Pegasystems Enhances Suite of Healthcare Applications for More Proactive, Personalized Healthcare

CAMBRIDGE, Mass. – February 4, 2019 – Pegasystems Inc. (NASDAQ: PEGA), the software company empowering digital transformation at the world’s leading enterprises, today announced enhancements to its suite of healthcare applications, including Pega Care Management, Pega Customer Service for Healthcare, and Pega Marketing, that create a seamlessly connected, unified healthcare engagement platform. This platform provides a more collaborative, transparent environment to deliver proactive, personalized patient and member experiences that improve engagement and health, as well as clinical and business outcomes. 

As healthcare organizations strive to compete in a digital world, many are still encumbered by siloed, legacy systems that create frustration and disrupt outreach, care, and disease management. Part of the Pega Infinity suite of digital transformation solutions, Pega’s healthcare solutions are now available as a fully unified platform, providing a comprehensive view into the entire health experience – from disease and care management to customer service interactions and outreach – so providers and payers can create fully connected experiences, accurately document entire health journeys, and quickly resolve issues from end-to-end to improve health and business outcomes. New features include:  

• Enhanced, holistic customer views: AI-powered dashboards analyze historic and contextual data and events, and recommend the next best action to take for individuals to improve engagement and care. This includes post-procedure outreach, early intervention when a member’s risk scores increase, and appointment reminders, delivered in real time as needed. 
• Seamless, secure experiences: Customer data is presented with role-based security to maximize service effectiveness while preventing unauthorized data access. Updates to the member/patient’s entire journey are visible at a level determined by security privileges (i.e. a service agent will be aware an individual recently visited a care provider, but not the specifics). This enables all users to best understand how to interact with individuals and achieve faster resolution. Assessments, prior authorizations, and program referrals can be performed easily by a customer service agent or a care team member as needed.
• Not just proactive, but preemptive service: Powerful AI capabilities analyze patient and member data to recognize engagement opportunities and anticipate issues before they arise. If a patient has an upcoming appointment and has previously missed appointments or has a transportation barrier, a care navigator can proactively provide a rideshare voucher with a reminder about what to expect once they arrive.  
• Advanced engagement capabilities: Fully-integrated capabilities help organizations determine appropriate individual communications (i.e. a patient in hospice care should not receive an outreach for a wellness program). Pega’s self-optimizing campaigns offer powerful AI that personalizes outreach on the fly for individuals while simplifying outreach and campaign development. Health plans can also now arbitrate between high priority plan communications and lower priority wellness campaigns during the U.S. Medicare Advantage open enrollment window, for example, to ensure appropriate outreach. 
• Self-service capabilities for fast resolution: Self-service capabilities enable patients and members to handle actions like IoT data sharing, benefit inquiries, provider selection, and wellness program enrollment without engaging with a representative. Pega’s chatbots respond quickly and provide detailed responses, while natural language processing capabilities identify issues and sentiment and either automate responses, or seamlessly reroute to an agent.  

Pega currently works with the largest global healthcare companies to help them achieve their digital transformation and customer engagement goals. For more information, visit Pega at HIMSS19 from February 11-15 in Orlando, Florida, Booth #3626.

Quotes & Commentary
“Healthcare is personal, so organizations need to do everything they can to give patients and members a seamless, personalized, and compassionate experience during each point of contact. However, the industry still struggles to provide frictionless end-to-end patient journeys,” said Kelli Bravo, vice president and industry market lead, healthcare and life sciences, Pegasystems. “Pega’s fully unified suite of healthcare applications will not only make it easier to interact with patients and members, it will – most importantly – help create better health outcomes.”