Pega Care Management Enhancements Improve Transparency for Payers and Providers for Better Patient Outcomes

By STS News Desk On Oct 30, 2019

Pega Care Management Enhancements Improve Transparency for Payers and Providers for Better Patient Outcomes

New features help healthcare industry meet growing expectations in new era of healthcare consumerism

Pegasystems Inc., the software company empowering digital transformation at the world’s leading enterprises, announced enhancements to Pega Care Management that improve transparency and care effectiveness between payers and providers for optimal patient care. These updates help ensure patients receive the most personalized engagement and care during every interaction within their healthcare network.

The US healthcare industry is entering a new era of healthcare consumerism, with patients more involved than ever before in their healthcare decisions. The industry is now shifting to a more human-centric model of care built on powerful and accessible technology, proactive engagement, open markets, and transparency. However, many healthcare organizations are struggling to keep pace, causing patients to switch providers in search of more responsive care.

Pega Care Management, part of the Pega Infinity suite of digital transformation solutions, now offers the following features to optimize patient engagement across the care continuum:

Improved delivery of personalized, proactive care:

While historically, payers and providers did not have full access to each other’s data, Pega Care Management now enables organizations to view the application through a payer or provider mode to access data such as demographics, claims, and authorization data, as well as clinical profiles with vitals, labs, medications, and history. This allows departments within an organization to access different views to fully understand patient context and provide the best care and service possible. Data and workflows automatically adjust based on the user with compliant, role-specific guidance, goals, task alerts, potential issues, and interventions. Additionally, users can access fully integrated marketing outreach and engagement strategies within the application, which provide next-best-action recommendations for patients.
Easier creation and delivery of tailored care plans:

Pega Care Management now offers easier reusability of clinical content, common workflows, policies, and procedures to expedite the creation of compliant, personalized care plans. Content is intelligently applied across business units, channels, and geographies, improving coordination and work routing across teams for interventions, escalations, tasks, alerts, and goal management. Pega has also extended its content library to include even more information for patients, such as clinically appropriate educational materials, organizational policies, and community program information.
Maximized business agility:
Pega Care Management provides a number of new capabilities to help make organizations more nimble, such as:
- Automated authorizations and pre-authorizations, correspondence, alert generation, notifications, and interventions that streamline care tasks and interactions;
- Low-code visual tools that enable seamless collaboration between business and IT, enabling business users to rapidly develop and customize standardized care plans and workflows with minimal IT assistance;
- Robotic automation capabilities that assist clinical staff with non-clinical tasks such as gathering data from external party websites used for clinical decision making, while automatically pulling regulatory information for optimal care.

Pega Care Management is a unified platform that enables care teams to deliver innovative, patient-centric programs across case, disease, utilization, and wellness management. The solution optimizes care planning, engagement, communications, operations, and reporting to deliver the highest quality, most cost-effective management possible. Pega works with many of the largest global healthcare and life sciences companies to help them achieve their digital transformation and one-to-one engagement goals.

Quotes & Commentary

“Consumerism is driving an immediate need in the healthcare industry to improve the way care is managed and delivered. To collectively move to a human-centric model, healthcare organizations need intelligent tools that enable personalized and compassionate interactions throughout a patient’s healthcare journey,” said Kelli Bravo, vice president and industry market lead, healthcare and life sciences, Pegasystems. “These new enhancements to Pega Care Management provide clients with more transparency and business agility than ever before so they can stay focused on what’s most important – creating better health outcomes.”