We make healthcare’s knowledge compute.And show its work.
The operating layer to drive business performance through clinical value across programs, contracts, and parties.
The trustworthy foundation for AI and automation, with people in control and every decision explainable, reproducible, and auditable.
“We don’t even know if we’re going to make or lose money until it’s all over.”
The strain
Healthcare is changing how it gets paid and how it organizes care, both at once. The systems underneath were built for neither.
Purchasers (e.g., state Medicaid, employers) · orchestrator hubs (e.g., health plans, ACOs) · service providers (e.g., health systems, practices) · enablers (e.g., care partners, apps)
Change the economics.
Carry a mixed book of fee-for-service, at-risk, and value-based contracts, each with its own rules: measure variations, attribution, risk methodology, policies, and incentives.
Organize care around populations and conditions.
So the system behaves like a system: care coordinated across settings and organizations, shared care plans, and shared risk.
Many-to-many complexity.
Most run on technology built for one domain and one enterprise: point-to-point integrations, bespoke rebuilds, vendor dependence, and siloed finance and clinical teams.
Clinical value and business value have almost never been aligned or computable in the same system.
We make them computable, shareable under your governance, and provable.
What we are
A health knowledge, reasoning, and orchestration platform.
To change the economics
Unify
Clinical, business, and process knowledge in one governed reasoning layer, so every insight carries the context of the person, the program, and the contract.
How it’s different
A knowledge-driven system, so reasoning is personalized and one source serves every use.
To organize care around populations
Orchestrate
Payers, providers, and affiliates working from the same trusted, near real-time insights and the same evidence, at the same time.
How it’s different
Multi-entity by design, with every party keeping control.
To reduce many-to-many complexity
Empower
Control over your own performance and risk, confidence in negotiations and audits, and independence from fragmented vendors, systems, and teams.
How it’s different
Governance, evidence, and reproducibility are structural.
“We are asked to take risk we cannot calculate or control.”
What it delivers
Timely, shared, trusted insights that raise quality and performance across complex networks of parties.
Optimize performance for each population, under each program’s incentives.
See where you and every party stand under each program, at once and in near real time. Put the same insights into every affiliate’s systems and workflows, all year. Stop finding out at settlement.
Reduce the cost and complexity of doing it.
Far less custom build for each new contract. Less staff time chasing, abstracting, and reconciling data, and less paid to vendors for reports, integrations, and services, with room to retire some and bring the work in house. Every deployment lowers the cost of the next.
Everything it takes to perform, driven by shared, governed knowledge.
Designed to work with your existing systems. Start with what matters most, and each additional solution reuses what’s already there.
Program design and governance
Model populations, contracts, and incentives as computable rules, and publish shared scorecards and registries from one governed set.
Performance management
Forecast, steer, and reconcile as you go, with leading indicators tied to each contract’s terms that each party can see during the year. Simulate a contract against your population before you sign.
Care value management
Contract-aware decision support, prior authorization, and care coordination, with the clinical assessment kept separate from each contract’s terms. Policy is fully specified at the point of care, and automatic evidence packs help cut manual review, rework, and appeals.
Network and ecosystem engagement
Bring affiliates, partners, and apps onto shared registries and insights, without rebuilding for each one.
Data quality, compliance, and evidence
Knowledge declares the data it needs, and every decision ships with its evidence and full lineage, from data to decision.
Our approach
Knowledge-driven all the way down.
When each measure, rule, or analysis is written for one use, it works like printed directions: brittle, costly to maintain, and rarely consistent with each other. A knowledge-driven system works like GPS, with every route derived from one complete map and rerouted when the roads or traffic changes. Derived from the same computable expression, every use stays connected and consistent, from plan and provider measures to authorization criteria. You can always get directions from a map, but you can’t reconstruct the map from directions.
Measures, rules, and analytics change all the time, all over the place.Govern the knowledge behind them.
Where AI fits
Provable and probable: two complementary technologies, better together.
What we build
Governed, deterministic knowledge
Provable.
The AI you choose
Generative AI
Probable.
Consistency
Deterministic. The same data and rules give the same answer every time, personalized to each person’s case and context.
Predicts the likeliest next words, which makes it fluent with open questions, but the same question can get different answers.
