Quality Management
Drive Quality Performance and Close Gaps with our AI-powered engine.
The Challenge
Data gaps and reporting lags hinder high-performance scoring.
Lagging indicators
Retrospective data prevents real-time interventions before reporting cycles close.
Provider friction
Manual chart chases and cumbersome workflows frustrate clinical partners.
Measure complexity
Ever-evolving HEDIS and Star Ratings requirements create constant compliance risks.
Inaccurate outreach
Poor member data leads to missed gaps and wasted engagement efforts.
Our Solution
From retrospective reporting to proactive, real-time gap closure.
Streamline compliance with an engine built to calculate and track industry-standard quality measures like HEDIS with precision.
Streamline retroactive reviews & audits by accessing member clinical summaries directly from EMRs without leaving the member record.
Track quality gaps across your population with role-based worklists, enabling targeted interventions and scaled quality improvement efforts.
Agentic AI
Our AI agents accelerate quality management.
Gap Closure Agent
Detects open gaps and recommends actions to improve compliance and outcomes.
Care Plan Recommendation Agent
Suggests evidence-based plans of care tailored to patient needs.
Prior Auth Review Agent
Accelerate medical review cycles and reduce administrative costs through intelligent automation.
Document Review Agent
Reduce processing time and rework by automating document validation and completeness checks.
Risk Adjustment Coding Agent
Improve quality scores and incentive performance through proactive, data-driven gap identification.
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.
Case Studies
See how we’ve helped others with quality management.
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.”