Advanced Medical Strategies

What Advanced Medical Strategies does

Advanced Medical Strategies (AMS), founded in 2003 and headquartered in Lynnfield, Massachusetts, is a privately held healthcare analytics company that sells the PREDICT Platform and its module family — PredictPi, PredictPx, Predict Profiler, PredictDx, PredictRx, and CensusRater — to health plans, payers, underwriters, stop-loss carriers, reinsurance carriers, third-party administrators (TPAs), and managing general underwriters (MGUs). The platform supports payment integrity, risk management, and business intelligence workflows, with the company claiming its risk management tools back over 90% of stop-loss and reinsurance premiums written annually and that the platform has analyzed more than $6.4 trillion in total billed charges.

The PREDICT Platform is the unifying analytics layer across the product family; individual solutions plug into a shared claims and pricing data backbone that triangulates hospital price transparency data, health plan transparency-in-coverage data, and Medicare pricing to produce payment-clarity outputs. Product functionality spans automated clinical review and questionable-spend identification (PredictPi), price-transparency triangulation (PredictPx, launched in 2024), specialty drug and high-cost claimant profiling (Predict Profiler), cancer treatment-course analytics for medical underwriters (PredictDx), dosed drug-cost benchmarking (PredictRx), and census-based underwriting for fully insured conversion groups (CensusRater). All solutions are delivered under HITRUST CSF Certification.

AMS operates a subscription-based revenue model with two commercial formats — non-contingency subscriptions for individual solutions and enterprise subscriptions for the full platform — sold through an enterprise field sales motion targeting regulated healthcare buyers. The company also operates a self-serve member portal at predictsuite.amspredict.com for subscribed users. There are no disclosed funding rounds, no parent company, and no listed institutional investors; ownership commentary suggests founder/management ownership, with leadership comprising CEO and co-founder Peter Borans, CMO and founder Stacy Borans, CIO Jay Donoghue, and Chief Strategy Officer David Cardelle. Operating geographies are restricted to the United States.

Name

Advanced Medical Strategies

Legal name

Advanced Medical Strategies LLC

Website

https://mdstrat.com

Company type

Private

Founded year

2004

Operating status

Operating

Headcount range

51–100 employees

Short description

Advanced Medical Strategies (AMS) sells the PREDICT Platform and its analytics modules — PredictPi, PredictPx, Predict Profiler, PredictDx, PredictRx, and CensusRater — to health plans, payers, stop-loss and reinsurance carriers, TPAs, and MGUs for payment integrity and risk management. The privately held company, founded in 2003, operates in the United States under a subscription model.

Ownership category

akta.pro rank

Product category

Healthcare Payment Integrity Analytics

NAICS

Software Publishers (5132), Custom Computer Programming Services (541511)

SIC

Services-Prepackaged Software (7372), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro industry

PRIMARYHLACAGAE

Risk Stratification, Early Warning Scores & Predictive Analytics

Healthcare & Life Sciences/Digital Health & Health IT/Clinical Decision Support (CDS) & Care Pathway Tools

SECONDARYHLAIAKAK

Pricing Operations & Analytics (Price Governance, Systems, Reporting)

Healthcare & Life Sciences/Pharmaceuticals/Pharmaceutical Market Access and Pricing

SECONDARYFSAGAHAJ

Credit Monitoring, Portfolio Analytics & Early Warning Systems

Financial & Insurance/Financial Technology (Fintech)/LendTech (Digital Lending Platforms & Credit Decisioning)

Keywords

• Healthcare payment integrity
• Claims analytics
• Stop-loss underwriting analytics
• Medical risk management
• Healthcare predictive analytics

Headquarters

HQ city

Lynnfield

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Subscription - Individual Solutions: Non-contingency subscription model for individual PREDICT solutions such as Predict Profiler, PredictDx, PredictRx, CensusRater, and PredictPi. Customers can purchase access to specific tools based on their needs.
2. Subscription - Enterprise Platform: Enterprise subscription providing full platform access to all PREDICT solutions. Targeted at organizations seeking comprehensive payment integrity, risk management, and business intelligence capabilities.

Pricing tiers

Go-to-market motion1 record

Distribution channels2 records

Marketing channels6 records

Core offering

AMS sells the PREDICT Platform — a subscription analytics suite that automates healthcare payment integrity, clinical and pharmacy anomaly detection, stop-loss underwriting risk profiling, and business intelligence reporting. Customers license either the full enterprise PREDICT Platform or individual solutions (PredictPx, Predict Profiler, PredictPi, PredictDx, PredictRx, CensusRater), and AMS additionally earns contingency fees on recovery gains delivered through the platform.

Product overview

Advanced Medical Strategies (AMS) offers a unified platform-plus-modules architecture built around its PREDICT Platform, which serves as the core analytics engine. The PREDICT Platform underpins three main solution areas: Payment Integrity (including PredictPi, PredictPx, and the broader automated claims review workflows), Risk Management (including Predict Profiler, PredictDx, PredictRx, and CensusRater), and Business Intelligence. Solutions are delivered as flexible subscriptions (individual solutions or enterprise platform access) with minimal IT integration requirements.

