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Healthcare Management

Healthcare management leaders today face multiple pressures that may seem difficult to reconcile. In the typical healthcare organization, managers are being asked to improve quality and consistency of service, comply with aggressive regulatory mandates and cut costs.


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.

Increasingly, progressive healthcare organizations are finding that the most effective way to meet these objectives is to apply a high degree of intelligent automation to healthcare management processes.

The benefits of automating healthcare management processes

Pegasystems is a leading provider of business process management (BPM) and customer relationship management (CRM) software systems. Pega’s Better Business Software™ enables organizations in healthcare, finance, insurance, manufacturing, and other industries to simplify, streamline and automate their core business processes and customer service functions.

Pegasystems healthcare software intelligently integrates and coordinates all of the people, systems, and data involved in a healthcare management process. In a typical process, a variety of tasks can be automated including workflow management (routing, prioritization, queuing, and escalation), generation of notifications and alerts, generation of patient/member correspondence, retrieving data from or writing data to existing systems, and evaluation of cases against defined criteria.

Intelligently automating healthcare management processes can help your organization to:

  • Cut costs by reducing the amount of staff time spent on a given process, and by reducing staff training requirements.
  • Reduce cycle time for a given process.
  • Eliminate errors associated with manually performed tasks.
  • Enforce consistency across different personnel and offices, thereby increasing compliance with corporate policy and government regulations.
  • Apply all relevant information to the handling of a case or a customer interaction.

An automated health management system also creates a comprehensive audit trail that supports your needs for compliance, reporting, and analytics.

Healthcare Management Automation Solutions from Pegasystems

In combination with our industry-leading Build for Change® platform, Pegasystems offers solution frameworks pre-built specifically for healthcare management. These healthcare management solutions accelerate your time-to-value by providing you with healthcare-specific data models, workflows, and user interfaces, while also being simple to extend and customize to meet your organization’s particular preferences and objectives.

Pegasystems offers pre-built healthcare solutions for key process areas including:

  • Healthcare product development
  • Sales and enrollment
  • Customer service
  • Marketing and retention
  • Care management
  • Claims processing
  • Medicare and Medicaid program administration
  • Compliance
  • Appeals and grievance processing

Pegasystems healthcare management technology is available for on-premise deployments, with assistance and guidance from our expert professional services team. Or for the ultimate in convenience and rapid time-to-value, you can use our healthcare solutions as a service in the Pega cloud.

Learn more about Pegasystems solutions for automating and optimizing healthcare management.

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