Modivcare connects care across Hawaii in just 42 days
See how Modivcare modernized prior authorization for inter-island medical transportation in Hawaii.
from initial kickoff to live production
to align four complex user personas
The Business Issue
Modivcare manages non-emergency medical transportation (NEMT) – a vital lifeline for individuals who lack financial or physical means to travel to medical appointments. By partnering with state Medicaid programs and Managed Care Organizations (MCOs) – the healthcare organizations that administer government-sponsored health plans – Modivcare coordinates medical travel for members so that vulnerable individuals can get the care they need while continuing to live independently in their homes.
When a health plan partner needed a new approach to managing prior authorization across Hawaii, Modivcare faced an urgent five-month timeline to deliver a scalable, automated solution. But coordinating medical travel across an island geography presents considerable operational challenges. Honolulu might boast modern seven-lane highways, but switchback roads are the reality in the islands’ remote, rural areas. Getting a path to care for members in these locations often requires coordinating commercial flights, hotel stays, meal allowances, personal care assistants, and specialized ground transit like wheelchair or stretcher vans.
Frontline coordinators managed complex, multi-stage travel for members with often urgent medical needs. Because booking flights and hotel lodging represented a significant financial commitment, tight controls were essential. But those controls were fragmented and slow. Four distinct user groups – medical providers, Modivcare reviewers, payer approvers, and logistics coordinators – each worked within different systems, governed by different rules, and connected through manual handoffs.
When members must travel across islands for time-critical care, every approval bottleneck and disconnected workflow potentially translates to patient risk. Modivcare needed a system that could handle approvals automatically and plan rules instantly, ensuring members weren’t left waiting for vital care.
The Solution
For Modivcare, the solution required connecting a vast, multi-tiered network spanning commercial airlines, hotel vendors, rideshare partners, and specialized transit fleets. Modivcare deployed Pega Platform™ and reused out-of-the-box healthcare capabilities within Pega Customer Service™ for Healthcare, creating a shared foundation for managing prior authorization workflows and approvals.
To stay within a tight timeline, Modivcare transformed its development approach using Pega Blueprint™. The company brought product, business, and technology teams together to align around workflows, personas, and integration requirements. Using Pega Blueprint, the team visually mapped end-to-end user journeys, persona handoffs, and system integrations in real time.
Frontline coordinators and reviewers walked through visual workflows early in the design phase to provide direct feedback. Removing any ambiguity around requirements before development began eliminated the risk of costly rework downstream. Modivcare defined integration points up front and maintained strict agile governance, enabling development to launch just 15 days after the initial kickoff.
The Results
Just 27 days after development began, Modivcare went live in production, completing the entire digital transformation in 42 days. The platform passed its operational launch smoothly, managing multi-tiered authorizations and logistics coordination without a single day’s delay.
This rapid execution earned Modivcare the inaugural Pega Blueprint Delivered Success Award at PegaWorld 2026, celebrating its operational discipline and rapid time-to-value. By taking advantage of out-of-the-box Pega assets and visual blueprinting, Modivcare compressed months of standard design work into a two-week visual alignment phase.
Hard metrics validate the impact. Modivcare aligned four complex user personas in 15 days, started development on day 15, and deployed to production on day 42. The system instantly enforced health plan rules consistently across air, hotel, and ground logistics. For health plan members, the software transformation was completely invisible – the ultimate proof of a successful solution. Vulnerable members experienced zero friction, receiving rapid prior authorizations and seamless travel arrangements to access life-sustaining medical care.
Beyond solving the immediate challenge in Hawaii, Modivcare created a repeatable framework to help the enterprise start building for change. The project provided the foundation for Modivcare to transition from a traditional software development model to an AI-driven lifecycle (AI-DLC). By using spec-driven development and Pega’s flexible architecture, Modivcare now synthesizes complex operational rules into repeatable AI-assisted workflows, preparing the organization to reimagine and run its healthcare operations for the future.
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“Pega Blueprint allowed us to provide our business partners with visual requirements that they could easily look at and see ‘Yes, this is exactly what I want.’ Or ‘No, we need to tweak that a bit.’ Removing ambiguity from the requirements early in the process made moving to development and then to a scalable production system a lot easier and faster.”