Serving Beneficiaries

The MedExpert Solution

MedExpert’s strong experience in assisting clients with their Medicare populations—especially those in underserved and low-income areas—has shown considerable success in preventing disease and promoting wellness with an advanced outreach system of proven effectiveness. The success of this model, recognized in 2012 by the Centers for Medicare and Medicaid Services (CMS) through selection from more than 3,000 applicants with a prestigious Innovations Award, provides a firm foundation for analysis, outreach, medical education, chronic disease management, coaching, and behavior programs.

According to validated results with Medicare recipients, MedExpert is the only organization in the United States able to deliver a cost-effective, triple-aim solution to an entire population:

  1. Improve medical outcomes;
  2. Improve the health status of an entire population, and;
  3. Reduce costs for the total population.

MedExpert lets beneficiaries base today’s health care decisions on today’s information and protects the integrity of the Medicare system by electronically delivering EOMB to Medicare beneficiaries; identifying overutilization; identifying erroneous billings; identifying provider practice patterns; and identifying provider billing patterns. Independent and unconflicted, MedExpert puts the beneficiary and the payer first, reducing costs by up to an astounding 20%.

For our Medicare suite, products are broken into two categories:

Direct Decision Support (DDS)

Medical Management

Case Management


Member Navigation

Member Advocacy

Medicare populations grow healthier and less resource-intensive through a DDS component that easily keeps pace with today’s frenetic pace of innovation while advocating for beneficiaries and helping them navigate the complex healthcare ecosystem.

On-staff doctors and nurses communicate the latest findings and health care intelligence in language your beneficiaries can understand and act on — often from the comfort of their own homes. Beneficiaries avoid unnecessary and duplicative tests and procedures when MedExpert is there to guide them to the most effective care paths in coordination with beneficiaries’ primary physicians. Emergency room use and unnecessary surgeries are reduced significantly when MedExpert becomes part of your population’s health ecosystem.

MedExpert’s DDS works at the level of the beneficiary by infusing any medical decision—from losing weight to radical surgery—with the most current, accurate, and unbiased quality information available today. This is made possible because of the speed and power of AI, without which such a distillation of medical knowledge would take days, weeks, or more. Instead, MedExpert surfaces actionable information within minutes. Key to this process is the fact that the technology itself is essentially invisible to patients: the platform is utilized by MedExpert’s on-staff doctors and nurses, who then present this fully customized medical state of the art to beneficiaries using their preferred language, unburdened by medical jargon. With MedExpert, your beneficiaries now have the power of access to the world’s leading practitioners and researchers.

In legacy models, DDS is split among uncoordinated efforts at disease management, care coordination, case management, transition care, lifestyle management, patient advocacy, and patient navigation. MedExpert’s DDS not only fuses these elements, it accelerates them to align with the pace of human decision-making. And, critically, MedExpert makes this new generation of comprehensive DDS services cost-effective. A traditional suite of fragmented tools costs anywhere from $28 to $230 per person per month. With the power of our AI-assisted unified platform, MedExpert can provide deeper, more powerful DDS for $5 to $8 per person per month. The gains of a unified, automated platform are not additive, but exponential.

Data & Oversight

Data from Everywhere

Data Today

MedExpert’s DAS provides administrators with a data analytic system that allows for near-instantaneous insight into cost containment and quality improvement efforts.

MedExpert extracts, translates, loads, verifies, authenticates, and maintains all medical, pharmaceutical, dental, vision, claim, and encounter data from all data sources servicing the population. Eligibility data is coupled with payer data from Medicaid, managed care organizations, children’s health insurance, prescription drug plans, and dental insurers, among others.

This secure, on-demand data system provides Medicaid administrators with powerful analytics on current data, right away. Indeed, MedExpert is distinguished by integrating and normalizing data within 24 to 72 hours of receipt. This means you can query the system for activities that occurred last week. You no longer need to wait weeks and, in some cases, months to learn from your own data.