Mosaic Health Solutions — MosaicRx by Nihit Gurram. Prevent prescribing cascades before they cause harm.
MosaicRx, by Mosaic Health Solutions, is a real-time medication risk prioritization layer at the moment of prescribing. Phenotype-driven, glass-box explainable, and designed for the clinician-in-the-loop.
Elevated anticholinergic burden
HighCumulative ACB score 7 across 3 active meds — associated with cognitive slowing & falls.
Prescribing cascade signal
WatchDiuretic started 14 days after NSAID initiation — temporal pattern consistent with cascade.
Fall-risk phenotype: high
HighOrthostatics + sedating load + recent gait change. Phenotype match 0.89.
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The most expensive medication errors don't look like errors.
They look like new diseases — until a patient falls, becomes delirious, or lands in the ED. By then, the chain is invisible.
We help prevent the fall that leads to a $30K+ hospitalization.
Top 3 risks · why they matter · what's driving them.
MosaicRx isn't another alert. It's a prioritized, patient-specific read on what could go wrong in the next 90 days — delivered the moment a clinician opens the chart.
- Phenotype-specific, not population-generic
Risks are scored against the patient's longitudinal trajectory, not a static drug-drug table.
- Glass Box explainability
Every signal exposes its evidence trail: contributing meds, timing, and the questions worth reviewing.
- Clinician-in-the-loop, always
MosaicRx surfaces. The clinician decides. Nothing auto-prescribes, nothing auto-stops.
Cumulative ACB ≥ 3 in adults >75 is associated with cognitive decline, urinary retention, and falls. Patient's score: 7.
- →Is amitriptyline still needed for sleep, or can it be tapered?
- →Substitute oxybutynin with mirabegron?
Three steps. No new workflow.
Context capture
EHR data, longitudinal medication history, labs, and real-world inputs where available — assembled into a patient-specific picture.
Risk engine
Phenotype-aware models rank by relevance, not completeness. Built explicitly to avoid alert fatigue.
Glass Box output
Top 3 risks with evidence trace, contributing meds, timeline, and questions to review. Clinician decides.
Not an alert. Not a scribe. Not a polypharmacy calculator.
MosaicRx sits in a category of one: a prioritization layer at the prescribing moment, designed around clinical judgment.
For the clinician making the call, and the team carrying the risk.
MosaicRx has to earn its place with two very different people at the same moment. Here is what each of them gets.
For the clinician
You did not go into medicine to fight your inbox or to second-guess a medication list at the end of a long Friday.
- It watches so you can decide. When an older patient is on ten or more medications, you already sense one of them might be the problem. Finding which one in a fifteen-minute visit is the hard part. MosaicRx does that watching in the background and hands you the few things most worth your attention.
- It stays in the passenger seat. Nothing auto-prescribes and nothing auto-stops. You see the reasoning, you weigh the questions it raises, and you make the call.
- It gives you something to point to. Every signal carries its own evidence, so you can talk it through with a worried daughter or document your thinking in the chart without hunting for it.
- It protects the moments that matter most. The fall that never happened. The patient who stayed in her own home another year. Those wins are quiet, and they are the reason you do this.
It means less noise in your day and fewer of the quiet worries you carry home.
For the value-based care leader
When your group carries risk on older, complex patients, medication-driven harm is one of the largest costs you cannot see coming.
- It protects total cost of care. Prevented falls, delirium, ED visits, and readmissions are the events that move your medical loss ratio. MosaicRx targets the high-cost, hard-to-see misses before they land.
- It strengthens quality and Stars performance. MosaicRx is built around the exact risks behind the medication-safety measures your plans are scored on by the Healthcare Effectiveness Data and Information Set (HEDIS): Use of High-Risk Medications in Older Adults, Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults, Polypharmacy: Use of Multiple Central Nervous System-Active Medications in Older Adults, and the Potentially Harmful Drug-Disease Interactions in Older Adults measure that flags sedating medications in patients with a history of falls. These are measures where a lower rate means better performance, and MosaicRx surfaces those risks before the prescription is written, with a defensible evidence trail when measures are audited.
