I’m very excited at the progress we’ve made using PCS to assist in streamlining the processes associated with product build management.
- Configured 250 medical products in five weeks
- Made source of record for claim engine and self-service portals
- Cut update configuration time by 50%
The Business Issue
CareFirst needed to speed its product delivery, while significantly reducing process redundancy. Siloed teams at the healthcare payer configured products and benefits in two different systems: the company’s claims engine and its enterprise benefit system, creating a barrier to providing a consistent member and provider experience.
CareFirst’s vision was to introduce a solution that would serve as a unified repository for its products and a standard set of benefits that could be exported to its claim engine and benefit quoting operation systems.
CareFirst selected Pega’s Product Composer System (PCS) for Healthcare to achieve its business goals: improve accuracy, reduce time to market, and decrease the complexity of benefit administration. PCS’s healthcare-specific context and ability to support the complexities of healthcare products was a critical feature to ensuring CareFirst met its objectives.
CareFirst was able to code its products and benefits in PCS and leverage the capabilities of the Pega 7 platform to create automated processes to extract configuration data in the format required by its enterprise systems, increasing speed and accuracy. What once was a manual process, was now automated, traceable, and reportable.
Upon implementation, CareFirst was able to configure 250 medical products in five weeks that were compliant with the Affordable Care Act. The organization saw a 50% uplift in time to market and 50% reduction of work effort. As a result, CareFirst broadened its original scope ofjust utilizing PCS to manage its 2016 ACA medical product portfolio, and now plans
To date, CareFirst manages more than 800 products in PCS and is expanding its configuration efforts to include its large group product markets, which are adjudicated by an alternative legacy claims engine.