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Case Study

Alere: 96% Member Satisfaction Across 4 Million Members

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Speed to Returns with Agile Technology

“A business-focused rules engine was crucial so that we could reduce our time to market,” says Lesley Brown, executive vice president of product management at Alere. Pega provides actionable analytics, using clinical data and guidelines to identify care gaps. The system selects and composes more than 10,000 recipient-appropriate messages based on just 100 rules. Messages may be sent through multiple channels, such as clinician desktops, fax, secure email, and member portals. The technology allows the solution to be easily tailored by health plans and large employer groups for managing common care gaps, including: prevention, medication adherence, and the health effectiveness data and information set (HEDIS), which is used by over 90 percent of U.S. health plans. “We knew Pega would be a great fit for CareAlerts because it makes complicated rules transparent with a language that can be easily understood by non-technical users,” says Sameh Ebeid, vice president of application development.

Reducing Gaps in Care by over 60 Percent

Pega has delivered the agile processes and dynamic case management Alere required. “Because Pega lets us shift control from IT to business, we have not only reduced our operating expenses, but also achieved the timeliness and scalability needed to better service our clients and members,” Brown says. In use by nearly 4 million members for over one year, CareAlerts is already helping close care gaps. “Overall, we are seeing nearly a third of the gaps closed in a 12-month period, which is a lot,” says Brown; the rate is 63 percent in the HEDIS performance category. Members and providers both give high marks to the program: 96 percent of members express satisfaction and 83 percent say the messages helped them better manage chronic conditions. “We knew Pega would be a great fit for CareAlerts because it makes complicated rules transparent with a language that can be easily understood by non-technical users.” Sameh Ebeid Vice President of Application Development, Alere Alere,


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