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Healthcare hero

Pega Care Management Application

Improve health outcomes.

"Going forward, Pega is like our conductor. It's the orchestrator of our systems."

Care Management
Care Management
Video duration: 02:08

Get to know Pega Care Management Application

care management software that provides personalized health plans for patients

Bring data to life with
personalized care plans

Each patient has their own health journey. Pega Care Management delivers a unique combination of managed care best practices and real-time connected data. Personalized care planning empowers care teams and patients to drive optimal outcomes across all settings.

care management software that provides clinical guidelines

Improve outcomes with
clinical guidelines

Pega promotes best practices to help lower costs and improve health outcomes. Certified integrations with MCG and Optum/Change Healthcare, standard clinical guidelines, and local business rules inform and guide clinical care teams as they manage patient needs and requests across the continuum of care.

Screenshot of Pega's unified process for care management

Empowered population health

Drive efficiency with a unified process across utilization management, disease management, care management, and health and wellness. Pega provides easy access to patient profiles, plan benefits, claims, authorizations, clinical, along with embedded GenAI coaching, providing opportunities to promote population health programs.

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      care management software that provides health risk management for patients

      Reduce gaps in care with
      health risk assessments

      Drive a system of coordinated heath care assessments, interventions, and communications for defined patient populations. Leverage advanced AI for next best action to identify and support personalized self-care efforts to produce quality outcomes, all while boosting organizational HEDIS and Star scores.

      care management software that provides cloud services

      Adapt and comply with
      on premises or on cloud

      Pega Cloud Services enable healthcare organizations to accelerate business objectives while meeting requirements for performance, data security, and HIPAA compliance. Immediate access allows you to rapidly create, test, deploy, and manage applications.

      Additional Product Features

      Pega’s integrated platform enables the collaboration essential to quality care management.

      Reporting Outcomes

      Reports provide insights for organizations see opportunities to improve operational excellence.

      Fulfillment and Letter Generation

      Pega simplifies sending educational materials and letters for health and wellness programs.

      Integration with External Vendors

      Connect the internet of medical devices with care teams so abnormal value alerts become actionable.

      Automate intelligent appeals, grievances, and complaints management.

      Clinical Assessments

      Everything from standard federal program assessments to short, actionable pain assessments included.

      Flexible, Configurable Reporting

      Business users can configure their own reports to see exactly the data they want and need.

      Direct integration with Pega’s Customer Decision Hub to predict customer needs, personalize every interaction, and deliver across channels.

      Leveraging top-rated customer service, Pega Care Management is not just integrated with, it is designed and built on top of Pega’s Customer Service for Healthcare.

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