Chief Financial Officers

Quality gaps are a direct EBITDA risk — and most CFOs see them too late

Healthmonix Prism™ gives chief financial officers real-time visibility into the quality and utilization drivers that directly affect margin — before CMS reconciliation, not after.

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We understand your challenges — and we address them

As a chief financial officer, you’re responsible for protecting margin in an increasingly complex reimbursement environment. Value-based care programs tie a meaningful portion of your revenue to quality and cost performance. But finance leaders often lack timely visibility into the data driving those outcomes.

Margin exposure from quality gaps. Missed performance targets in the Medicare Shared Savings Program (MSSP), Transforming Episode Accountability Model (TEAM), Ambulatory Specialty Model (ASM), commercial payer quality programs, and MIPS equals lost revenue, often discovered too late to act.

Shared savings leakage. Going without prospective performance management risks leaving a significant share of achievable savings unrealized.

Fragmented data. Finance and quality teams rely on different tools, making it difficult to model financial impact ahead of time.

Downside risk uncertainty. Entering risk-bearing contracts requires clear insight into financial exposure. Many organizations lack that insight.

Tool sprawl. Managing quality across multiple systems drives unnecessary vendor cost and operational inefficiency.

How Healthmonix Prism™ helps

Healthmonix Prism™ is a unified ecosystem that centralizes your data, streamlines your workflows, and adapts in real time to evolving CMS, payer, and interoperability standards.

Unify cost and quality data. Prism connects clinical, claims, and operational data across MSSP, TEAM, ASM, commercial payer programs, and MIPS into a single source of truth.

Normalize performance across settings and programs. Prism aligns measures and benchmarks so finance teams can model revenue impact.

Protect revenue prospectively. Prism surfaces actionable care gaps and utilization risks during the performance year, when intervention still matters.

Quantify downside risk. Prism is positioned to model financial exposure before organizations enter new risk tracks.

Consolidate vendor costs. Prism replaces fragmented quality tools with one platform.

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Healthmonix by the numbers

$3–7M

Annual margin impact of a 1% CMS performance swing for a mid-sized health system

40%

The spread in ACO net savings rates due to reactive performance management

$300M+

Shared savings and MIPS incentives secured for Healthmonix clients in 2024

Answers for Chief Financial Officers

How does quality performance affect a health system’s bottom line?

CMS ties reimbursement bonuses and penalties to quality and cost performance across its value-based care programs including MSSP and MIPS. Prism makes that financial exposure visible and manageable before reconciliation.

How does Prism help CFOs prepare for downside risk?

Prism models financial exposure across CMS and commercial risk-bearing programs, helping CFOs evaluate risk, set targets, and identify the highest-impact levers.

Can Prism reduce the cost of managing quality programs?

Yes. Prism consolidates reporting across MSSP, TEAM, ASM, commercial payer programs, and MIPS. This reduces vendor cost, staff time, and reconciliation effort.

We already have an EHR-based quality module. How is this different?

Prism can aggregate and normalize data not only across multiple EHRs from different vendors, but also can incorporate supplemental data from external systems such as billing systems, health information exchanges, QHINs, and others. EHR quality modules also typically report a limited set of measures that may not be clinically relevant to your physician specialties.

From quality performance to margin protection

See how Prism gives CFOs real-time insight into the quality and utilization drivers that affect financial performance.

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