For those managing highly regulated risk-bearing care

We’re not here to join your vendor list.
We’re here to shorten it.

Alberto is a domain-native analytics platform for health plans and the organizations that carry risk alongside them. It multiplies your analytical capability and your speed of change, at a fraction of what transformation used to cost — by mapping your data sources onto one proprietary taxonomy and running every domain from it: network sufficiency and provider network analysis, risk adjustment and chart review, encounter integrity, care management, payment integrity and fraud, waste and abuse, HEDIS measures.

Large plans use it to move faster than their organizations allow. Smaller plans use it to pay less, wait less and risk less. MSOs use it to see every payer and every practice at once.

We count in contracts retired and intelligence delivered.

Not logins, not dashboards. The measure of whether this is working is the number of line items that come off your renewal calendar and do not return, improvements to your bottom line, and frictionless compliance.

In productionFlorida MA and Dual Eligible plans, live data, daily

One taxonomyYour sources mapped once; every domain reads from it

Auditable by constructionEvery figure cites its published rule

Truthful by designThe model never produces a number; no training on your data

The stack

A 20,000-member plan carries the same ten vendors as a 200,000-member plan.

Network sufficiency and directory compliance. Risk-adjustment suspect generation and chart review. Encounter submission monitoring. Quality measure calculation. Utilization and prior-authorization analytics. Payment integrity. Audit defense. Population health. Risk-share settlement. Somewhere in there, a call center answering questions about your own claims.

Each one is a contract, an annual renewal, an extract pipeline somebody babysits, and a workflow your team conforms to. Each holds a fragment of the answer. None of them talk to each other, because none of them share a model of your organization — each one has its own definition of a member, a provider, a claim, an encounter. Every one of them is reading data you already own.

The burden doesn’t scale with your membership. It scales with the number of regulated domains you operate in — and that number is the same for everybody.

Ten contracts. Ten extracts. Ten private models of your organization, all reading the same data.

How we think

One taxonomy. Every domain reads from it.

The taxonomy

Every vendor in the stack builds its own private model of your organization and reads your data into it. Ten vendors, ten models, ten definitions of “active member,” and a question that crosses two of them becomes a project.

Guardiant has one. A proprietary taxonomy of how a risk-bearing organization’s data fits together — members, providers, claims, encounters, authorizations, care, the federal return files, and the rules that govern all of it. Your sources map onto it once. Every domain reads from it. A question that crosses domains is just a question.

And when a rule changes — a payment model, a directory requirement, a prior-authorization mandate — it is absorbed once, against the taxonomy, and every organization on the platform inherits it. That is why we move in weeks. The taxonomy is the tailwind.

Compute and attestation

Every regulated analytic splits into two jobs. The first is labor: sampling, scoring, calculating, matching, reconciling. It’s most of the invoice, it recurs forever, and it’s bound entirely to data you already hold. The rules are published; vendors hold implementations, not privileged interpretations.

The second is the sign-off: the certified quality audit, the chart abstraction, the actuary’s certification, the clinical indemnity behind a medical-necessity decision. That carries real liability and a name a regulator recognizes. It’s worth paying for.

Alberto takes the first job. We’ll tell you to keep the second, no larger than it needs to be. That boundary isn’t a hedge; it’s why the consolidation holds up in an audit instead of collapsing in one.

Where you fit

One platform. Three very different reasons to be on it.

Move

Faster than your organization allows.

You are not short of data, expertise or budget. You are short of the ability to change. Every initiative routes through a vendor’s release cycle, an IT roadmap with no open slot, and three internal owners with a good reason to wait until next year. That isn’t a people problem. Institutions are built to resist change, and most of the time that’s a feature.

But sometimes leadership needs a lever that doesn’t run through the committee. We are that lever: sponsored by you, reporting to you, delivering a working result in weeks — at a fraction of what the stack it replaces costs.

We’re not here to join your vendor list. We’re here to shorten it.

For large health plans

Roll it up

Every payer. Every practice. One view.

You carry delegated risk across a panel of practices and a portfolio of payer contracts, and every number that decides whether you made money arrives in somebody else’s format, from somebody else’s system, on somebody else’s schedule. Three payers, three portals, three settlement methodologies, and no way to roll any of it up.

Alberto maps your whole portfolio onto one taxonomy: performance by practice and by payer, submission trails you can prove, settlements you can check before you sign them, and the panel view your practices keep asking you for — in your brand, if you want it. It is, after all, the capability you sell them.

Analytics is a key MSO advantage. Let Alberto be part of the reason practices join you.

For MSOs & risk-bearing networks

Consolidate

You pay the most per member. And wait the longest.

