In recent years healthcare managers and IT staff have seen operational challenges grow well beyond what can be handled by legacy healthcare solutions. Profound changes in the healthcare purchasing marketplace, a squeeze on profit margins, shifts in care delivery models and payment models, and layer upon layer of complex regulation are some of the major healthcare management challenges facing today’s health payers and providers. Fortunately a new generation of healthcare solutions built on modern healthcare management technology is now available to help healthcare organizations thrive even in today’s demanding environment.


CRM Evolved

Can you keep up with always-improving technology and ever-growing customer demands? See how CRM evolved helps your business do more, faster.


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.

Healthcare Solutions from Pegasystems

Pega’s Better Business Software™ delivers business process management (BPM) and customer relationship management (CRM) platforms that simplify and automate your business processes and customer service functions so you can reduce costs and boost operational agility. For healthcare payers and providers, Pega offers a comprehensive suite of healthcare management solutions built on our industry-leading Build for Change® platform. 13 of the 14 largest U.S. healthcare payers use Pegasystems BPM and CRM healthcare solutions to improve efficiency in their daily operations.

Pegasystems offers proven healthcare solutions for critical business functions including:

  • Product creation. Accelerate your ability to design, test, approve, and implement new benefits and products.
  • Marketing, sales, and enrollment. Leverage marketing and salesforce automation and real-time analytics to make the right offer to the right prospect at the right time; and streamline and automate the customer on-boarding process based on best practices.
  • Claims processing. Automatically correct problematic claims to reduce the need for manual intervention and increase first pass rates. Automate routing, prioritization, and correspondence generation to cut costs and boost claims processor productivity.
  • Customer service. Automatically provide your customer service representatives with the real-time information and guidance they need to efficiently meet customer needs while also advancing company objectives and policies.


Pegasystems also offers purpose-built healthcare solutions that apply intelligent automation to care management, Medicare and Medicaid program management, regulatory compliance management, and appeals and grievance processing.

Healthcare Solutions Build for Change

All our healthcare software systems leverage Pega’s innovative Build for Change® technology. With Build for Change technology you can create custom healthcare software applications without having to do any programming. Simply specify your business requirements, and the system automatically generates the programming code to support those requirements. Build for Change technology empowers business users and enables your organization to adapt quickly to changes in your business objectives, the marketplace, or the regulatory environment.

Learn more about Pegasystems healthcare solutions.