Certilytics Risk Scores & Clinical Analytics
Contact for pricing
Overview
Certilytics offers AI-driven predictive analytics solutions specifically designed for the healthcare industry. The company leverages proprietary deep learning and generative AI technology for risk stratification and clinical analytics. Its core purpose is to predict high-cost events, enhance clinical outcomes, and provide actionable insights to healthcare organizations.
The Certilytics platform unifies enterprise data into a single source of truth, enabling users to quickly move from data to action. It helps organizations predict emerging clinical and financial risks, optimize programs and strategies to lower costs, and improve outcomes.
Key offerings include the Healthcare Data & Prediction Platform, BrainstormAI Model Library, Data Logistics Suite, and CertHLM (Healthcare Language Model). The platform is built by healthcare experts and processes over 30 million lives weekly, with over 250 million lives on the platform and 21 billion total member records. It boasts a 90-day implementation period and has identified over $10 billion in savings, a 2.4x increase in patient engagement, and $200 PMPY in savings for its clients.
Reviewed by Pouyan Golshani, MD — Interventional Radiologist
Key Features
- Deep Learning and Generative AI technology
- Risk stratification and clinical analytics
- Prediction of high-cost events
- Enhancement of clinical outcomes
- Unify and enrich healthcare data
- Healthcare Data & Prediction Platform
- BrainstormAI Model Library
- CertHLM (Healthcare Language Model)
- Unmatched Data Processing (30M+ lives processed weekly, 250M+ lives on platform)
- 90-day implementation
Use Cases
- Transform Population Health Strategies
- Develop High Performing Value-based Networks
- Improve Patient Engagement
- Accelerate Revenue Growth
- Measure Program Performance and ROI
- Identify Cost Savings and Outcome Opportunities
What Physicians Need to Know
Risk Stratification Models
Certilytics provides a library of over 1,000 AI-powered clinical, financial, and behavioral predictive risk scores to identify future risks within populations. Their 'All COREu00ae Condition (ACC) Model' predicts five outcomes (diagnosis, relative cost, ER visit, surgery, inpatient admission) for each of 432 COREu00ae condition categories at the member level, enabling the calculation of both clinical and financial opportunity values. The platform also supports client-specific custom models built on their BrainstormAIu00ae technology.
Social Determinants Integration
The platform integrates Social Determinants of Health (SDOH) data, including county-level factors, into its predictive models. Certilytics offers an AI-powered model that predicts a patient's SDOH risk and generates individual patient 'personas' to highlight key factors driving risk, facilitating personalized intervention strategies.
Disease Registry Support
While not explicitly named 'Disease Registry Support,' Certilytics' Healthcare Data & Prediction Platform ingests and enriches diverse data sets, including clinical data. Their proprietary COREu00ae Clinical Episode Grouper organizes member claims into comprehensive clinical condition categories, providing a foundation for managing and analyzing disease-specific populations.
Care Gap Identification
Certilytics' BrainstormAIu00ae platform features a 'Sub-Population Algorithm' that calculates the financial impact of closing Gaps In Care (GIC) for specific, comorbidity-based sub-populations. This allows for the prioritization of clinical care management resources to patients where interventions are most likely to yield significant short-term net financial savings. Their CORE Pathways also supports advanced predictive analytics for identifying gaps in care.
Readmission Prediction
The platform includes a 'Hospital Readmission Risk' model that utilizes deep learning to predict the likelihood of a patient being readmitted within 30 days of discharge after an acute hospitalization. This enables proactive discharge planning and interventions to reduce costly repeat visits.
Claims Data Analysis
Certilytics' cloud-native platform processes billions of data records weekly, encompassing over 30 unique healthcare-focused domains, including medical claims. It employs natural language processing (NLP) and deep learning to encode claims data into a foundational machine learning feature space, and its CORE Pathways standardizes and aggregates raw claims data for detailed analysis. A GenAI model is also used for accurately identifying claims that deviate from expectations.
Quality Measure Reporting
Certilytics offers 'COREu00ae Quality Measures,' an extensive suite of over 80 quality measures, including NCQA Certified HEDIS measurements. The platform allows for the evaluation of clinical quality and the creation of custom measures tailored to specific programs or populations, supporting comprehensive quality reporting and benchmarking.
Cohort Builder
The Nucleus Analytics Platform incorporates a 'member stratification tool' called Forecasts, which enables the segmentation of populations based on prospective risk. Certilytics' overall capabilities involve stratifying patients and matching them to appropriate programs, indicating robust cohorting functionalities for targeted interventions and population health management.
Geographic Mapping
Certilytics integrates county-level SDOH data into its models and helps users understand the 'who' and 'where' of SDOH risk, facilitating geographically informed outreach and interventions. While a dedicated visual mapping feature isn't explicitly detailed, the capability to analyze and prioritize risk based on geographic factors is inherent in their SDOH integration.
Physician Tip
Certilytics' AI-driven insights empower physicians to move beyond retrospective analysis to proactive care. Leverage the predictive risk scores to identify patients at high risk for specific conditions, readmissions, or care gaps, enabling timely interventions and personalized care plans. Utilize the SDOH integration to gain a holistic understanding of patient challenges beyond clinical data, informing more effective support strategies. The ability to quantify the financial impact of closing care gaps can also help advocate for necessary resources and programs.