Explainability
Shows its work: the answer, the logic path, and the evidence used and missing.
Explains in plain language and can cite its sources, though how it reached the answer is largely a black box.
Auditability
Replay any decision exactly as it was made, against the knowledge and data as they stood.
Brings broad knowledge and the context of the moment to each answer, which makes a past answer hard to recreate.
When it’s wrong
Every rule has an owner and a version, so the cause can be traced and one governed fix reaches everywhere the rule runs.
Can hallucinate, sound overly certain, or tell you what you want to hear, so it works best with a person in the loop.
Best for
Payment, contract performance, and care decisions, where the stakes are high and the tolerance for error is low.
Suggesting, summarizing, and drafting; surfacing patterns and hypotheses across more information than any team can.
What we build
The AI you choose
Governed, deterministic knowledge
Generative AI
Provable.
Probable.
- Consistency
- Governed, deterministic knowledge: Deterministic. The same data and rules give the same answer every time, personalized to each person’s case and context.
- Generative AI: Predicts the likeliest next words, which makes it fluent with open questions, but the same question can get different answers.
- Explainability
- Governed, deterministic knowledge: Shows its work: the answer, the logic path, and the evidence used and missing.
- Generative AI: Explains in plain language and can cite its sources, though how it reached the answer is largely a black box.
- Auditability
- Governed, deterministic knowledge: Replay any decision exactly as it was made, against the knowledge and data as they stood.
- Generative AI: Brings broad knowledge and the context of the moment to each answer, which makes a past answer hard to recreate.
- When it’s wrong
- Governed, deterministic knowledge: Every rule has an owner and a version, so the cause can be traced and one governed fix reaches everywhere the rule runs.
- Generative AI: Can hallucinate, sound overly certain, or tell you what you want to hear, so it works best with a person in the loop.
- Best for
- Governed, deterministic knowledge: Payment, contract performance, and care decisions, where the stakes are high and the tolerance for error is low.
- Generative AI: Suggesting, summarizing, and drafting; surfacing patterns and hypotheses across more information than any team can.
We use AI to build faster: AI drafts, and experts review and test what it drafts before release.
Grounded in governed knowledge, generative AI has less room to guess, and its answers are easier to check and trust.
AI proposes and explains. Governed knowledge adjudicates. People decide.
Why now
Outcome-based programs were missing a layer. It is now buildable.
The push for value tied to outcomes is only getting stronger.
Today’s quality and value programs matter, but the real goal, paying for outcomes, has stayed out of reach, largely because clinical risk and outcomes couldn’t be computed as contract terms at scale. Now they can.
The standards are real.
FHIR, TEFCA, and digital quality measurement are being implemented in earnest, and regulators now require standards. Agentic pipelines are collapsing the cost of both complying and innovating.
The AI is here.
Its value and its risk both depend on what it stands on. Governed, deterministic knowledge underneath makes any AI you choose more useful and easier to govern.
Founders
Brad Ryan, MD
Co-founder
More than twenty years helping payers and providers align business value to clinical value, and building large-scale platforms to make it work.
Matthew M. Burton, MD
Co-founder
More than twenty years taking healthcare knowledge-driven systems from academia into real-world use at institutions including Mayo Clinic.
Who this is for
If you fund or run a program.
Employers, states, and federal programs that set the priorities and pay for the outcomes. Health plans, health systems, ACOs, and risk-bearing groups that administer the rules and answer for results.
We also partner with
If you deliver care under one.
Health systems, practices, specialty groups, home and virtual care, and everyone else operating and paid on healthcare contract rules.
If you set the standards.
Quality programs and measure developers who own the measures and the policies. We make the knowledge behind them computable and usable by everyone you choose, under your governance.
If you build AI or applications.
Copilots, agents, and point solutions need governed knowledge underneath them so results are grounded, explainable, auditable, and reproducible.
If you publish knowledge or run a registry.
Medical societies, guideline developers, and registry stewards. Publish on your terms, keep control after delivery, and share in what your work earns. Collect registry data on the same governed definitions the care runs on, with less manual abstraction, and feed what you learn straight back into the guidance.
Contact
Request a briefing
We’re early, and working with a small group of co-development partners. Tell us what you’re working on, and we’ll be in touch.
Prefer email? Write to info@coefficienthealth.com.