Care Management
Enable care managers with intelligent AI insights and seamless automation to optimize patient support and streamline workflows.
Features
Proactive, data-driven solutions
to optimize health outcomes
Empower care teams with Medecision’s advanced Plan of Care feature, designed to streamline care management and drive personalized, actionable health insights. With real-time collaboration and goal tracking, you can improve outcomes and deliver patient-centered care efficiently.
Engage individuals across all risk profiles – from low, to rising, to high-risk – through personalized, real-time, guided health journeys that adapt to their unique needs.
- Sub features: Scheduling, Chat, Digital Assessments, Periodic Check-Ins, Alerts to Members & Clinicians, Educational Content
Reduce pharmacy spend and minimize high-touch processes through adoption of Medecision’s end-to-end PCM solution.
Proactively close care gaps with streamlined solutions that ensure every patient gets the attention they need, when they need it.
Drive higher HRA completion rates and accelerate risk identification & care program enrollment through digital HRA.
Take a Closer Look
Agent Spotlight
Featured
Care Plan Recommendation
Boost care team efficiency and reduce avoidable costs through personalized, evidence-based guidance.
Generates evidence-based, personalized care plans that improve clinical outcomes and care coordination.
Featured
Call Review
Drive operational efficiency by automating call analysis to uncover high-impact care opportunities.
Analyzes call transcripts to surface care management opportunities, ensuring timely intervention and better member engagement.
Featured
Program Advisor
Improve program ROI and population health by directing members to the most effective care pathways.
Recommends optimal care programs by analyzing claims, clinical, and engagement data to drive improved health outcomes.
Featured
Medical Summary
Cut review time and enhance program recommendation accuracy with a unified, AI-driven view of member data across the platform.
Delivers an integrated member clinical summary with next-best-action insights to guide more informed, efficient care decisions.
Prior Authorization Review
Accelerate medical review cycles and reduce administrative costs through intelligent automation.
Evaluates clinical records against medical policies to determine medical necessity, highlight key evidence, and accelerate authorization decisions.
Document Review
Reduce processing time and rework by automating document validation and completeness checks.
Automates validation of submitted clinical documents to ensure completeness, reduce delays, and support faster, compliant reviews.
Gap Closure
Improve quality scores and incentive performance through proactive, data-driven gap identification.
Identifies open care gaps and recommends targeted actions to boost quality scores, compliance, and member outcomes.
Risk Adjustment Coding
Increase reimbursement accuracy and coding compliance while reducing manual review burden.
Detects and applies accurate risk codes to improve documentation integrity, compliance, and reimbursement accuracy.
AgentFoundry is our healthcare native Agentic AI Platform with a library of pre-built agents.
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