Customer Relationship Management (CRM)

Promote Your Brand with the Ideal Service Experience

Bob's Customer Journey: Healthcare

The challenge: Retail healthcare is on our doorstep. The shift to individually purchased health coverage presents real market opportunity – and real risk, as more consumers will be free to change plans and provider networks at will. Healthcare organizations need advanced technology to move quickly beyond the limitations of traditional CRM technologies that cannot handle mass personalization while also safeguarding quality and consistency.

With Pega CRM, every customer interaction becomes an opportunity to enhance your brand by delivering the personalized service consumers want while simultaneously increasing efficiency throughout your service operations. Uniquely, Pega delivers advanced CRM that combines the strength of customer relationship management, business process management, flexible business rules, dynamic case management and real-time analytics with a unified platform to tailor each interaction to the individual, situation, channel, line of business and care setting. The result is dynamic interactions that deliver personalized service at production-line costs. With Pega, healthcare organizations can thrive in the world of retail healthcare, protecting and growing market share by addressing both consumer needs and cost-containment objectives.

  • Increase one-and-done service calls. Unified multi-channel interaction management and intent-led processes guide representatives through each step.
  • Add value during service interactions. Proactively triggered retention, wellness and cross-sell offers based on such factors as the consumer’s profile, responses and history deliver a personalized experience that increases consumer engagement.
  • Promote self-service and shared accountability. Intuitive self-service portals provide automated guidance and a universal customer view to facilitate better self-management.
  • Optimize the experience. Business-focused tools rapidly turn service strategies into intelligent processes without any coding. Measure, simulate, adapt and change performance strategies in real time to immediately refocus the service experience.

Learn more: Customer Process Manager for Member Services and Customer Process Manager for Provider Services data sheets

Customer Success

Amerigroup Enhances Customer Care with an Integrated Desktop (case study)

Pega is the power behind Amerigroups’s integrated desktop, which has eliminated the need to use multiple systems and automatically applies the appropriate regulations for Medicaid members and providers across eleven states.  In use by 700 customer care associates and nurses for member and provider services, authorizations, claims research and issue resolution, the Pega solution has delivered at 15% reduction in clinical average handle time and has doubled productivity in the claims unit.

Amerigroup - Redefining Customer Centricity (podcast)

Lynne Ecker, AVP, Technology Services and Leona Rickerson, Director, National Customer Care, at Amerigroup discuss how using Pega in the national contact centers for business processes like member and provider services, claims issue resolution and pre-certifications among other processes, has improved service and driven down costs.

Customer must be king in the web world (Financial Times article)

In the US, Amerigroup, a healthcare company, found its customer care centres were becoming bogged down by isolated systems and complex workflows that drove up operating costs, hampered growth and stopped the company from being able to deliver consistent service. Using Pega, average call handling time has been cut by 15 per cent, training time has been reduced and regulatory compliance has improved.

TriWest's Customer Service Receives 5th Consecutive J.D. Power Certification

TriWest—the Department of Defense (DoD) contractor that administers TRICARE, the military's health care entitlement, in 21 western states—handles about 20,000 phone calls daily across its six contact centers. Providing military families and medical providers with “An Outstanding Customer Service Experience” has earned TriWest Healthcare Alliance its fifth-consecutive J.D. Power and Associates certification.

Capturing a New Market in Record Time

Deployed in under 90 days, this Pega solution enabled CSC to deliver a prescription drug plan that has grown its client’s Medicare Part-D business from $0 to $1 billion in less than a year. The organization has increased enrollment to over a million members while significantly reducing staffing levels, average call times and training costs.

 

Fast, High Quality Service with Pega

One of the largest managed care organizations in the U.S. provides care through its extensive network of physicians, hospitals and medical offices. Using Pega to implement a comprehensive customer service solution that offers a 360-degree view of patients, the organization has increased first-call resolution by more than 90% while cutting average handle time and training time by 20%.