MEDecision
- Company typePrivate
- Founded1988
- HeadquartersWayne, United States
- Headcount251–500
- GTM typeB2B
- OfferingSoftware
MEDecision firmographics
Firmographics- Name
- MEDecision
- Legal name
- Medecision, Inc.
- Website
- https://medecision.com
- Company type
- Private
- Founded year
- 1988
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Ownership category
- akta.pro rank
MEDecision industry classification
Industry- Product category
- Healthcare Management Software
- NAICS
- Software Publishers (513210), Computer Systems Design and Related Services (54151)
- SIC
- Services-Prepackaged Software (7372), Hospital & Medical Service Plans (6324), Services-Management Consulting Services (8742)
- akta.pro primary industry
- Value-Based Contracting Analytics (ACO/MSSP/MA, shared savings/risk) (HLACAHAA)
Keywords
Where MEDecision is headquartered
LocationHeadquarters
- HQ city
- Wayne
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
MEDecision business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Marketing or Sales, Infrastructure, Operations
Revenue model
- SaaS/Platform Subscription: Medecision operates as a cloud-based healthcare technology platform providing subscription access to its unified data platform, AgentFoundry, and various care management modules. Customers include health plans, providers, and third-party administrators that subscribe to the platform for data integration, analytics, AI-driven workflows, and care coordination capabilities. Pricing is quote-based and negotiated at an enterprise level.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Enterprise SaaS platform with modular solutions for health plans and providers |
Go-to-market motion1 record
Distribution channels2 records
Marketing channels7 records
MEDecision product offering
Product offeringCore offering
MEDecision provides a cloud-native, healthcare-specific Unified Data Platform and AgentFoundry agentic AI platform that integrate clinical, claims, behavioral, and social data from 90+ EMR systems to deliver care management, utilization management, quality management, risk management, provider enablement, and patient engagement solutions to health plans and providers. The platform is sold as a SaaS subscription with module-based configuration and supported by an embedded consulting arm (Excell Healthcare Advisors).
Product overview
Medecision offers a unified data platform architecture centered on the Unified Data Platform as the core product, augmented by AgentFoundry for agentic AI capabilities. The platform serves Commercial Health Plans, Government Health Plans, Third-Party Administrators, and Providers through a modular solution portfolio. Key solution modules include Care Management, Utilization Management, Quality Management, Risk Management, Provider Enablement, Patient Engagement, and Pharmacy Management. Excell Consulting Services provides strategic, operational, and change management consulting. The platform is cloud-native and SaaS-delivered, currently impacting over 95 million American lives. The platform ranked #1 in Care Management, LTSS, and Complex Care Coordination by Black Book Research 2026.
Differentiator
Problem solved
Functional benefit
Brands
- AgentFoundry: Healthcare-native Agentic AI Platform that offers configurable AI agents for clinical and operational workflows including care management, utilization management, risk coding, and quality gaps.
- Unified Data Platform
- Excell Consulting Services
Products and services
- Unified Data Platform Cloud-native, modular healthcare data integration and analytics platform that harmonizes fragmented clinical, claims, behavioral, and social data into actionable intelligence for health plans and providers. Powers event-driven workflows, real-time automated interventions, FHIR-API interoperability across 90+ EMR systems, and supports care for over 95 million lives.
- AgentFoundry Healthcare-native agentic AI platform offering pre-configured AI agents for clinical and operational workflows (Care Plan Recommendation, Prior Auth Review, Document Review, Benefits Review, Gap Closure, Risk Adjustment Coding) plus a no-code Agent Builder for custom healthcare agents, embedded in the Unified Data Platform with human-in-the-loop oversight.
- Care Management AI-enabled care management solution with Plan of Care, Guided Health Journeys, pharmacy care management, care gap closure, and digital HRA tools that connects health plans, providers, and members through a unified digital experience with personalized interventions and automated engagement.
- Utilization Management Solution that streamlines prior authorization and care review with AI-powered policy management, automated decision rules, smart workflow routing, integrated appeals/grievances, peer-to-peer scheduling, provider portal, and fax AI automation to reduce administrative burden.
- Quality Management HEDIS measures engine for quality management that supports retrospective and post-audit reviews, role-based administrator worklists to track performance, and chart audit review support accessing member clinical summaries from EMRs to close quality gaps.
- Risk Management Risk adjustment solution leveraging HCC risk models (CMS HCC v24 and v28), chart review workflows, missing code recapture, and suspect code recommendations to improve coding accuracy, documentation integrity, and reimbursement accuracy for risk-adjusted populations.
- Provider Enablement Provider portal with EMR interoperability via SMART on FHIR APIs, direct messaging to EMR, self-service request submission, and real-time population health intelligence and alerts for provider network collaboration.
- Patient Engagement Hyper-personalized member activation solution including targeted campaigns, scheduling, periodic check-ins, dynamic monitoring, personalized next-best actions, interactive secure chat, and educational content across omni-channels.
- Excell Consulting Services Healthcare consultancy offering strategic planning, interim leadership, program/project management, operational evaluation and transformation, business analysis, and change management services to drive clinical transformation for health plans and providers, delivered as part of MEDecision's solution suite.
Quantifiable outcome
- 10% reductions in ER utilization
- +5 more outcomes
Companies that use MEDecision
Customer profileNamed customers4 records
Segments4 records
Ideal customer profiles4 records
MEDecision technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
AI capability9 records
Feature7 records
MEDecision partnerships and signals
Strategic signalPartnerships
Two partnerships are on record, tiered core.
