex and expensive


Nudge Network Participant Behavior through Next-Gen Visualizations

Make sense of your performance data in minutes rather than  weeks through our next-gen visualizations. 

And monitor cost and revenue leakage across the system using visual aids, such as quadrant mappings and dynamic dashboards linked to network-wide expenditures, revenue sources and risk-based contract performance


Gain Actionable Insights to Optimize Cost, Revenue & Quality

Predict how current population dynamics and behaviors may impact future cost and quality operating metrics vis à vis likely trajectories of communities interactions, physician behaviors and patient journeys

Introducing ClearPrism’s Vertedge Health

Graph and AI-Powered Performance Optimization Analytics for Healthcare Providers

Answer Four Key Questions that Matter

  • How can ACOs, DCEs and other VBC providers identify and evaluate hidden “communities” of high cost within their networks to achieve material savings?
  • How do you predict which patients in your population will have complex, high-cost care patterns for proactive management?
  • How do you identify primary and specialty care providers, whose pricing and behavior patterns present unwarranted cost exposure for your care network?
  • How can you better understand individual physician referral patterns over time (i.e., beyond the first referral) to mitigate the overall impact of out-of-network revenue leakage?

Step 1: Full Provider Network Mapped

5 Minutes Elapsed

Step 2: Patient Journeys Isolated

7 Minutes Elapsed

Step 3: Subnetwork Communities Formulated

8 Minutes Elapsed

Step 4: Unique Patient Journey Analyzed

10 Minutes Elapsed

We Deliver Actionable Insights

Unlike more traditional analytic approaches that are focused on risk segmentation and often struggle to model complex queries that require the harmonization of highly disparate and variable data across multiple actors, Vertedge Health Analytics easily aggregates patient, physician and other care provider data from multiple sources to efficiently generate actionable, patient journey-based insights and powerful visualizations in response to key performance challenges facing ACOs, DCEs and other value-based care systems. 

Unique features of our insight solutions include: 

  • Cost and revenue insights derived from highly flexible and powerful   graph-powered models and advanced statistical analytics

  • Advanced community detection algorithms that enable the identification of hidden sub-networks of high cost based on individual patient journeys
  • Centrality models that identify spheres of provider influence that impact cost and revenue leakage

Vertedge Health’s Performance Optimization  Analytics Answer Your Organization’s Most Challenging Performance Questions


Deep insights – powered by AI & advanced graph-based patient journey analytics – provide a new perspective into an organization’s key network relationships and the financial implications of their care delivery interactions…INSIGHTS THAT ENABLE CARE NETWORKS TO MEET THEIR REVENUE, COST AND QUALITY OBJECTIVES HEAD-ON.

Direct benefits include:

  • Improved visibility into costs of delivery and the impact of referrals on quality outcomes – achieved by mapping patient journeys through each care system’s integrated provider and physician network

  • Insights and correlations among physician productivity and referrals in and out-of-network, system-wide expenditures, revenue sources and concentrations, and risk-based contract vs. current performance metrics

  • Visual insight and mapping of care outcomes and provider networks with operating metrics from both “community” and “cluster” perspectives (augmenting traditional segment-based analytical studies) – including identification of outlier behaviors across patient journeys to dig into and/or address anomalies.



What are Graph Analytics & Healthcare Network Dynamics?

Vertedge Health’s Network Dynamics insight engine helps answer the most challenging questions on how to optimize care delivery costs, referral revenue retention and patient outcomes by delivering…

Physician & Referral Insights

  • Ability to single out instances of individual physician centrality (i.e., high degrees of physician influence on community behaviors) and associated cost leakage implications for proactive remediation
  • Insights that help answer the question as to how provider decision-making has impacted network behavior over time with respect to cost and quality

Actionable Patient Prediction

  • Prediction of future costs and quality based on current population dynamics and behaviors (e.g., concentrated high-impact provider interactions, etc.)
  • Cost and quality metrics identifying how communities are performing vs. established baselines for existing at-risk contracts
Graph Powered Insights

Patient Journey Insights

  • Ability to identify inefficient patient journeys with physicians and providers whose practices and behaviors warrant rehabilitation by VBC system leadership
  • Prediction of patients at risk for long, complex and expensive care journeys on current and past encounter information, health claims and health determinant demographics
  • Ability to project-specific subnetworks or communities or clusters that are developing negative performance indicators in order to improve risk-based contract planning

Hidden Community (Subnetwork) Insights

  • An innovative, graph-powered modeling approach identifies hidden “community” and “cluster” relationships across patients, physicians and providers
  • Community detection and clustering analytics reveal high-cost patient journey interactions over time with no marked improvement in patient outcomes
  • Ability to identify specific factors for community under-performance (e.g., more costly procedures, higher-risk patient populations, longer lengths of stay, high readmission rates, etc.)

"You've done more in five weeks than it typically takes one of the Big Four do to in six months."

– CEO of Major ACO

Healthcare AI Case Studies

Leading Health System-based ACO

How we orchestrate our ecosystem of partners and customers around our new 20% to leap-frog our competitors in terms of growth & profitability?

Global Pharmaceutical Company

How do we tackle anti-microbial resistance, given the criticality for an ecosystem-centric business model and new set of capabilities to do so?

Global Healthcare Company

How do we provide radically new care delivery and patient outcomes around diabetes in a way that drive both greater economic and societal value?


We love to solve impossible problems. 

Share Yours with Us.

Take the next step to strengthen your organizational resilience while capturing new sources of value. Contact ClearPrism today.


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Accelerating the value of your business through focus, execution excellence, comprehensive technology services and tools—powered by algorithms and machine learning.

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