Solutions for Payers
PhenOM®, OM1's AI foundation model, reads each member's clinical history, not just their claims, and turns it into a calibrated, explainable risk score for what happens next. See the cost before the claim does, target care management where it will change the outcome, and prove which programs worked.
The Cost Arrives in the Claims. The Chance to Change It Was Months Earlier.
Health plans manage trend for conditions that are diagnosed years too late. Care-management programs are aimed with last year's claims and measured against a baseline nobody can isolate. Members with undiagnosed or undertreated disease generate avoidable cost long before they generate a diagnosis code. Claims tell you what happened. The clinical record already knows what is likely to happen next.
PhenOM® for Payers
PhenOM®, OM1's AI foundation model, reads a member's history the way a language model reads a sentence. It is trained on 400M+ longitudinal patient journeys that link clinical, claims, lab and patient-reported data, so its view of a member is not bounded by what flowed through your claims system. It brings predictive medicine, the earlier view clinicians are adopting at the point of care, to the populations you insure. It produces calibrated risk for 1,500+ outcomes from one model, with the reasoning behind every score, delivered by API into the systems your teams already run.
Why PhenOM®
One model, many outcomes: One foundation model, not a handful of narrow point predictions.
Breadth of data: Not bound to a single EHR's view.
Explainability by design: Every flag comes with its reasoning.
Built to drop in: API delivery into your care-management, analytics or payer-platform stack without replacing what you already run.
One integration, many uses: Multiple programs and value propositions over time.
One model. Every point of care. See it for yourself.
AI-Powered Risk Tiering
OM1’s PhenOM® solution enables payers to predict and monitor clinical outcomes with precision—so interventions can be timely, targeted, and effective.
Select any outcome or time period to understand event risks—such as hospitalization, disease progression, mortality or therapy response.
Rank patient populations across multiple risks (using the OMBI® global risk score) to effectively triage and intervene before costly events or to close gaps in care. Care managers leverage patient summaries, explanations of risk drivers and potential interventions to act efficiently.
Prioritize high-risk individuals for care management or preventive programs to improve outcomes and reduce avoidable costs-even new members with limited data.
Measure and forecast ROI for interventions or changes to coverage
Easily measure ROI for disease management programs and interventions rapidly. The ROI calculator compares the intervention population to a comparator group for relevant costs.
Simulate the impact of changes to formulary and coverage to anticipate impact on outcomes and related costs.
Who We Help
Health Plans & Medicare Advantage
Find the members who will drive next year's cost before the claims arrive.
PhenOM® ranks your population by the risk of high-cost events, disease progression and undiagnosed chronic conditions, with the clinical reasons behind each score. Care management gets a list it can act on, and finance gets a forecast it can plan against.
Care Management & Quality Programs
Prove which programs changed the outcome.
Predicted trajectories give every member an expected course. Measure each program against what would have happened without it, close gaps in care that affect quality ratings earlier, and redirect spend from programs that don't move outcomes to ones that do.
Payer Technology Platforms & TPAs
Predictive capability is becoming table stakes. You don't have to build it.
Embed PhenOM® as the predictive layer inside your platform. Your customers get a foundation model's breadth of outcomes and a defensible explanation for each score; you get it without building or validating a model of your own.
Life & Health Insurers and Reinsurers
One risk score from the full clinical record.
Underwriting, risk analytics and in-force management from a single calibrated score built on real clinical history, delivered by API into your book of business.
Built on the Broadest View of Patient History
curated patient journeys behind every prediction
years of real patient history to learn from
outcomes PhenOM® can predict
more likely to correctly flag your highest-risk patients
What It Looks Like in Practice
Population View
Your enrolled or attributed population ranked by predicted cost and clinical risk, with the drivers of each score.
Program View
Each care-management cohort against its predicted trajectory, so impact is visible while the program is running.
Explanations
The specific clinical factors behind every member's score, for clinical reviewers and for member outreach.
API Delivery
Standardized codes with dates in, calibrated risks out, into the systems you already run.
Proven Where it Matters
2 RCTs
evaluating PhenOM® predictions of treatment benefit and risk in joint replacement surgery
12 patents
in AI phenotyping, outcomes prediction and explainability
EHR deployment
through leading applications and in live specialty screening programs
Get in Touch
For you, the cost seen before the claim and programs you can prove. For your members, better outcomes.
Fill out the form to learn more about PhenOM® today.
Our Solutions
Built on our award-winning AI platform, OM1 solutions redefine how real-world evidence is generated, shared, and applied.
Patient Finding and Outcomes Prediction
PhenOM® is OM1’s healthcare foundation model, trained on over 1 billion patient-years. It powers digital phenotyping and medical event prediction that accelerates diagnoses, uncovers subtypes, estimates treatment effects and forecasts outcomes for individuals and populations.
Clinical Registries and Automated Studies
OM1 brings unmatched experience and automation to registries and observational studies, reducing burden for sites and patients while generating regulatory-ready evidence that’s fit for purpose, scalable, and cost-effective.
Clinical Datasets and
Insights
Access curated datasets and OM1's Real-World Data Cloud, covering 350M+ patients with linked, longitudinal data from EMR, claims, and specialty networks. License cohorts, analyze real-world outcomes, and generate insights that drive decision-making.
Scientific and Consulting Services
Work with OM1’s experts in data science, epidemiology, AI and regulatory strategy to design and execute fit-for-purpose programs, align evidence with requirements, and maximize the value of AI and real-world data.
Let’s Talk About Your Goals
From research and evidence to predictive insights and beyond.