Science & Technology
Science and TechnologyScience and Technology 
Tue, February 22, 2011
Mon, February 21, 2011
Pegasystems Helps Payers Meet U.S. Government Healthcare Cost-Cutting Mandates
CAMBRIDGE, MA--(Marketwire - February 21, 2011) - [ Pegasystems Inc. ] (
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.
Quotes & Commentary:
Joanne Galimi, Research VP, Gartner (from report titled "Key Issues for Healthcare Payers, 2011")
"The customer experience is reaching a crunch point for many healthcare payers. Customer churn due to one poor customer experience is increasing. Customer expectations continue to rise, and customers are increasingly willing to share their poor experiences online. At the same time, more payer executives believe that the customer experience will make their organizations unique, leading them to try to differentiate themselves with a superior experience."
Janice Young, Program Director, IDC Health Insights
"Healthcare payers' ability to meet reform medical loss ratio, cost control, and clinical effectiveness targets requires better customer partnership and retention."
Elizabeth Hart, Principal, Healthcare Solutions at Pegasystems
"Virtually every other industry is ahead of healthcare in providing consumer-focused capabilities and superior customer service. Reform is moving healthcare firmly to the consumer market and it's crucial for healthcare payers to leverage advanced technology in order to succeed. Pega's proven healthcare-specific solutions efficiently deliver enhanced service capabilities, driving down costs while improving customer satisfaction and retention. Plus, with Pega's Build for Change® technology, the solutions are easily modified to respond to ongoing changes in the healthcare market."
Supporting Resources:
For more information, visit [ http://pega.com/resources/customer-process-manager-for-member-services ] and [ http://pega.com/resources/customer-process-manager-for-provider-services ].
To read more about Pega healthcare customers' successes, visit: [ http://www.pega.com/solutions/by-industry/healthcare/customer-success ]
For more information on Pega's healthcare-targeted solutions, visit: [ http://www.pega.com/industries/healthcare/bpm-for-healthcare.asp ] and [ http://www.pega.com/industries/healthcare/frameworks.asp ]
To hear more about the CPM-HC solutions' impact on cost and service, please attend Pega's breakout session at the [ Gartner Customer 360 ] Summit on March 31, at the JW Marriott in Los Angeles, Calif. The session will feature Mark Knutson, VP, Customer Service at Prescription Solutions, a UnitedHealth Group Company.
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About Pegasystems
Pegasystems, the leader in business process management solutions and a leading provider of CRM solutions, helps organizations enhance customer loyalty, generate new business, and improve productivity. Our patented Build for Change® technology speeds the delivery of critical business solutions by directly capturing business objectives and eliminating manual programming. Pegasystems enables clients to quickly adapt to changing business conditions in order to outperform the competition. For more information, please visit us at [ www.pega.com ].
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