Medicare.dev

Medicare.dev is the home of the Codify System, a proprietary and sophisticated AI engine designed to transform the landscape of value-based care. It addresses a fundamental challenge in healthcare: the gap between identifying a patient's needs and efficiently executing a coordinated, evidence-based care plan. The system operates on a powerful 5-step framework that automates the translation of natural language health descriptions into dynamic, adaptive clinical pathways. This is not merely a data tool; it is an end-to-end orchestration platform that defines problems, generates structured protocols, assembles specialized virtual care teams, guides patient execution through a personal AI agent, and verifies outcomes for accountability and payment. Built for healthcare payers, providers, and care coordination organizations, Medicare.dev's core value proposition lies in its ability to systematize complex care management, reduce administrative burden, ensure protocol adherence, and ultimately, drive better health outcomes at a lower total cost by closing the loop between care planning and verified results.

The 5-Step Codify AI Engine

This is the core proprietary technology that structures the entire care management process. It begins by analyzing unstructured patient data to define the precise health problem and eligible programs. It then automatically codifies this into a structured clinical protocol with defined KPIs and branching logic for different patient responses. This engine is what enables the automation and intelligence behind every subsequent feature, ensuring care is not just planned but dynamically adapted.

Automated Clinical Pathway Generation

Moving beyond static guidelines, this feature dynamically creates structured, step-by-step care protocols tailored to the individual's defined problem. These pathways include key performance indicators (KPIs) for measurement and built-in branching logic that allows the pathway to adapt based on patient progress or setbacks, ensuring the care plan remains relevant and effective throughout the engagement.

AI-Driven Care Team Assembly

Once a pathway is established, the system intelligently matches the case to a network of qualified specialists and healthcare professionals. It automatically assembles the optimal virtual care team for the task, assigning specific roles and responsibilities. This eliminates manual coordination overhead and ensures the right expertise is applied to each patient's unique situation from the outset.

Personal AI Agent for Patient Guidance

Execution is managed through a dedicated AI agent that guides the patient through their personalized care program. This agent acts as a 24/7 coach, adapting instructions in real-time to patient failures or changes in condition, providing reminders, tracking progress against KPIs, and offering support. This continuous guidance increases patient engagement and adherence to the prescribed pathway.

Chronic Disease Management Programs

Health plans and provider groups can deploy the Codify System to automate and scale management for populations with conditions like diabetes, hypertension, or CHF. The AI defines the patient's status, generates a personalized management pathway, assembles a team of dietitians, nurses, and specialists, and uses the AI agent to guide daily patient behaviors, verifying outcomes for improved HbA1c or blood pressure control.

Post-Hospitalization Discharge and Readmission Prevention

The system can be activated at discharge to create a tailored recovery pathway. It defines risks like medication non-adherence or mobility issues, generates a home-based rehab protocol, assembles a team of home health aides and physical therapists, and uses the AI agent to ensure the patient follows wound care, medication schedules, and exercise plans, verifying recovery to prevent costly readmissions.

Complex Case Coordination for High-Need Patients

For patients with multiple, interacting chronic conditions, the platform cuts through complexity. It analyzes the full picture to define the most pressing integrated problems, generates a coherent, multi-specialty care plan that avoids conflicting advice, assembles a coordinated team from various disciplines, and guides the patient through a unified program, verifying outcomes across all conditions.

Value-Based Contract Fulfillment and Reporting

For organizations operating under risk-based contracts, Medicare.dev provides the operational backbone. It systematically defines patient cohorts, executes evidence-based pathways at scale, and, crucially, verifies outcomes with auditable data. This closes the loop from intervention to result, enabling accurate quality reporting, performance bonus attainment, and efficient distribution of funds based on achieved outcomes.

What is the "Codify System"?

The Codify System is Medicare.dev's proprietary 5-step AI engine. It is the core technology that transforms a simple description of a health need into a fully automated and adaptive clinical care pathway. The five steps are: Define the Problem, Codify the Solution, Assemble the Team, Execute the Program, and Verify the Outcome. This end-to-end process ensures care is systematically planned, delivered, and measured.

How does the AI "Define the Problem"?

The AI engine uses natural language processing to analyze patient descriptions, clinical notes, and other unstructured data. It identifies the core health issues, contextual factors, and matches them against known clinical criteria and eligible care programs. This step moves from vague symptoms or needs to a precise, actionable problem definition that the rest of the system can act upon.

Who is the primary user of the Medicare.dev platform?

The primary users are healthcare organizations rather than individual patients. This includes Medicare Advantage and Medicaid health plans, Accountable Care Organizations (ACOs), provider groups, and digital health companies. These organizations use the platform to design, deploy, automate, and scale structured care management programs for their member or patient populations.

What does "Verify the Outcome" mean in practice?

This is the critical final step that ensures accountability and closes the loop. The system confirms that the KPIs and goals set in the care pathway have been met through data collection and analysis (e.g., lab results, patient-reported outcomes, device data). This verification triggers the next actions, such as progressing the patient to a maintenance program or facilitating value-based payments to the care team, linking results directly to compensation.