The stakes are high for healthcare management leaders as pressures mount to improve operational performance, cut costs, and maintain or increase market share in a dramatically changing marketplace. Now more than ever, health plan managers and healthcare providers need healthcare management solutions that have proven their value on the front lines of today’s healthcare industry.


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The Total Economic Impact of the Pega 7 Platform

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.

Pegasystems: Healthcare Management Solutions to Improve Performance and Reduce Costs

Leading healthcare organizations turn to Pegasystems to help them improve service quality while also cutting costs. In fact, 13 of the 14 largest U.S. healthcare payers use a Pega healthcare management system, as do over half the Blues plans.

Pega healthcare management solutions streamline and automate healthcare business processes to drive out inefficiencies, shorten cycle times, reduce errors, and enforce compliance. With Pegasystems business process management (BPM) technology, business users can model, test, and implement automated business processes without any need for programming. The system executes the program code automatically, based on business objectives and workflows that users configure through an intuitive graphical interface.

To accelerate your time to value, Pega’s Better Business Software™ supplements its core BPM platform with a variety of pre-built healthcare management solutions targeted toward pressing needs in today’s healthcare industry. These easily customizable healthcare solutions automate and optimize sales and enrollment, customer service, marketing and retention, claims processing, care management, and more.

Customer Successes with Pega Healthcare Management Solutions

Healthcare payers and providers that adopt Pegasystems healthcare management solutions consistently gain clear, measurable returns on their investment. For example:

  • Using Pega technology to automate sales and enrollment for a new prescription drug plan, CSC enrolled over a million members in less than a year while generating $1 billion in revenue and earning a #1 rank for customer satisfaction.
  • A regional BCBS plan used Pega software to reduce new program development cycle time by 75% and cut enrollment process time by 80%.
  • Amerigroup eliminated multiple systems in favor of a Pega-powered integrated customer service desktop, boosting CSR productivity by 15% and enabling Amerigroup to support its 22% growth with 4% fewer agents.
  • A Midwest BCBS employed a Pega healthcare claims processing solution to increase straight-through-processing rates by 38% and reduce claims late payment fees by 90%.
  • A large Blues used Pega health information systems to implement a Health Savings Account (HSA) claims processing solution in which 97% of claims are processed without staff intervention.
  • Alere Health used Pega technology to power its new CareAlerts health management system which reduced HEDIS gaps by 63% and boosted medication adherence by 56%.


Learn more about Pega’s on-premise and cloud-based healthcare management solutions.