Prodigy Benefit Management

In the years following the enactment of the Affordable Care Act, employer healthcare moved through a period of readjustment. Premiums rose sharply and the familiar playbook no longer applied. Business owners across New York State began re-examining how their plans were structured and what actually drove their costs.

Among those listening closely was financial advisor David Middlemiss. When one of his business clients asked for help designing a healthcare plan, he approached it the only way he knew how—by following the numbers.

He soon realized that the existing system operated through opacity, making it difficult for employers to trace how their healthcare dollars were spent. Community-rated plans spread costs evenly across groups, limiting control over pricing. Self-insured plans offered transparency, but put all risk on the employer. In both cases, the structure lacked the balance and insight employers needed to manage benefits intelligently.

“My background in finance taught me that transparency brings more discipline into processes, and that changes outcomes,” says Middlemiss.

“The healthcare industry is no different. When people understand their risk profiles, they stop reacting to healthcare costs and start preventing them.”

Our value is more than savings. We help employers balance care and cost, turning health from a recurring expense into a shared responsibility.

That realization led Middlemiss to build something new in the employer benefits category, and Prodigy Benefit Management was established.

The firm advocates for preliminary healthcare, bringing financial logic and transparency to employer plans so that care starts before a claim is ever filed. In doing so, it reframes healthcare costs from fixed expenses into variables that can be improved through education, engagement and prevention.

That philosophy comes to life through Prodigy’s Paradigm Integrated Healthcare Plan app. It gives employees access to health-risk data once reserved for insurers and connects them to preventive resources through Prodigy’s partnership with U.S. HealthCenter. Within the app, nutrition guidance, behavioral health support and condition-specific coaching converge into a single, adaptive experience that helps employees engage, close care gaps faster and ultimately allows employers to see costs stabilize.

“Our value is more than savings,” Middlemiss adds. “We help employers balance care and cost, turning health from a recurring expense into a shared responsibility.”

Begins As Education and Quickly Becomes Empowerment

A health-risk assessment initiates the engagement lifecycle. Employees answer brief questions about how they eat, sleep, move and manage stress while connecting their fitness devices and logging medical visits. Over time, these small details come together to form a clearer picture of daily habits and long-term risk.

The input is fed into a HIPAA-compliant dashboard provided by U.S. HealthCenter, which applies multiple evidence-based algorithms—some developed by institutions such as Kaiser Permanente, Harvard Medical and the University of Wisconsin. The overall model has been validated by the Validation Institute, demonstrating an 86 to 93 percent accuracy rate in identifying predictable and preventable diseases three to five years before symptoms appear.

That means employees can track emerging health risks and take steps to prevent conditions from worsening. For employers, that same foresight helps reduce healthcare utilization and stabilize premiums.

From awareness comes understanding. The platform reinforces that awareness through built-in guidance. Short videos and clear, conversational explanations show employees how everyday habits shape long-term health. Each participant is also paired with a licensed healthcare professional, typically a dietitian, nutritionist or registered nurse, who helps translate those insights into practical steps. As understanding grows, so does confidence. Employees meet their doctors better informed, ready to have meaningful, proactive conversations about their care.

The impact comes to life in real moments. When one employee’s young son fell from a tree, she turned to Prodigy’s telemedicine line for help. Within minutes, an ER physician was examining the injury through her phone camera and arranged an outpatient imaging appointment when the view wasn’t clear. By evening, her son was home with a cast—treated, comfortable, and spared the hours-long wait of a traditional emergency visit.

A Reward Paycheck Hidden in Engagement

Completing a health-risk assessment earns 25 points, reviewing a personal health profile adds another 25 and connecting with a coach or educator brings in 25 more. Smaller actions—like pledging to wear a seatbelt or improving daily nutrition—carry a single point, while deeper learning activities, such as reading an article or watching a short video about a personal health risk, earn five. Those who reach the 100-point benchmark unlock the full reward, a pre-tax benefit they can apply toward personal coverage.

The model works because it aligns education with accountability. Instead of one-size-fits-all wellness challenges, it rewards consistency and curiosity. Each point reinforces a positive behavior that improves individual wellbeing. Participation becomes a habit, learning becomes instinct, and health improvement becomes measurable.

A Trusted Network

Before even launching a single plan, Middlemiss surrounded himself with legal, financial and compliance experts to test every assumption.

“It was like taking a two-year master class,” Middlemiss recalls, describing how that process deepened his understanding and shaped the foundation of Prodigy’s compliance culture.

The discipline never faded. Every aspect of Prodigy’s structure continues to be reviewed by independent legal and tax professionals who track updates from the Department of Labor and the IRS. Nothing is left static; every policy and incentive formula is read, verified and retested. This ongoing cycle of scrutiny keeps the company’s framework current and its credibility intact.

The same rigor defines how Prodigy safeguards data. Every vendor handling personal health information, from telemedicine providers to third-party administrators, operates in full compliance with HIPAA. An independent IT firm monitors systems daily to ensure the platform remains secure, auditable and resilient. A separate accounting partner validates each incentive transaction to confirm that rewards are accurately recorded and reported.

For Middlemiss, this external network is extremely important.

“I don’t want people telling me what I want to hear,” he says. “I want people who’ll tell me what’s right.”

When the pandemic froze hiring, Middlemiss leaned on these relationships to sustain operations. Today, through partners like U.S. HealthCenter and their national care network, Prodigy connects to hundreds of healthcare systems and thousands of licensed clinicians across the country. Its telemedicine provider links directly to more than 150 accountable care organizations, expanding access without compromising oversight.

That same relationship-driven mindset continues to propel Prodigy’s market growth.

“We’ve always been broker-centric,” Middlemiss says. “The health and benefit brokers are the ones who bring us in. That’s our model. We don’t step over a broker because they’re the relationship builder.”

“So, when you ask me about my team and their work,” he adds, “it’s not just what we are doing here in the office. It’s the entire extended network we’ve built around us.”

Grounded Innovation

Many competitors have turned to experimental technologies, such as facial recognition AI for health prediction, in an effort to outpace the market. Middlemiss chooses otherwise.

“We’ve looked at the research,” Middlemiss explains. “Right now, those models have data bias, limited samples and inconsistencies, making them risky. Innovation matters, but not if it puts people or outcomes in question.”

That choice defines Prodigy’s difference. It’s not about doing more, but doing what’s right— reliably and repeatedly. By grounding innovation in validated science and human judgment, the company achieves what automation alone can’t: measurable savings that never come at the expense of trust.

In the end, that’s what separates Prodigy Benefit Management from the crowd. It’s a healthcare benefits company that delivers real, provable value, not another wellness program you can find in a handbook.