You carry the same regulated burden as a plan ten times your size — the same submissions, the same audits, the same specifications — and vendor contracts don’t scale down to meet you. So per member, you pay more for analytics than anyone in the market. Every piece of it is rented, so every piece runs on somebody else’s clock: a rule change means a release, a question means a ticket, a new county means a statement of work.

And building it yourself isn’t the way out. Getting this right takes several attempts, and a plan your size gets one.

One platform, integrated with your systems and operated reliably by us, at a fraction of the stack. And a question answered the day you ask it.

You don’t need an AI team. You need the framework, run for you, at a price that scales down.

For smaller health plans

The platform

Every regulated domain. One taxonomy. One place to ask.

Each domain below is a line item in a typical analytics budget. Each is live in the platform today. They share one taxonomy, one set of definitions and one place to ask a question — which is the part no stack of specialists can copy, and the reason the benefits compound.

Network Sufficiency & Directory

The compliance verdict, computed the way the regulator computes it.

Time-and-distance analysis on real road routing against the federal beneficiary geography, submission-ready network tables, member-level access evidence, and a ranked list of who to recruit to close each gap.

Consolidates: network adequacy platforms · submission tooling · gap-sourcing research

Provider Network Analysis

Who’s actually in your network, what they’re doing, and what it costs you.

Provider scorecards on documentation quality and panel outcomes, roster reconciliation against what’s contracted and what’s credentialed, directory accuracy, termination impact on member access, and where a contract would close a gap — the network as a managed asset, not a list.

Consolidates: roster and directory vendors · provider-performance reporting · the annual network consulting exercise

Risk Adjustment & Chart Review

You’re on the hook for every condition in your population. Make sure CMS knows — and is funding them.

Suspect and recapture worklists that name the member, the condition, the evidence and the deadline — and a chart-review workstation where a coder’s judgment becomes an auditable instruction, with the controls enforced by the system.

Consolidates: outsourced suspect generation · chart-chase targeting · chart-review vendors · coding-quality reporting

Encounter Integrity

Find out what CMS did with your submission before the money is gone.

The full lifecycle of every encounter — internal rejection through federal acceptance through risk-adjustment filtering — reconciled back to the originating claim and forward to what you were actually paid for. Leverage and transparency over claims processing.

Consolidates: encounter monitoring tools · submission-quality reporting · delegated-group reconciliation

Care Management & Population Health

The member your five systems each know a fifth of.

Cost and utilization concentration, readmission and admission risk, frequent utilizers, homebound identification, care-plan alignment — one member view across claims, clinical, pharmacy, authorization and network data.

Consolidates: population-health platforms · care-management analytics modules · risk-stratification tooling

Payment Integrity & FWA

What was billed, what was authorized, what was actually delivered — and what the DRG was paid on.

DRG validation — whether the paid tier rests on a complication that was actually present on admission — prior-authorization metrics and turnaround on the federal clock, authorization-to-claim reconciliation, unplanned readmissions, and transport and ancillary anomaly review with the data-quality control run first.

Consolidates: utilization-management analytics · DRG and payment-integrity review · the mandated public metrics pack · the contingency-priced anomaly vendor

HEDIS Measures & Stars

The visit that closes a care gap is the visit that documents a condition.

Measure calculation on the same taxonomy and the same visit data as risk adjustment, so a gap and a suspect condition are chased once, not twice — and a Stars projection tight enough to act on. Keep your certified auditor; retire the calculation engine.

Consolidates: the measure-engine contract · the separate gap-closure vendor

Ask it anything

The analyst who has read every table.

A question in plain language — in English or Spanish — becomes real analysis: queries against your warehouse, a working spreadsheet, a map, a chart, a written answer with its own denominators stated. Eliminate or reduce the investment in Tableau, Snowflake, Databricks and the rest.

Consolidates: the ad-hoc analyst backlog · the report request queue · the BI and data-platform spend · the “can someone pull this” tax

Alberto Voice In pilot

And it answers the phone.

The same data, spoken — claim status, payments, authorizations, eligibility, denials explained in plain language, in English or Spanish. The full story is one page away.

Consolidates: outsourced provider-services call handling · the IVR platform contract

Why one taxonomy

One member. Four questions. Four vendors who can’t answer together.

Is this member’s care plan treating the conditions we’re being paid for?
Were their open quality gaps closed at the same visits?
Did the diagnosis we submitted ever actually reach CMS?
And is their physician an outlier on documentation?

Across a vendor stack

Four extracts. Four definitions of “active member.” Four refresh cadences. Four tickets, four analysts, and three weeks — by which time the answer has moved.

On one taxonomy

One question.

Organizations buy population-health platforms specifically to solve “the data lives in five places.” Alberto solves it by not having the problem: every domain reads from one taxonomy, so a question that crosses them costs nothing extra. That is what compounding capability looks like.

