Fallon Community Health Plan Deploys Pegasystems to Address and Go Beyond Affordable Care Act Mandates

Top-ranked health plan in the United States implements Pega technology in five months with innovative programs to help address government regulatory changes.

CAMBRIDGE, Mass. – November 19, 2013 – Pegasystems Inc. (NASDAQ: PEGA), the leader in Business Process Management (BPM) and a leading provider of Customer Relationship Management (CRM), today announced that Fallon Community Health Plan (FCHP) has implemented Pegasystems to help meet requirements of the Affordable Care Act (ACA).

By using Pega, FCHP was able to turn the October 1, 2013 federal deadline into an opportunity to improve business operations and provide better service. FCHP used Pega to help comply with ACA’s mandates for member-level rating and execute Health Insurance Exchange requirements. They successfully exchanged HIPAA-based electronic information with the Massachusetts Health Connector within four months of selecting Pega, and released a new broker portal called QuoteNow, just one month later. While consumers across the country have experienced difficulties using sales and enrollment portals for the Federal Exchange, Healthcare.gov, FCHP has been accepting applications and enrolling members, since open enrollment officially started. QuoteNow streamlines health insurance application and enrollment activities, provides best practice quoting, rating and underwriting and offers many new features to FCHP’s broker community.

Fallon Community Health Plan is a nationally-recognized, not-for-profit health care services organization. In addition to being the highest-ranked Medicaid health plan in the U.S., FCHP’s commercial and senior products are in the top 10% in the country (according to NCQA’s 2013-2014 rankings).

Pega is used cross-functionally across the healthcare enterprise by five Fortune 50 healthcare companies, 18 of the 25 largest U.S. health payers, more than 65% of the Blues network, many leading provider organizations and most of the largest pharmacy benefit managers.

Quotes & Commentary:

“The scope of the Affordable Care Act is so immense that the glitches which have arisen so far are not a surprise. Fallon Community Health Plan’s approach, embracing Pega’s technology to use the changes as an opportunity to help improve their business operations, has been brilliant,” said Susan Taylor, VP and Business Line Leader, Healthcare for Pegasystems. “Fallon Community Health Plan embodies how an agile organization can adapt for growth when using the benefits of Pega.”

“FCHP takes seriously our obligation to be a part of the solution when it comes to health care reform,” said David Przesiek, Senior Vice President and Chief Sales Officer at Fallon Community Health Plan. “Realizing that there are tremendous opportunities to work more efficiently and improve workflow, we’ve partnered with Pegasystems not only to work smarter, but to promptly respond to the needs of our external customers  including brokers, employers  and individual consumers. Through Pega technology, we’re able to enhance our customers’ experience and exceed their expectations for service.”

Supporting Resources:  



  • Pega customer FCHP video – Leveraging ACA as a catalyst for change


About Pegasystems

Pegasystems (NASDAQ: PEGA) develops strategic applications for marketing, sales, service, and operations. Pega’s applications streamline critical business operations, connect enterprises to their customers seamlessly in real-time across channels, and adapt to meet rapidly changing requirements. Pega’s Global 3000 customers include many of the world’s most sophisticated and successful enterprises. Pega’s applications, available in the cloud or on-premises, are built on its unified Pega 7 platform, which uses visual tools to easily extend and change applications to meet clients’ strategic business needs. Pega’s clients report that Pega gives them the fastest time to value, extremely rapid deployment, efficient re-use, and global scale. For more information, please visit us at www.pega.com.

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The information contained in this press release is not a commitment, promise, or legal obligation to deliver any material, code or functionality. The development, release and timing of any features or functionality described remains at the sole discretion of Pegasystems, Pegasystems specifically disclaims any liability with respect to this information.


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