Differentiator

Problem solved

Functional benefit

Brands

• PREDICT Platform: Industry-leading analytics platform for healthcare that delivers data and insights for payment integrity, claims analysis, and risk management.
• PredictPx
• Profiler
• PredictPi
• PredictDx
• PredictRx
• CensusRater

Products and services

• PREDICT Platform The enterprise subscription to the PREDICT Platform, providing payment integrity automation, clinical and pharmacy risk analytics, stop-loss underwriting profiling, and business intelligence reporting in a single HITRUST-certified environment. Sold to health plans, payers, TPAs, MGUs, and reinsurance / stop-loss carriers.
• PredictPx Individual subscription to AMS's predictive payment-integrity analytics, applying the PREDICT engine's clinical and billing logic to identify anomalies and recovery opportunities on claims. Sold as a standalone solution or as part of the PREDICT Platform enterprise subscription.
• Predict Profiler A 360° risk-profiling analytics subscription that consolidates clinical, financial, plan, geographic, demographic, and self-funded dimensions for groups being evaluated for stop-loss or underwriting decisions. Sold to stop-loss carriers, reinsurers, and MGUs.
• PredictPi A standalone payment-integrity analytics subscription designed for TPA and payer adjudication workflows, flagging anomalous and erroneous claims and integrating with existing claim adjudication systems.
• PredictDx A standalone subscription for analyzing cancer treatment billing and clinical patterns, identifying aberrant billing, coding, and care-delivery patterns relative to benchmarks. Sold to health plans, payers, and TPAs.
• PredictRx A standalone subscription that analyzes specialty drug and pharmacy spend, drug pricing anomalies, and procurement compliance, providing benchmarking for underwriting and stop-loss decisions. Sold to payers, stop-loss carriers, and MGUs.
• CensusRater A standalone census-based rating subscription that uses an employer group's census data to produce clinically and financially informed rating outputs for stop-loss, MGU, and self-funded underwriting.

Quantifiable outcome

• $11.5M in significant clinical issues identified within first 3 months of using PredictPi, with projected annual questionable spend of $46M for a large national TPA
• +3 more outcomes

Named customers6 records

Segments5 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature8 records

Scale indicators3 records

Recent moves4 records

Expansion highlights5 records

Direct peers

• Cotiviti: Cotiviti is a direct competitor to AMS in healthcare payment integrity, providing claim accuracy and overpayment recovery analytics to health plans, payers, and retailers. Both target similar enterprise buyers with overlapping claims analytics and payment-integrity offerings.
• Inovalon: Inovalon operates a cloud-based healthcare data analytics platform serving health plans, pharmacies, and providers with risk score accuracy and quality analytics. It competes with AMS in payer-facing predictive analytics and risk stratification.
• SCIO Health Analytics (EXL Health): EXL Health (formerly SCIO Health Analytics) provides payment integrity, risk adjustment, and care management analytics to payers and providers — directly comparable to AMS's payment integrity and risk management PREDICT modules.

Emerging players

• Cohere Health: Cohere Health provides AI-powered prior authorization and utilization management analytics for payers and providers — adjacent to AMS's payment integrity franchise with overlap in intelligent clinical review automation.
• Datavant: Datavant specializes in healthcare data connectivity and de-identification, enabling analytics on patient and claims data. It is an enabling/ecosystem peer to AMS's claims-analytics platform, sharing the same payer and provider buyer base.
• Apixio: Apixio applies AI to clinical and claims data for risk adjustment, payment accuracy, and care quality analytics. It overlaps with AMS's predictive risk analytics and payment integrity workflows for health plans.

Broad incumbents

• Change Healthcare (Optum): Now part of Optum/UnitedHealth, Change Healthcare historically provided claims processing and payment integrity analytics to payers — a directly overlapping space, though under a much broader UnitedHealth-owned portfolio.
• Optum (UnitedHealth Group): Optum is the dominant healthcare analytics and services incumbent serving payers, providers, and pharmacies with risk, payment integrity, and population health solutions — competing broadly with AMS across enterprise health-plan buyers.
• Health Catalyst: Health Catalyst provides a healthcare data and analytics platform used by health systems and payers for population health, financial transformation, and risk analytics — overlapping with AMS's Business Intelligence and analytics offerings at enterprise payer/provider buyers.

Others

• LexisNexis Risk Solutions: LexisNexis Risk Solutions provides data, analytics, and risk decisioning used by health insurers, life insurers, and reinsurers — overlapping with AMS's stop-loss, reinsurance, and underwriting analytics buyer set though with a broader data-monetization angle.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/mdstrategies
• LinkedInlinkedin.com/company/advanced-medical-strategies-llc

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Advanced Medical Strategies