Data to
doing.
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.
Data Platform
Our Unified Data Platform is the foundation of our solutions
Unified
data
Harmonize fragmented data into a platform built for healthcare to ensure seamless integration and effortless data management.
Actionable
intelligence
Trigger both human and automated interventions at the right moments to improve quality, reduce administrative burden, and lower medical costs for over 43 million lives.
Event-driven
workflow
Deliver personalized, context-rich workflows by transforming data into real-time insights and eliminating unnecessary administrative tasks through automation.
Agentic AI
AgentFoundry offers healthcare agents you can configure, trust & scale.
Experience
Deliver intelligent, adaptive interactions with an agentic AI platform that dynamically personalizes patient and provider journeys in real time.
Efficiency
Optimize medical cost performance and reduce administrative burden through autonomous agents, smart automation, and no-code configurability–enabling a self-service approach.
Productivity
Empower teams to focus on high-value care by offloading routine work and accelerating the creation of scalable, AI-driven solutions.
Who We Serve
Purpose-built for leading payers and providers.
health plans
Efficiently manage at-risk populations to optimize revenue and improve outcomes.
The shift to value-based care requires health plans to share and manage risk across all business lines and provider networks while optimizing member health. A holistic view of the medical, behavioral, and social determinants that impact outcomes and cost of care is critical so you can focus scarce resources on managing those members who need the most support, avoiding unnecessary ED and hospital visits.
health plans
Reduce wait lists and efficiently manage beneficiaries.
As CMS accelerates the shift to value-based care, government entities must adapt their business models to do even more with less. New processes and systems are needed to enable efficient and precise targeting and management of individuals and populations who cost the most so organizations can stretch their valuable resources to maximize the number of beneficiaries they can reach.
administrators
Meet the diverse needs of your membership and clients.
Value-based care presents new challenges to TPAs as they struggle to meet the diverse needs of the membership across employer groups and health plans—even those with complex relationships or different state regulations.
De-risk the move to value-based contracts.
As CMS accelerates the move to value-based care models with downside risk, health systems need shared patient/member information, quality insights and clear signals of financial performance so they can achieve success with value-based contracts. Success requires collaborating with organizations outside your four walls to address the medical, behavioral and social determinants that impact the cost and effectiveness of care.
Solutions
Our solutions optimize healthcare workflows.
Care Management
Connect 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.
Utilization Management
Streamline 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.
Quality Management
Improve outcomes and meet regulatory standards with an industry-standard HEDIS measures engine. Support retrospective and post-audit reviews and provide an administrator worklist to track performance and close quality gaps. By ensuring compliance and focusing resources on the right interventions, drive continuous quality improvement and reduce costs tied to preventable hospitalizations and penalties.
Risk Management
Strengthen clinical accuracy and care coordination with advanced HCC risk models and streamlined chart review workflows. Identify 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, support early treatment and avoids downstream high-cost events.
Provider Enablement
Accelerate care delivery and provider network collaboration with our intuitive provider portal, seamless direct messaging to EMR, and advanced SMART on FHIR APIs for streamlined EMR connectivity. Empower providers with the tools they need to make informed decisions and enhance patient care.
Patient Engagement
Strengthen connections and empower healthier outcomes with targeted campaigns, streamlined scheduling, and proactive periodic check-ins. Leverage dynamic monitoring and personalized next best actions, interactive secure chat, and tailored educational content to keep patients actively engaged in their care journey.
Excell Consulting Services
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
Most importantly, we never launch and leave.
HarmonyCare Health Plan
“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.”
Hawaii Medical Service Association
“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.”
Health Home Partners of Western NY
“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.”
Brand New Day
“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.”