- Sendero Health PlanscoreMedecision announced a strategic partnership with Sendero Health Plans, a nonprofit HMO in Central Texas, to improve health outcomes and care coordination for Sendero's members. The collaboration utilizes Medecision's data and care management platforms to enhance regional health and reduce costs. This partnership demonstrates Medecision's focus on community-based health outcomes in Central Texas.
- Excell Healthcare AdvisorscoreMedecision completed the strategic acquisition of Excell Healthcare Advisors, a nationally-recognized healthcare consultancy with over 40 years of experience supporting healthcare organizations with clinical operations transformation. Excell specializes in clinical, operational, project management, training, and change management services, providing Medecision with embedded change management capabilities to support customer adoption and sustained utilization of its technology platform. Excell operates as a brand under medecision.com (excellha.com).
Scale indicators10 records
Recent moves6 records
Expansion highlights6 records
MEDecision competitors and assessment
Company assessmentOthers
- Datavant: Datavant is a healthcare data exchange and connectivity platform enabling clinical and claims data sharing across providers, payers, and life sciences. It is an ecosystem participant adjacent to MEDecision's FHIR-based interoperability and unified data integration capabilities.
Emerging players
- Color Health: Color Health provides population health, cancer screening, and virtual care platforms for employers, health plans, and providers. While narrower in scope, it represents an emerging player building AI-driven care navigation and population health tools overlapping MEDecision's patient engagement focus.
Direct peers
- Innovaccer: Innovaccer offers a unified healthcare data platform with AI agents, population health management, and value-based care tools for payers, providers, and government health plans. Its agentic AI roadmap and payer focus make it a direct competitor to MEDecision's AgentFoundry and Unified Data Platform.
- Health Catalyst: Health Catalyst is a leading provider of healthcare data and analytics enterprise SaaS, serving health systems and payers with a Data Operating System and analytics applications. It is one of the closest direct competitors to MEDecision in value-based care analytics and population health management.
- Arcadia: Arcadia provides a healthcare data platform with population health management, value-based care, and risk adjustment capabilities for payers and providers. It directly competes with MEDecision in unifying fragmented clinical and claims data to power care management workflows.
- Cotiviti: Cotiviti provides payment accuracy, risk adjustment, and quality analytics for health plans, with deep focus on Medicare Advantage and commercial payers. It overlaps with MEDecision's Risk Management, Quality Management, and UM modules in payer environments.
- Cedar Gate Technologies: Cedar Gate delivers value-based care analytics, population health, and payment transformation platforms for payers, providers, and employers. It directly overlaps with MEDecision's value-based contracting analytics and bundled payment use cases.
- Altruista Health (HealthEdge): Altruista Health, part of HealthEdge, provides care management, utilization management, and population health solutions for health plans. It is a direct competitor in care management workflows and member engagement for government and commercial payers.
Broad incumbents
- Salesforce Health Cloud: Salesforce Health Cloud is a broad CRM and patient engagement platform for payers and providers. It overlaps with MEDecision's Patient Engagement and Provider Enablement modules but as part of a horizontal cloud platform rather than a healthcare-native solution.
- Optum (UnitedHealth Group): Optum is UnitedHealth Group's health services and innovation arm, operating one of the largest healthcare data, analytics, and care management platforms globally. It is a broad incumbent competing across payer analytics, risk adjustment, and care management.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks1 record
Key highlights7 records
Customer concentration
MEDecision social profiles
Digital presenceMEDecision compliance and trust
Trust signalCompliance3 records
MEDecision financial estimates
Financial estimateRevenue estimate
Valuation estimate
MEDecision leadership team
Management profileNumber of profiles
Profiles9 records
MEDecision subsidiaries and ownership
Company hierarchySubsidiaries1 record
MEDecision funding detail
Funding detailFunding overview
Funding rounds2 records
Investors4 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
MEDecision M&A and investment
M&A and investmentM&A3 records
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about MEDecision
What does MEDecision do?
MEDecision provides a cloud-native, healthcare-specific Unified Data Platform and AgentFoundry agentic AI platform that integrate clinical, claims, behavioral, and social data from 90+ EMR systems to deliver care management, utilization management, quality management, risk management, provider enablement, and patient engagement solutions to health plans and providers. The platform is sold as a SaaS subscription with module-based configuration and supported by an embedded consulting arm (Excell Healthcare Advisors).
Is MEDecision a public or private company?
MEDecision is a private company. It is classified as corporate owned and is currently operating.
When was MEDecision founded?
MEDecision was founded in 1988. It employs 251 to 500 people.
Where is MEDecision based?
MEDecision is headquartered in Wayne, United States, in the North America region.
How does MEDecision make money?
One revenue line is on record: saaS/Platform Subscription.
Who are MEDecision's main competitors?
Datavant is listed as an others. Color Health is listed as an emerging player. Direct peers are Innovaccer, Health Catalyst, Arcadia, Cotiviti, Cedar Gate Technologies and Altruista Health (HealthEdge). Broad incumbents are Salesforce Health Cloud and Optum (UnitedHealth Group).
Does MEDecision have an API?
Yes. Medecision offers FHIR-API interfaces and SMART on FHIR APIs for integration with 90+ EMR systems, enabling payer and provider data exchange, prior authorization workflows, and interoperability with existing EHR systems. Developer documentation is at www.medecision.com/unified-data-platform.
What industry is MEDecision in?
MEDecision's product category is Healthcare Management Software. Its primary akta.pro industry code is HLACAHAA, Value-Based Contracting Analytics (ACO/MSSP/MA, shared savings/risk). Its NAICS code is 513210 and its SIC code is 7372.