Purpose-built for health plans and providers, our platform transforms fragmented data into actionable intelligence, powering event‑driven workflows and timely, automated interventions that improve efficiency and outcomes at scale.
Purpose-built for health plans and providers, our platform transforms fragmented data into actionable intelligence, powering event‑driven workflows and timely, automated interventions that improve efficiency and outcomes at scale.
10%
Reductions in ER utilization
20%
Improvements in gaps in care
20%
Efficiencies in administrative costs
AgentFoundry
Deliver intelligent, adaptive interactions with an agentic AI platform that dynamically personalizes patient and provider journeys in real time.
Optimize medical cost performance and reduce administrative burden through autonomous agents, smart automation, and no-code configurability – enabling a self-service approach
Empower teams to focus on high-value care by offloading routine work and accelerating the creation of scalable, AI-driven solutions.
Platform
Harmonize fragmented data into a platform built for healthcare to ensure seamless integration and effortless data management.
Trigger automated interventions at the right moments to improve quality, reduce administrative burden, and lower medical costs for over 43 million lives.
Deliver personalized, context-rich workflows by transforming data into real-time insights and eliminating unnecessary administrative tasks through automation.
Who We Serve
Efficiently manage at-risk populations to optimize revenue and improve outcomes.
Solutions
Revolutionize operations with our healthcare native Agentic AI Platform – featuring an agent builder designed for self-service configurability to empower organizations to automate complex workflows. Built with safety and trust at its core, the agentic platform ensures seamless integration with human oversight, delivering reliable, actionable insights while keeping you in control.
Our care management platform connects health plans, providers, and members through a unified digital experience. It supports personalized plans of care, secure messaging and assessments, and automated check-ins and alerts to keep members engaged. With integrated care gap closure tools, pharmacy management, and digital Health Risk Assessments, it improves care coordination, reduces avoidable complications, and helps lower medical costs through proactive intervention.
Our utilization management platform streamlines prior authorization and care review with AI-powered policy management and automated decision rules. Smart workflow routing, integrated appeals and grievances, and peer-to-peer scheduling improve collaboration and ensure timely access to appropriate care. By reducing delays, avoiding unnecessary services, and guiding members to the right care setting, it improves outcomes while lowering unnecessary medical spend.
Our quality management platform helps health plans and providers improve outcomes and meet regulatory standards with an industry-standard HEDIS measures engine. It supports retrospective and post-audit reviews and provides an administrator worklist to track performance and close quality gaps. By ensuring compliance and focusing resources on the right interventions, it drives continuous quality improvement and helps reduce costs tied to preventable hospitalizations and penalties.
Our risk management platform strengthens clinical accuracy and care coordination with advanced HCC risk models and streamlined chart review workflows. It identifies uncaptured diagnosis codes and delivers intelligent suspect condition insights, helping care teams close gaps, improve documentation, and ensure members receive the right level of care. By aligning risk profiles with actual clinical needs, our solution supports early treatment and avoids downstream high-cost events.
Drive meaningful change with expert support in strategic planning, interim leadership, and program and project management. Empower your organization with robust program governance, operational evaluation & transformation, business analysis & insights, and seamless execution of initiatives that deliver impactful results to your enterprise.
Testimonials
From day one, Medecision treated us like partners, not just clients. Their implementation team made onboarding smooth and surprisingly fast, and their support team continues to feel like an extension of our own staff.”
I’ve enjoyed working with the Medecision team since 2003. They’re very professional, knowledgeable and energetic. They inspire me to go the extra mile, to work harder. We started years ago with utilization management workflow, administration and reporting. By listening to customer feedback, Medecision has a positive impact on healthcare. Its solutions and services continue to help us achieve our vision of building a healthier, happier Hawaii.”
We were able to leverage the technology to help us find our patients, evaluate acuity, prioritize and coordinate actions, even when all other services were down.”
We’re always looking for ways to make our technology do more, and Medecision is a big help. We were able to configure our system to process authorizations much more easily for all of our Medicare Advantage members. Our physicians flock to Medecision once they learn their members’ risk scores – including pharmacy and lab data – are there and that they can automate their own authorizations. We all like the idea of having everything coordinated in one system. That’s Medecision.”
