Pegasystems Helps Payers Meet U.S. Government Healthcare Cost-Cutting Mandates

CAMBRIDGE, Mass. – February 21, 2011Pegasystems Inc. (NASDAQ: PEGA), the leader in business process management (BPM) solutions, today unveiled a significant upgrade to its customer relationship management (CRM) offerings.  With Pega’s Customer Process Manager for Healthcare, organizations can deliver on new reform-mandated cost efficiencies while also providing superior customer service consistently across all communication channels.

New mandates including medical loss ratio (MLR) requirements and other reform-based cost constraints are forcing healthcare payers to produce dramatic operational efficiencies and shift their cost curves.  These cost limits are being imposed at the same time that customer service is becoming the predominant market differentiator and transactional volumes are rising.


The anticipated spikes in healthcare transactions, driven by 35 million new and previously uninsured members entering the market and more than half the market now in a position to switch plans if they want, will result in exponential increases in service inquiries, claims, bills, and authorizations. This will further pressure healthcare payers’ ability to ensure quality while containing costs. 


As a recognized industry leader, Pega enables healthcare organizations to meet these challenges by automating manual processes and delivering a more personalized customer experience across channels, lines of business, and service needs.  Pega solutions are now in use on more than 20,000 healthcare desktops.  Payers using Pega have reported up to a 30-percent increase in first call resolution, 20-percent greater elimination of duplicate calls, and 40-percent improvement in throughput for service requests. 


To see the new solution, please visit Pega at Booth #2581 at HIMSS, at the Orange County Convention Center, Orlando, Fla.


Pega’s solutions are widely used by major healthcare organizations including seven of the eight largest US health plans, two of the four largest pharmacy benefit managers, several leading healthcare delivery systems, and US government agencies at the state and federal level.  Healthcare transactions for more than one of every two Americans, including members from over 60 percent of the Blues network, are processed with Pega technology.


Quotes & Commentary:

Joanne Galimi, Research VP, Gartner (from report titled “Key Issues for Healthcare Payers, 2011”)

“The customer experience is reaching a crunch point for many healthcare payers. Customer churn due to one poor customer experience is increasing. Customer expectations continue to rise, and customers are increasingly willing to share their poor experiences online. At the same time, more payer executives believe that the customer experience will make their organizations unique, leading them to try to differentiate themselves with a superior experience.”


Janice Young, Program Director, IDC Health Insights

“Healthcare payers' ability to meet reform medical loss ratio, cost control, and clinical effectiveness targets requires better customer partnership and retention.”


Elizabeth Hart, Principal, Healthcare Solutions at Pegasystems

“Virtually every other industry is ahead of healthcare in providing consumer-focused capabilities and superior customer service.  Reform is moving healthcare firmly to the consumer market and it’s crucial for healthcare payers to leverage advanced technology in order to succeed.  Pega’s proven healthcare-specific solutions efficiently deliver enhanced service capabilities, driving down costs while improving customer satisfaction and retention.  Plus, with Pega’s Build for Change® technology, the solutions are easily modified to respond to ongoing changes in the healthcare market.”


Supporting Resources:

For more information, visit and


To read more about Pega healthcare customers’ successes, visit:


For more information on Pega’s healthcare-targeted solutions, visit: and

To hear more about the CPM-HC solutions’ impact on cost and service, please attend Pega’s breakout session at the Gartner Customer 360 Summit on March 31, at the JW Marriott in Los Angeles, Calif.  The session will feature Mark Knutson, VP, Customer Service at Prescription Solutions, a UnitedHealth Group Company. 

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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