Pega Care Management Application

KEY CHALLENGE

Payers and providers alike continue to struggle with the ever-changing and complex rules for prior authorizations as well as the need to provide personalized case management that ensures coordination of services and engagement activities to drive health outcomes. Operations across these two disparate areas are as diverse as the legacy technologies supporting the work. As organizations struggle to realize the goal of enabling each staff member to work at the top of their training, they encounter barriers of multiple, legacy siloed systems. New technology is needed to automate appropriate workflows to eliminate unnecessary work and increase the value of work and add real-time intelligence so that every staff member is always doing the most valuable work..

THE SOLUTION

The Pega Care Management solution enables care teams to accelerate access to care, personalize care, deliver innovative, patient-centric programs and maintain compliance across regulatory and business rules. Leveraging Pega’s best-in-class workflow automation and AI-powered decisioning, the solution optimizes care planning, engagement, communications, operations and reporting to deliver the highest quality, most cost-effective management possible.