Today’s healthcare managers are looking for two key operational benefits from using a healthcare management system: efficiency and agility. Operational efficiency is a top objective because in the current profit-constrained healthcare environment, reducing the costs associated with core healthcare management processes is a must. At the same time, healthcare professionals want agility from a healthcare management system because they operate in a context of profound change in regulation, customer expectations, and healthcare technologies.


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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.

Many leading healthcare organizations have found that the company best able to deliver the efficiency and agility-boosting healthcare management technology they need is Pegasystems.

The Pega Platform for Fast, Flexible Automation of Healthcare Management Processes

Pega’s healthcare management system is built on the Pega Build for Change® platform, the #1 business process management (BPM) solution for the digital enterprise. The Pega BPM platform is distinguished by its ease of use, flexibility, and ability to transform business processes to reduce costs while improving quality. With a healthcare management system based on the Pega platform you can:

  • Easily model business processes, objectives, and rules through a graphical interface that’s intuitive for business users as well as IT.
  • Have the system automatically translate business requirements into finished applications, without any need for programming.
  • Automate work, to include not only workflow management but also applying real-time analytics to automate decisions or to guide decisions made by process participants.

Pega’s Healthcare Management System Solutions

On top of the core Pega platform, Pega offers a range of solution frameworks for specific areas of healthcare management. These Pega healthcare solutions jump-start your own custom application creation by providing you with pre-defined, healthcare-specific data models, workflows, decision tables, and user interfaces.

With health management system solutions from Pega, your organization can:

  • Design and implement new and innovative healthcare products.
  • Market your products across multiple channels, improve sales performance, and on- board new members/patients.
  • Create and execute care management programs for diverse patient populations, leveraging real-time automated health information systems.
  • Deliver outstanding, personalized customer service that adheres to organizational policies while leveraging real-time analytics to maximize the value of the customer relationship.
  • Optimize high-volume claims processing operations to boost first-pass rates, increase productivity, and cut costs.
  • Ensure that processes comply with ever-changing government regulations.
  • Design and manage Medicare and Medicaid programs


Pega’s health management system solutions scale to meet the needs of the largest healthcare enterprises. 13 of the 14 largest U.S. healthcare payers use Pega technology to control costs and enhance service quality, as do more than half of the Blues plans.

Learn more about how a Pega healthcare management system can help make your operations more efficient and agile.