Industries

Pegasystems’ industry-leading SmartBPM® suite provides private and government healthcare organizations with applications for core functions.

 

Solutions In Action

Quick Solution Captures New Customers	CRM Grows to 98% Customer Satisfaction	Average Handling Time Cut by 26%	Safety, Compliance, and Automation
New Value Comes to Old Systems	Automation and Call Centers	Automatic Resolution Spurs New Productivity	Benefit Coding Compliance
Real-Time System Boosts CRM	Personalized and Responsive Service	Claims Processing Automated	Paperless System and CMS Compliance
Rapid Deployment for Member Surge	Personalized and Responsive Service	100% Straight Through Processing	Automated Claims Processing

What keeps healthcare industry executives awake at night? The simple answer is change

Every single day, healthcare leaders have to deal head-on with changes in:

• The competitive landscape
• The costs of providing quality care
• The needs of large employer groups
• The regulatory environment
• How to best ensure patient safety
• The demands of consumers for control of their care
• The best way to manage physician productivity
• How best to streamline support services
• How to integrate and deploy information technology
• How to manage capacity and use resources effectively

In healthcare, the only thing you know for sure is that change is constant.

As the pace of change increases, the rules change as well. When business operations are unable to change as quickly as management objectives and policies, it creates an execution gap. The signs of an execution gap in a healthcare organization may include lost staff productivity, slower service response, decreased stakeholder satisfaction, financial distress, loss of market share, or lower quality of care. It's enough to keep anyone awake at night.

Now you can Build for Change®.

Pegasystems has the answer for those sleepless nights.

Pegasystems' industry-leading BPM platform, PegaRULES Process Commander® (PRPC), enables healthcare organizations to automate and enhance a wide range of business and clinical processes for greater agility. PRPC enables continuous improvement by providing a full life cycle of application functionality — model, build, execute, and monitor.  This allows healthcare organizations to capture objectives, optimize processes and drive work to completion.

Leading healthcare organizations such as the Blue Cross Blue Shields of Massachusetts, Wisconsin, Vermont, Rhode Island, and Kansas City rely on Pegasystems to provide flexible, scalable BPM solutions that enhance their existing systems and deliver increasing value.

• Revenue Growth - Pegasystems' SmartBPM® gives healthcare organizations the agility they need to drive revenue growth, productivity, and compliance. Healthcare organizations can quickly capture best practices in member and provider services or in claims management. Build for Change® solutions enable healthcare organizations to move at the speed their markets and their competition require. They can bring new products and new offers to market quickly. Sophisticated procedural and declarative rules drive intent-driven customer support that completely satisfies all parties — members, providers, and employers.
• Productivity - SmartBPM is much more than mere workflow.  While it intelligently routes work to the right users, in many cases it actually does the work — calling on outside systems or third parties to research necessary information, resolving work with sophisticated decision rules, and adjusting multiple systems to drive work to completion. Healthcare organizations use SmartBPM to address a broad range of issues, from common customer service requests to completely automating claims adjudication. In doing so, they achieve straight-through processing, cut training times in half, realize dramatic productivity gains, and significantly reduce claims inventory.
• Compliance - SmartBPM not only captures healthcare organizations' best practices, but ensures they are applied consistently across the organization with write-once, use-anywhere simplicity, matched by patented rules-inheritance technology that ensures compliance with regulations (e.g., HIPAA) and employer service-level agreements. Pegasystems' SmartBPM is self-documenting and maintains a complete audit trail — not only of every piece of work, but of the rules that are applied to that work when it is performed. This is a discipline that's critical, given the scrutiny placed on business and clinical practices today.