Certilytics' platform is designed for flexible integration, allowing connection of its predictive models and enriched data with existing tools, applications, and workflows. It supports integration with legacy care management programs and offers IT services for configuration and development of new tools. The cloud-native platform is scalable and can synchronize enriched data and AI-insights with operational databases and applications.
Details
| Category | Population Health Analytics |
| Pricing | Contact for pricing |
| Deployment | Cloud-based |
| Compliance | |
| BAA Available | Unknown AI-estimated |
| HIPAA Compliant | Unknown AI-estimated |
| FDA Status | Unknown AI-estimated |
| Integrations | |
| EHR | Not specified |
| Specialties | Family Medicine, Geriatrics, Internal Medicine |
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Press & Coverage
PR Newswire
Certilytics Launches AI-Powered Answers Solution for Real-Time, Expert-level Healthcare Intelligence
Certilytics announced the commercial availability of its Health Language Model (CertHLM), an AI-powered interface providing real-time data intelligence and expert decision support to healthcare organizations.
2026-03
Certilytics
Certilytics, Inc. Launches AI Accelerator to Help Healthcare Organizations Operationalize AI and Move from Dashboards to Answers
Certilytics launched its AI Accelerator, a program designed to help healthcare organizations operationalize AI and transition from exploratory initiatives to scalable answer intelligence.
2026-06
PR Newswire
Certilytics and IKS Health Bolster Strategic Partnership with New Agentic AI and Expert-in-the-Loop Oversight to Improve Healthcare Workflows and Impact Across the Patient Journey
Certilytics and IKS Health expanded their strategic collaboration, integrating Certilytics' GenAI-powered predictive intelligence into IKS Health's platform to modernize administrative operations and enhance member engagement.
2026-04
Certilytics
Certilytics Introduces BrainstormAI Studio a Tool to Help Healthcare Accelerate its AI-Powered Analytic Capabilities
Certilytics introduced BrainstormAI Studio, an AI development environment for healthcare data science teams to train models and generate predictions without building their own infrastructure.
2026-01
Certilytics
Joint Release: Carenet Health Partners with Certilytics for Data Management & Predictive Analytics
Carenet Health announced a new partnership with Certilytics, Inc. for data management and predictive analytics.
2025-06
Certilytics
Certilytics Announces New Customer Partnership with the Healthcare Purchaser Alliance of Maine
Certilytics, Inc. partnered with the Healthcare Purchaser Alliance of Maine (HPA), a nonprofit representing over 60 members including employers, providers, and health plans.
2025-05
Certilytics
AI-Powered Predictive Insights Reducing Unnecessary Surgeries
This article discusses how Certilytics' AI and predictive analytics are enabling payers and providers to intervene earlier with patients at risk for unnecessary surgeries, steering them toward more effective and less costly treatment pathways.
2022-05
Certilytics
Improve Patient Population Heart Health with AI-Powered Analytics
This article highlights how Certilytics' advanced predictive analytics focus on prospective opportunity analytics to help health managers intervene before a patient suffers an adverse cardiovascular outcome, leading to healthier populations and lower costs.
2021-02
Videos
Product demos, reviews, and walkthroughs for Certilytics Risk Scores & Clinical Analytics.
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Frequently Asked Questions
Certilytics' AI-powered solutions help identify patients at future risk for high-cost events or specific conditions, allowing for proactive interventions and optimized clinical program participation. This enables physicians to better stratify patient populations and target resources effectively to improve health outcomes.
Certilytics is HIPAA compliant, HITRUST r2 certified, and SOC 2 Type II compliant, maintaining robust administrative, technical, and physical safeguards for data security. As a Business Associate, they process identifiable health information on behalf of clients, with privacy rights exercised through the health plan or provider.
While Certilytics' AI models are built on extensive data and rules-based logic, their effectiveness relies on the quality of client-provided data and they are designed to enhance, not replace, clinical judgment. The insights primarily support population health management and strategic decision-making rather than direct individual patient diagnosis or treatment.
Yes, several alternatives exist in the market, including companies like Physera, Omada Health, PatientGenie, Clarify Health Solutions, and Arcadia. These platforms offer various AI-driven predictive analytics and data insights for healthcare organizations, often with different specializations.
Certilytics primarily serves larger entities like health plans, employers, and health systems, with a business model that includes subscription, usage-based, and service fees. Specific pricing structures for individual physician practices or smaller groups are not publicly detailed and would likely involve direct consultation with Certilytics.
Certilytics' platform is designed for data integration and can provide customized collections of predictive analytic outputs. While direct EHR integration details aren't explicitly stated for physicians, their solutions aim to support enterprise healthcare decision-making and can be delivered through business intelligence toolkits.
Certilytics emphasizes building trusted AI by grounding insights in sound, traditional healthcare logic and rules-based analytics, which provides a level of transparency. Their models aim to offer insight into clinical drivers of outputs, but the deep learning nature means the exact 'black box' explanation for every single prediction might be complex.
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| Last Verified: 2026-05-26 | First Added: 2026-05-26