Why trust us

Not a startup guessing at your business. Not a vendor you end up working for.

Where we come from

Guardiant’s team comes out of some of the largest and most innovative EMR and TPA technology and services firms in Medicare Advantage — the systems your claims, encounters, authorizations and clinical records already flow through. We know the plumbing because we built it, ran it and delivered on it for years.

We are self-funded and financially self-sufficient: no investor timetable, no exit to engineer, and nothing about how we work with a customer that depends on a funding round.

We are here to force the future on this industry — and to rekindle in our customers the instincts that once led it.

Why the numbers hold up

Traceable to the published rule

Every regulated calculation cites the specification it implements — the regulation section, the technical-notes year, the reference-file edition. The citation travels with the output, so a reader always knows which version of the rule produced the number.
Evidence, not just percentages

Anything a regulator could ask about is reproducible from your own inputs, at the row level: which member, which provider, which distance, which claim, which date. A compliance percentage with no evidence behind it is an opinion.
It tests itself

Integrity checks run after every data cycle and print their results inside the deliverable — populations, definitions, mappings, plumbing. A scorecard that has not proved its own inputs isn’t a scorecard. Failures surface in the artifact, not in a support ticket.
Definitions are versioned

Value sets, thresholds, weights and code crosswalks change every year. Each module records the edition it was calculated against and reports drift when a new one lands, so last year’s answer stays legible next year.

On the AI, precisely

Alberto runs on a frontier language model chosen for truthfulness and quality, under an enterprise agreement with a business associate agreement in place. The model reads the question and writes the explanation. It does not produce the numbers — those come from queries executed against your database and returned deterministically. The same question on the same data returns the same answer. Where a figure is an estimate, the platform says so and says what it rests on.

The boundary

Five things Alberto is not.

Consolidation has a limit, and pretending otherwise is how these projects fail in year two. These are the categories we will tell you to keep, every time.

Your systems of record. Care-management workflow, claims adjudication, enrollment, appeals and grievances. Transactional users, real-time write access, operational audit trails. Alberto makes them better targeted and better measured. It does not replace them.
Medical-necessity criteria. A utilization-management criteria vendor sells the criteria and the indemnity behind applying them. Alberto supports utilization review with analytics. It does not decide what is medically necessary.
Chart abstraction labor. Reading medical records and producing acceptable defense documentation is human work. We do the sampling, the scoring and the projection — and the workstation the coder works in. Somebody else reads the chart.
Your certifying auditor or actuary. The calculation engine is interchangeable. The signature a regulator recognizes is not. Keep it — the relationship gets cheaper, not shorter.
Outbound member campaigns. Alberto produces the target list and the reason each member is on it. Dialers, mail houses and campaign platforms are a different business.

Everything else on this page is the analytical labor between those boundaries. That part, you should own.

Engagement

Everything starts with one domain, not ten.

Whichever door you come through, the same thing happens underneath: we map your data sources onto the taxonomy, integrate the pipeline with your systems, and take ownership of operating it reliably from then on — the loads, the return files, the reference data, the integrity checks.

Track A — Move

Large health plans, sponsored by leadership

A leadership conversation, not a vendor evaluation.
Two hours with the executives who own the P&L: which line items you resent most, which initiatives have stalled, and where a result in weeks would change the internal argument.
One domain, in weeks, under your sponsorship.
Stood up inside your boundary against your own data, outside the roadmap queue. The artifact goes on the table next to the vendor’s, next to the cost.
Let the result do the politics.
A working thing that cost a fraction of the incumbent is an argument nobody in the building has to make. Expansion follows the renewal calendar.

Track B — Roll it up

MSOs & risk-bearing networks

Bring one payer and one month.
The contract whose data is cleanest, or the one whose settlement came in worst.
We map it and trace it.
That payer’s sources onto the taxonomy; every practice’s performance with the reason attached; every disputed claim walked through the trail.
Expand payer by payer.
Each contract maps onto the same taxonomy as its feeds come online, until the roll-up is the whole book — and your practices get the view you promised them, in your brand.

Track C — Consolidate

Smaller health plans

One county, or one month.
A fixed-fee proof against your own data, judged next to the artifact you’re paying for today — with both invoices beside them.
Stand up the domain, and start asking questions.
The platform goes up inside your boundary; we integrate the pipeline and operate it reliably. Deliverables arrive on the regulator’s schedule, and a question gets answered the day it’s asked.
Retire on your renewal calendar.
Domains come on as contracts come up, and each one that comes on takes a contract off. The per-member cost falls every renewal.

Alberto can run against your warehouse inside your own cloud boundary. The data, the history and the outputs are already yours.