Overview

Medecision Care Management is a cloud-native, SaaS care management platform designed for health plans, providers, and risk-bearing organizations to improve health outcomes, reduce administrative and medical costs, and enhance member engagement with data-driven insights and automated workflows. The platform consolidates clinical, claims, and engagement data to power proactive, personalized plans of care, guided health journeys, pharmacy management, risk identification, and care gap closure. Medecision’s solution uses AI and advanced analytics to support care teams in making timely decisions and elevating care coordination across the care continuum.

Features and Capabilities

• Core Platform:
  • Cloud-based SaaS architecture with scalable deployment for payers and providers.
  • Unified data platform harmonizes fragmented clinical and administrative data.
  • Real-time data access for event-driven workflows and interventions.
• Care Management Functions:
  • Plan of Care: Personalized, data-informed care plans to support improved outcomes.
  • Guided Health Journeys: Adaptive journeys engaging individuals across risk levels.
  • Pharmacy Care Management: Tools to reduce pharmacy spend and streamline CM processes.
  • Care Gap Closure: Identifies and closes care gaps proactively.
  • Digital Health Risk Assessments: Boosts risk identification and program enrollment.
• AI & Automation:
  • Automated call review and transcript analysis to support engagement.
  • Intelligent care plan recommendations driven by evidence and AI insights.
  • Program Advisor analyzes multi-source data to guide optimal care pathways.
  • Automated document and prior authorization review reducing manual burden.
• Operational Tools:
  • Medical Summary providing an integrated member clinical view.
  • Risk Adjustment Coding for coding accuracy, compliance, and reimbursement precision.
• Integration & Analytics:
  • AI-driven analytics to stratify populations and trigger interventions.
  • Seamless integration with existing workflows to enhance interoperability.
• Security & Compliance:
  • HITRUST CSF® certified for information protection assurance.