Skip to main content

We'd prefer it if you saw us at our best. is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice

Case Study

Blue Shield of California reimagines the digital healthcare experience

  • Launched Health Reimagined initiative to transform healthcare system
  • Partnered with Pega to build connected member experiences
  • Improved agent and member satisfaction

"What really separates Pega is their ability to deliver and seamlessly integrate with multiple systems."

The Business Issue

Blue Shield of California is an independent member of the national Blue Cross and Blue Shield Association, serving more than 4.5 million members.

In response to the growing issues of rising healthcare costs and fragmented member experiences, Blue Shield of California launched Health Reimagined, an ambitious plan to transform the healthcare system with innovative ideas and new technologies that improve quality while making care more affordable.

Health Reimagined focuses on three key aspects:

  1. Developing safe and effective care support technology that streamlines the provider and member experience.
  2. Defining a personal care model that is patient centric, data driven, and evidence based.
  3. Providing a holistic health experience.

The Solution

Blue Shield of California partnered with Pega to build a connected member experience and proactively engage with members to close care gaps using a multi-channel strategy.

The Pega Platform™ provides automation and workflow capabilities for customer outreach. It also measures customer engagement across channels and allows Blue Shield to monitor, report, and configure each member’s journey.

Using Pega Customer Decision Hub™, the insurer has implemented next-best-action configuration that anticipates members’ needs and provides an opportunity for Blue Shield to engage members proactively.

The Results

Some of the key operational benefits that Blue Shield of California has realized since implementing Pega include:

  • Reduced average handle time
  • Improved agent satisfaction
  • Improved member satisfaction
  • Improved first call resolution rates
Share this page Share via x Share via LinkedIn Copying...

Related Resources

Case study

See how Anthem achieved an 11-point increase in NPS over 90 days.

Data sheet

Transform healthcare engagement, efficiency, and self-service.


See why healthcare engagements should be personalized, prioritized, and preemptive.

Pega Customer Service

Create a simple, consistent customer experience anywhere.
Learn more


Industry: Healthcare Product Area: Customer Service Solution Area: Customer Engagement Solution Area: Customer Service
Share this page Share via x Share via LinkedIn Copying...