Key new features and benefits for healthcare payers include:
•Enhanced Member Composites - Access to comprehensive member information plus a new message and alerts capability provide a better guided interaction for agents and an improved customer experience for members. •Distinct Provider and Practitioner Relationship Management - Expanded data models and workflows provide faster access to critical information from provider organizations and individual clinical practitioners to drive higher quality patient care. •Social Interactions - Social interactions can be installed and added to the agent portals to enhance visibility of relevant customer tweets and Facebook posts. A tab combines both Twitter and Facebook posts, providing agents with more visibility and more effective management of customer social interactions.
The enhanced solution enables healthcare insurers to better navigate the turbulence of health reform, rising consumerism, and quality of care initiatives. Many payers are facing these critical challenges with inflexible and outdated CRM solutions that are unable to handle the complexity of the healthcare industry and hamper their ability to deliver consistently high-quality and differentiated customer service. Pega's CPM-HC helps payers better engage with members, simplify work for staff, and effectively change as their business changes. The ability to create consistent omni-channel user experiences (UX) through "design once-deploy everywhere" models reduces operational costs and provides users with a consistent experience regardless of device or operating system.
The solution enables payers to capitalize on newer technologies and communicate via the preferred channels of their members and providers. Capabilities include an omni-channel UX that opens payers' applications to mobile and social channels with consistent, attractive and intuitive experiences across all channels. Additionally, Pega Live Data simplifies the use of data in business processes, ensuring that agents have access to the right data, in the right place, at the right time. New case lifecycle management capabilities intuitively mirror the way agents and executives approach opportunities to increase efficiency and production.
Pega technology is used by many leading healthcare enterprises, including four Fortune 50 healthcare companies, 13 of the 15 largest healthcare payers, more than 65% of the Blues network, many leading providers, and most of the largest pharmacy benefit managers.
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"Today's healthcare organizations are undergoing rampant change," said
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