Streamline the Delivery of Personalized, High-Touch Care Programs

The challenge: Healthcare organizations face huge increases in service utilization from an aging and increasingly unhealthy population at the very moment when reform-based mandates demand dramatic improvements in efficiency and cost curves. This requires an agile organization that can quickly respond to the needs of the individual while driving costs down at every opportunity.

Pega delivers the ideal solution for transforming care management operations. The solution offers a unified portal for utilization and case management, automating time-consuming functions such as authorizations, pre-authorizations and discharge planning. It provides an effective way to personalize the delivery of disease management and wellness programs as well, providing numerous self-service vehicles and adjusting recommendations and advice in real time to account for the unique patient and situation. And it is all delivered on a flexible foundation for clinical rules that can be authored and delivered across a wide range of end-users.

With Pega, healthcare organizations can engage in truly person-centric care management while successfully addressing a full range of business needs and industry regulations, such as meeting Medical Loss Ratio or Accountable Care Organization requirements, simplifying readmissions, improving CMS star rankings and increasing the effectiveness of home health options.

• Improve health outcomes. Real-time decisioning and enterprise case management facilitate high-touch, personalized care plans to deliver the right care to the right person based on individual needs, clinical best practices and organizational policies.
• Reduce costs. End-to-end process automation orchestrates all of the people, channels, data and systems required to automate tasks, alerts and correspondence, eliminating manual hands-offs, reducing errors and increasing compliance.
• Increase productivity. Rules-driven processes guide staff through complex interactions to ensure the consistency of decisions and adherence to accepted protocols while automating the application of specialized requirements.
• Differentiate your service. Sophisticated predictive and adaptive analytics combined with Next Best Action decisioning enable customized care programs for distinct customer populations, enhancing brand value, promoting consumer engagement and increasing savings.

Customer Success
	With Pega, Alere's Disease Management empowers chronically ill individuals by connecting the widest range of health management solutions, devices and diagnostic tests, resulting in improved health and productivity and lower healthcare costs. Alere's Disease Management Program (video) - See for yourself what the participant experiences in Alere’s Disease Management Program and how they were able to achieve an 8% reduction in costs for heart failure participants. Empowering Alere Health's Apollo, A Personalized Health Management System - This IDC Health Insights Perspective highlights how Alere Health leveraged Pega’s unified platform to create Apollo, an integrated health management system and highly personalized health portal. Driving Success in Collaborative Health (video) Successful collaboration across the numerous participants in the healthcare ecosystem is happening. Check out this clip from AHIP Institute 2011 featuring IDC Health Insights, Alere Health and Pega.
	Streamlined Prior Authorizations at Smart Blues Health Plan A leading Blue Cross and Blue Shield plan followed up its success with Pega for claims processing to automate its medical management process. By streamlining authorizations, the Plan has significantly cut response times while achieving 100% authorization accuracy.
	A Fast-Growing PBM Transforms Prior Authorization A major pharmacy benefit manager has transformed its prior authorization system with Pega’s business process automation and real-time decisioning, resulting in a 55% reduction in cost per authorization, double-digit increases in contact center productivity and the delivery of more customer-centric service to each member.