- It focuses your scarce care-management time. Rather than flooding pharmacists and care managers with noise, MosaicRx ranks patients by real risk, so your highest-cost members get attention first.
- It proves value fast. A focused 30 to 60 day pilot, no deep EHR build to start, and a single prevented hospitalization can offset the annual cost.
Under risk, every prevented complication drops straight to your margin.
When the medication list gets safer, a family breathes easier.
Behind most older patients on a long medication list is a family member tracking the pillbox, noticing the new confusion, and quietly wondering why their mother seems worse. As care moves into the home, that family member has become part of the care team.
In 2024, about 59 million U.S. family caregivers provided an estimated $1.01 trillion in unpaid care, a workforce now larger in value than all Medicaid spending (AARP, Valuing the Invaluable 2026).
- It turns a silent change into a conversation. When a clinician adjusts a medication, the family usually hears only that something changed. MosaicRx gives the clinician an explainable reason to share, so the daughter at the bedside understands the why.
- It protects the thing families want most. Fewer medication-driven falls and less confusion means more time at home and fewer crises that pull a family into the emergency department at 2 a.m.
- It lightens an invisible load. Every prevented complication is a hospitalization a family did not have to manage, a workday they did not have to miss, and a worry they did not have to carry.
MosaicRx stays a clinical tool used by clinicians. The family is who feels the difference when it works.
Reduce complications. Protect margin under risk.
For risk-bearing groups and value-based systems, prevented complications are the line item. MosaicRx targets the high-cost, hard-to-see misses.
- Reduce medication-driven complications, LOS extension, and readmission risk.
- Improve financial performance within DRG-based reimbursement by reducing outlier cases.
- Strengthen quality and safety metrics with a defensible evidence trail.
One prevented fall.
The average fall-related hospitalization for an older adult exceeds $30K. A single prevented event can offset the annual cost of MosaicRx.
Illustrative only. Actual results depend on population, baseline, and workflow.
Built to generate the evidence, not only the intervention.
For health economics and outcomes research, the question is whether an intervention produces measurable, defensible value in the real world. MosaicRx is designed to generate that evidence as a byproduct of normal use. Every surfaced risk, clinician action, and downstream outcome is logged, which creates a real-world evidence pipeline on medication burden, cognition, and fall risk in older adults.
- Anticholinergic and psychoactive burden reduction. Change in average anticholinergic burden and CNS-active and sedative medication load per patient, the exposures most tied to cognition and falls in older adults.
- Fall and cognitive harm reduction. Change in medication-related falls, delirium, and cognitive and functional decline, along with the avoidable emergency visits and readmissions those events drive.
- Phenotype-stratified outcomes. Results stratified by the dimensions that actually govern medication risk in this population: cognitive burden, fall risk, activity and functional status, and psychoactive exposure. Physiologic factors that affect drug handling adjust the underlying score but are not the lens.
- Modeled cost avoided per 1,000 patients. A conservative total-cost-of-care estimate sized for risk-bearing populations.
This positions MosaicRx as both a point-of-care tool and a source of real-world evidence for value demonstration and budget-impact modeling.
Pilot MosaicRx in a community clinic.
Designed for risk-bearing outpatient groups managing complex older adults. Start with a focused workflow — integration follows once value is proven.
- A clinical champion and 3–10 prescribing clinicians
- Synthetic or de-identified workflow for week 1 (no integration required)
- Defined patient cohort (e.g., 65+ with ≥5 active meds)
- Optional EHR integration scoped after pilot validation
- Cascade interception rate
- Insight acceptance rate
- Repeat use per clinician
- Time recovered per encounter
- Explainability engagement rate
The team building MosaicRx.
A clinician-aware, builder-first team backed by senior clinical and commercial advisors across Stanford, community medicine, and value-based care.
Operator-clinician translator. Builds at the intersection of value-based care, medication safety, and prescribing workflow.
Chemistry, B.S. Biotechnology and pharmaceutical expertise. Founder of Prasad Marketing Company.
Engineering leader. Built mission-critical civic tech at scale. Owns architecture, security, and the EHR integration path.
The questions clinical and economic buyers actually ask.
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