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Using Pegasystems’ SmartBPM® solutions, healthcare organizations have achieved rapid and measurable value:

• PDP Seizes New Market in Record Time
  Deployed in under 90 days, Pegasystems’ BPM technology provided the platform that allowed the Prescription Drug Plan to grow its Medicare Part-D business from $0 to $1 billion in less than a year; increasing enrollment to over a million members while at the same time earning the #1 ranking in customer service and significantly reduced staffing levels, average call times, and training costs.
• Regional Blues Plan Leapfrogs Peers in Claims Processing Performance
  Suffering an unanticipated explosion in claim inventories and lengthy processing cycle times as a result of a large adjudication system conversion, a regional Blues Plan deployed Pegasystems’ Healthcare Claims Solution Suite for both its IPP and local claims. The company’s substantial success using Pegasystems to optimize claims – including 90% automated resolution for targeted pended claims, 62% improvement in claims processor productivity, and 31% improvement in cycle time for pended claims processing – led the company to expand Pegasystems’ BPM technology to both its middle office (for utilization management) and its front office (for underwriting and customer service) where similarly impressive results were achieved.
• National PBM Deftly Handles Phenomenal Growth
  Experiencing exponential growth of over 100% per year for several years in row, a national Pharmacy Benefits Manager (PBM) deployed Pegasystems to automate its prior-authorization processing for prescription drugs. The PBM dramatically reduced costs and improved customer service including 44% improvement in handling time and 55% reduction in cost per case after deploying Pegasystems’ BPM technology.
• Major Hospital System’s Compliance Transformation Leads to Operational Success
  Dealing with the effects of non-compliant processes, a major hospital system completely transformed itself around a values-based ethics program. The key was to operationalize new policies and procedures by putting practical guidelines and alerts at the fingertips of clinicians, staff, and management – rather than in dusty, 3-ringed binders – and integrating these guidelines into day-to-day medical decision-making. Pegasystems was put in place to unify these efforts under one cohesive, agile platform. The new solutions support the company’s stringent goal of delivering healthcare that is considered compliant when it meets each of eight different requirement categories, including patient rights, medical necessity and billing. The systems utilize Pegasystems industry-leading BPM technology, support adherence to the ethics program as well as efficient monitoring and reporting, both internally and to regulatory agencies.