Pegasystems Helps Healthcare Insurers Optimize Customer Experience, Loyalty, and Care Coordination

Pega’s upgraded Customer Process Manager for Healthcare solution enables payers to deliver omni-channel customer experience to handle rapidly emerging demands in retail and care management

CAMBRIDGE, Mass. – June 17, 2014 – Pegasystems Inc. (NASDAQ: PEGA), the software company powering the digital enterprise with Better Business Software®, today announced enhancements to its Customer Process Manager for Healthcare (CPM-HC) solution that enhance service delivery to members and providers, and improve the user experience.  The solution can be leveraged by healthcare payers to increase customer satisfaction and sales opportunities, and facilitate the entry into new markets.

Key new features and benefits for healthcare payers include: 

  • Enhanced Member Composites – Access to comprehensive member information plus a new message and alerts capability provide a better guided interaction for agents and an improved customer experience for members.
  • Distinct Provider and Practitioner Relationship Management – Expanded data models and workflows provide faster access to critical information from provider organizations and individual clinical practitioners to drive higher quality patient care.
  • Social Interactions – Social interactions can be installed and added to the agent portals to enhance visibility of relevant customer tweets and Facebook posts. A tab combines both Twitter and Facebook posts, providing agents with more visibility and more effective management of customer social interactions.


The enhanced solution enables healthcare insurers to better navigate the turbulence of health reform, rising consumerism, and quality of care initiatives.  Many payers are facing these critical challenges with inflexible and outdated CRM solutions that are unable to handle the complexity of the healthcare industry and hamper their ability to deliver consistently high-quality and differentiated customer service. Pega’s CPM-HC helps payers better engage with members, simplify work for staff, and effectively change as their business changes.  The ability to create consistent omni-channel user experiences (UX) through “design once-deploy everywhere” models reduces operational costs and provides users with a consistent experience regardless of device or operating system. 

The solution enables payers to capitalize on newer technologies and communicate via the preferred channels of their members and providers. Capabilities include an omni-channel UX that opens payers’ applications to mobile and social channels with consistent, attractive and intuitive experiences across all channels. Additionally, Pega Live Data simplifies the use of data in business processes, ensuring that agents have access to the right data, in the right place, at the right time. New case lifecycle management capabilities intuitively mirror the way agents and executives approach opportunities to increase efficiency and production.

Pega technology is used by many leading healthcare enterprises, including four Fortune 50 healthcare companies, 13 of the 15 largest healthcare payers, more than 65% of the Blues network, many leading providers, and most of the largest pharmacy benefit managers. 

Quotes & Commentary:

“Today’s healthcare organizations are undergoing rampant change,” said Susan Taylor, Business Line Leader for Healthcare at Pegasystems.  “They face a constantly changing regulatory environment, increased competition and a far more demanding customer base.  They have also had to change their business models to address the Affordable Care Act.  With such a fluid landscape, healthcare organizations need the power to change quickly to address evolving business requirements.  Our enhanced solution helps organizations future proof their operations and meet their immediate needs today.”

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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

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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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