Pega Care Management enhancements improve transparency for payers and providers for better patient outcomes
New features help healthcare industry meet growing expectations in new era of healthcare consumerism
Pegasystems Inc. (NASDAQ: PEGA), the software company empowering digital transformation at the world’s leading enterprises, has announced enhancements to Pega Care Management that improve transparency and care effectiveness between payers and providers for optimal patient care. These updates help ensure patients receive the most personalised engagement and care during every interaction within their healthcare network.
The U.S. healthcare industry is entering a new era of healthcare consumerism, with patients more involved than ever before in their healthcare decisions. The industry is now shifting to a more human-centric model of care built on powerful and accessible technology, proactive engagement, open markets, and transparency. However, many healthcare organisations are struggling to keep pace, causing patients to switch providers in search of more responsive care.
Pega Care Management, part of the Pega Infinity suite of digital transformation solutions, now offers the following features to optimise patient engagement across the care continuum:
• Improved delivery of personalised, proactive care: While historically, payers and providers did not have full access to each other’s data, Pega Care Management now enables organizations to view the application through a payer or provider mode to access data such as demographics, claims, and authorization data, as well as clinical profiles with vitals, labs, medications, and history.
• Easier creation and delivery of tailored care plans: Pega Care Management now offers easier reusability of clinical content, common workflows, policies, and procedures to expedite the creation of compliant, personalized care plans.
• Maximised business agility: Pega Care Management provides a number of new capabilities to help make organizations more nimble, such as:
o Automated authorizations and pre-authorizations, correspondence, alert generation, notifications, and interventions that streamline care tasks and interactions;
o Low-code visual tools that enable seamless collaboration between business and IT, enabling business users to rapidly develop and customize standardized care plans and workflows with minimal IT assistance;
o Robotic automation capabilities that assist clinical staff with non-clinical tasks such as gathering data from external party websites used for clinical decision making, while automatically pulling regulatory information for optimal care.
Pega Care Management is a unified platform that enables care teams to deliver innovative, patient-centric programs across case, disease, utilization, and wellness management. The solution optimizes care planning, engagement, communications, operations, and reporting to deliver the highest quality, most cost-effective management possible. Pega works with many of the largest global healthcare and life sciences companies to help them achieve their digital transformation and one-to-one engagement goals.