What keeps healthcare payer executives awake at night? The simple answer is change.

Every single day, change creates significant challenges in:

• Growing the top line; managing the bottom line
• Remaining compliant with federal and state regulations
• Meeting the requirements of service-level agreements
• Ensuring consistent growth in the number of covered lives
• Meeting the demands of consumer-driven healthcare
• Maintaining a competitive edge
• Managing complex provider collaborative relationships
• Ensuring high-quality member products and services
• Keeping employees satisfied
• Managing costs and risk in the member population
• Integrating and maximizing the value of IT resources
• Coordinating the care continuum

At healthcare payer organizations, the only thing you know for sure is that change is constant.

Pegasystems not only can help payers survive change, but help them Build for Change®. With Pegasystems' rules-driven SmartBPM® solution frameworks, payers can become more agile and experience new levels of growth, productivity, and compliance.

For more information about Pegasystems' industry solution frameworks for payer organizations, please click on the links below:

• Member Services™ — customer-interaction solution framework
• Provider Services™ — customer interaction solution framework
• Claims Workstation+™ — claims management solution framework
• Claims Repair™ — automated claims-adjudication solution framework
• Appeals and Grievance Manager™ — complaint-management solution framework
• Sales Process Manager™ — sales-channel management for health plans
• Healthcare Payer Industry Framework™ — foundation for rapidly deploying personalized solutions across healthcare organizations

For more information about other healthcare industry segments that Pegasystems serves, please click on the links below:

• Provider Organizations
• Pharmaceutical Industry
• Government Agencies

Learn how businesses use SmartBPM to achieve new levels of growth, productivity and compliance.
  
Payer Improves Patient Care and the Bottom Line

Payer Streamlines Clinical Procedure Authorization

Significant Benefits Gained by Sales Campaigns Tied to Life Events

Large Regional Payer Takes Control of Member Complaints

Payer Streamlines Appeals and Grievances Process

Healthcare Payer Handles Leap in Membership - with Lower Costs

Provider Credentialing Process is Significantly Improved