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Health Management System

Healthcare business professionals looking to purchase a health management system face something of a dilemma. The dilemma is that in today’s healthcare environment, an effective health management system must satisfy two conflicting needs: on the one hand, the system must impose a high degree of standardization on healthcare processes; and on the other hand, the system must be highly flexible.


Pega 7 provides tools for business people to define the major steps of how work gets done.

Analyst Report

Pegasystems commissioned Forrester Consulting to conduct a TEI study to examine the potential return on investment (ROI) enterprises may realize by deploying the Pega 7 Platform.

The Health Management System Challenge

To provide enduring value to healthcare organizations, healthcare software systems must drive standardization into business processes yet also provide process managers with a great deal of flexibility.

The standardization imperative that a healthcare management system must satisfy comes about for two reasons. The first is that because human health and lives are at stake, healthcare is an arena where the consequences of operational mistakes or departures from best practices can be severe. The second factor driving the standardization imperative for a health management system is that healthcare is one of the most highly regulated industries. Healthcare organizations face steep fines and damage to reputation if, for example, their health information systems fail to ensure that personal health information is handled in compliance with the dictates of HIPAA.

At the same time, a health management system must satisfy a flexibility imperative because the healthcare industry is undergoing profound change and will continue to do so for the foreseeable future. Some of the most far-reaching changes are driven by regulation, such as the Affordable Care Act and the requirement to convert to ICD-10 standards. Healthcare software systems must also be responsive to changes in the healthcare competitive landscape, customer expectations and demands, marketing and communication channels, the nature and scale of healthcare data, and more.

How Pega Solves the Health Management System Challenge

Fortunately for healthcare process managers, Pega’s healthcare management solutions meet the challenge of delivering both standardization and flexibility:

  • By intelligently automating healthcare operational processes, Pega health management systems drive standardization across the organization to ensure adherence to best practices and applicable regulations.
  • While standardizing processes, Pega healthcare management technology also delivers operational flexibility in two ways. First, Pega makes it fast and easy to create and update business process applications. The Pega Build for Change® platform directly captures business objectives that business users specify through an intuitive GUI; and the system then automatically generates an executable application based on the business objectives—no programming is necessary. Second, applications created on the Pega platform can be easily customized and differentiated for different regions, lines of business, products, channels, and so on, using the Pega Situational Layer Cake™ framework which overlays common, organization-wide elements with context-specific elements.

Pega Better Business Software® offers health management system solutions for all major healthcare operational areas including product design, marketing and sales, new customer on-boarding, claims processing, and more.

Learn more about how your organization can benefit from a Pega health management system.