What is the Medecision Platform?
The Medecision Platform is a cloud-based healthcare SaaS solution that supports care management and utilization management workflows, personalizes digital patient engagement, and streamlines data operations for health plans, provider networks, and government programs. As a cloud-based solution, the Medecision Platform enables secure, real-time processing of both clinical and administrative tasks at scale.
Platform Architecture
The Medecision Platform features a flexible, scalable infrastructure. It is deployed/hosted on Google Cloud Platform using containerized services and scalable compute resources, such as, Google Kubernetes Engine, Cloud Functions, BigQuery, and Spanner.
Built with interoperability in mind, the Medecision Platform features FHIR and REST API support for CRD, DTR, PAS, and real-time data exchanges. The platform is also HITRUST CSF® certified, SOC2-audited, and HIPAA-compliant to keep data secure.
The following Application Modules are available:
Utilization Management (UM)
Care Management (CM)
Appeals & Grievances
Quality & Risk Programs
Digital Outreach
Core Operational Capabilities
Real-Time Orchestration: System triggers targeted workflows, programs, and tasks based on data from updates including Admission-Discharge-Transfer (ADT), claims, and labs.
Low-Code Configuration Tools: Self-service builders for programs, populations, workflows, rules, templates, and journeys.
AI & ML Automation: Machine learning models enhance intake routing, member engagement prediction, decisioning, and fax classification.
Multi-Tenant Isolation: Dedicated Virtual Private Cloud (VPCs) per client. No data sharing across tenants.
Supported Use Cases
The Medecision Platform supports the following use cases:
Prior Authorization Review & Processing
Clinical Program Execution (e.g., diabetes, maternity, complex case)
Social Determinants of Health Engagement
Appeals & Grievances
Digital Onboarding Campaigns
Fax-to-Digital Conversion
Delegated Entity Oversight
Real-Time EHR Integration with CRD/DTR/PAS
Member and Provider Nudging
Care Management
Medecision’s Care Management (CM) application is built to support scalable, configurable, and multi-channel care delivery across member risk strata. It is driven by real-time data, customizable workflows, and modular tooling. For more information, see care-management-cm.md.
Utilization Management
Medecision's Utilization Management (UM) application supports end-to-end authorization processing—from intake to review and outcome—while automating routing, documentation, and approvals. It is optimized to reduce administrative burden and ensure compliance with regulatory SLAs. For more information, see utilization-management-um.
Clinical Intelligence Engine
The Clinical Intelligence Engine enables the creation and execution of rule-based, AI-driven workflows across the platform. It integrates data from multiple sources and applies configurable logic to categorize populations, personalize interactions, and automate outcomes. For more information, see overview-of-the-clinical-intelligence-engine.md.
Data Platform Integration
The following data types are supported: ADTs, HL7, claims (837, 835), enrollment, labs, social risk, provider feeds.
Data can originate from any of the following pipelines:
Data Ingestion (batch or streaming)
Entity Matching
Enrichment (rules-based and AI-driven)
Intelligence Layer (real-time rules, segmentation, program triggers)
Data can be moved downstream into analytics data products (dashboards, reporting datasets). Support is also offered for BigQuery, Bring your own BI Device, and direct API extraction.
For more information about the Data Platform, see overview-of-the-data-platform.md and data-platform.
Security Framework
The following framework is in place for the Medecision Platform to align with current cybersecurity standards:
Access Control: Role-based access control (RBAC), policy-based authorization
Data Isolation: Each client has a segregated environment (dedicated VPC)
Encryption:
AES-256 encryption at rest
TLS 1.2+ for data in transit
Audit Logging:
All system activity is logged and monitored
Retention aligned with HIPAA and GDPR
For more information about security, see security-and-compliance.