Pegasystems Enables Healthcare Organizations to Increase Quality of Care While Driving Down Clinical Resource Costs

SOURCE:  Pegasystems

Pegasystems Inc. (NASDAQ: PEGA), the leader in business process management (BPM) solutions, today unveiled new capabilities for its care management solution, which enables healthcare insurers, hospitals and pharmacy benefit managers to reduce utilization costs and deliver higher quality care.  Pega’s patient-centric solution automates more of the creation, use and on-going improvement of personalized care management programs, allowing increased productivity for case managers, nurses and physicians, and improved satisfaction for patients.

Amid market pressures from healthcare reform mandates and the need for more effective coordinated care planning, healthcare organizations need to reduce costs and complexities while continuing to deliver higher quality care.  They must adopt innovative approaches that allow them to not only meet these increased demands, but also excel in a more competitive industry.  By unifying utilization management, disease/protocol management, case management, as well as health and wellness across the healthcare enterprise, this new solution gives care professionals the ability to provide more holistic care, and more effectively comply with new mandates.  They can also collaborate in real-time for unified care management across the entire network.

Built on Pegasystems’ Build for Change^® technology, the Care Management solution significantly reduces the cost of care management program development.  The latest version, which features program design accelerators and more tightly embedded workflow integration with industry-leading clinical guideline systems, builds upon broad protocol and disease management strengths to enable interactive, intent-led personalized care planning that allows mass-customization for care plans tailored to each person’s needs.  The solution enables medical directors, chief nursing officers and medical staffs to more easily navigate often-conflicting mandates.

Offering the only care management solution based on industry-leading BPM technology, Pega solutions are widely used by major healthcare organizations including seven of the eight largest US health plans, two of the five largest healthcare providers, two of the four largest pharmacy benefit managers, as well as US government agencies at the state and federal level.  Healthcare transactions for more than one of every two Americans, including members from over 60 percent of the Blues network, are processed with Pega technology.

Quotes & Commentary:

Janice Young, Program Director, IDC Health Insights

“Although there are a few healthcare organizations that are thinking strategically about ways to connect, reach and reach out to consumers better, for the most part, silo’d behavior still prevails – perhaps due to locked in technology legacy contracts or long standing legacy business practices.  When ready, though, healthcare payers will find new investments and strategies among a number of technology companies to support a more integrated consumer management strategy.  There have been announcements of initiatives attacking this problem by technology vendors over the past 12 months, including Pega…”

Dr. Peter Angood, international expert on patient safety who serves as President and CEO, PBA Solutions Insight, LLC, and Senior Advisor, Patient Safety at National Quality Forum

“The healthcare industry continues to refine and narrow its collective focus on improving patient safety and quality of patient care.  This ongoing change requires the management of clinical cases across the care continuum – in a well-coordinated, intelligent process. That means physicians, nurses and other non-physician ancillary providers, as well as utilization managers and case managers – essentially everyone who interacts with patients – need to collaborate and deliver on a personalized care plan for each patient.  Pega’s flexible and adaptable approach is well-suited to meeting this need.”

Bill Marshall, Principal, Healthcare Industry Solutions at Pegasystems

“Payers, providers and pharmacy benefit managers alike have recognized a clear need to improve care planning and mitigate growing risks as they deliver effective care management programs.  They want to ensure the best possible level of care, while still being mindful of the associated costs.  Our agile technology gives them an invaluable tool to achieve this objective.”

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