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Pegasystems Helps Payers Meet U.S. Government Healthcare Cost-Cutting Mandates

February 22, 2011 No Comments

SOURCE: Pegasystems

Pegasystems Inc. (NASDAQ: PEGA), the leader in business process management (BPM) solutions, today unveiled a significant upgrade to its customer relationship management (CRM) offerings.

With Pega’s Customer Process Manager for Healthcare, organizations can deliver on new reform-mandated cost efficiencies while also providing superior customer service consistently across all communication channels.

New mandates including medical loss ratio (MLR) requirements and other reform-based cost constraints are forcing healthcare payers to produce dramatic operational efficiencies and shift their cost curves.These cost limits are being imposed at the same time that customer service is becoming the predominant market differentiator and transactional volumes are rising.

The anticipated spikes in healthcare transactions, driven by 35 million new and previously uninsured members entering the market and more than half the market now in a position to switch plans if they want, will result in exponential increases in service inquiries, claims, bills, and authorizations. This will further pressure healthcare payers’ ability to ensure quality while containing costs.

As a recognized industry leader, Pega enables healthcare organizations to meet these challenges by automating manual processes and delivering a more personalized customer experience across channels, lines of business, and service needs.Pega solutions are now in use on more than 20,000 healthcare desktops.Payers using Pega have reported up to a 30-percent increase in first call resolution, 20-percent greater elimination of duplicate calls, and 40-percent improvement in throughput for service requests.

To see the new solution, please visit Pega at Booth #2581 at HIMSS, at the Orange County Convention Center, Orlando, Fla.

Pega’s solutions are widely used by major healthcare organizations including seven of the eight largest US health plans, two of the four largest pharmacy benefit managers, several leading healthcare delivery systems, and 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.

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