Healthcare: Customer Success
Tab 1
- 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.
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Tab 2
2012: The year to 'Build for Change'
March 20, 2012 Health Management Technology
In Managed Care, Data Plus Integration Plus Rules Equals Information
March 7, 2012 Forbes
“We realized we needed to get some sort of integrated workstation. When we started looking, Pegasystems rose to the top rather quickly on the basis of its functionality," (said Russell R. Esposito, senior vice president for information technology services at Amerigroup).
Now call center reps work from Compass, an integrated workstation. Their training time has been reduced from 45 days to 20 to 25 days, and the average call from 6 minutes to 5, a 15 percent reduction with increase resolution on the first call. Read more »
Customer must be king in the web world
January 24, 2012 Financial Times
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. Read more »
The who, what and where of winning with business process improvement
November 23, 2011 SearchCIO.com
The use of Pegasystems Inc.'s BPM product lets Coffee's team bring applications to production much faster than they could before. "And our ability to make ongoing tweaks to the system has improved by orders of magnitude," he said. The technology lends agility to Tenet Healthcare's business process improvement efforts, but that agility in turn also results in rapid changes for users. Read more »
A New Era Promises Better Outcomes: BPM Systems are the Best Decision for Decision Support Software
October 27, 2011 Health Management Technology
Growing healthcare complexity and rising consumerism have come together to create a greater need for better decision-support tools – ones that are... Read more »
Disease Classification Changes Test Med Firms
October 18, 2011 Investor's Business Daily
"What we're seeing is that the groups who are ahead of the curve have recognized the enormity of the ICD-10 conversion," Bill Marshall, head of... Read more »
Pega Collaborative Healthcare Summit
October 1, 2011 IDC Health Insights
Pega has teamed with Partners Healthcare Center for Connected Health to bring you this thought leadership event. Attendees will learn how technology... Read more »
June 27, 2011 Health Management Technology
Today, every healthcare insurer needs high-performing claims operations. With strict medical loss ratios, growing rigidity around pricing, prior... Read more »
It's time for payers to build trust, partnerships with providers
June 21, 2011 Fierce Health Payer
The pros from Pegasystems agreed, adding that payers are more interested in collaboration than providers right now. Read more »
Health insurers must abandon silo mentality to profit from ACO model
June 19, 2011 Fierce Health Payer
Folks from Pegasystems shared this perspective. “The ACO is a piece of the larger puzzle helping drive collaboration,” Bill Marshall, principal,... Read more »
Use today’s tech to the maxJune 9, 2011 Healthcare IT News
For more than two years now, the focus of healthcare conversation has been on how the provider community will ensure “meaningful use” of electronic... Read more »
Meaningful Use: Are We doomed to Fail?
May 9, 2011 EMR Daily News
April 18, 2011 marked the latest milestone in the industry’s quest for meaningful use of electronic medical records (EHRs). That was the day the... Read more »
Case study: US pharmacy firm Medco deploys enterprise app store
April 6, 2011 Computer Weekly
Healthcare firm Medco, which provides pharmacy benefits for 65 million Americans, has introduced the concept of an iPhone-like AppStore for its... Read more »
Tenet Healthcare Boosts Agility And Adaptability With SmartBPM
March 31, 2011 BPM Institute.org
Coffee and his team spent six months researching solutions. The effort unearthed eight candidates, including several major BPM software providers.... Read more »
How Medco transformed its $65bn business: a Q&A
April 5, 2011 CBRonline.com
This month CBR caught up with Medco's VP of business process transformation Michel Dufresne, to find out more about the company's ambitious project,... Read more »
Vendor NotebookApril 29, 2011 Healthcare IT News
Pegasystems has unveiled new capabilities for its care management solution, which enables healthcare insurers, hospitals and pharmacy benefit... Read more »
Pegasystems introduces new CRM solution for healthcare payers
February 22, 2011 Pharmaceutical Business Review
Pegasystems, a provider of business process management (BPM) and customer relationship management (CRM) solutions, has unveiled its Customer Process... Read more »
Vendor NewsFebruary 17, 2011 Health Data Management
Pegasystems Inc., a vendor of business process management applications, has introduced a new revenue cycle management system for provider... Read more »
CRM for Healthcare Payers: Expanding to Care, Health and Wellness in the Reform Market
January 27, 2011 IDC Health Insights
Although there are a few healthcare organizations that are thinking strategically about ways to connect, reach and reach out to consumers better, for... Read more »
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