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