Overview
Healthcare organizations are being challenged to meet the changing needs of their customers. Whether driven by the need to be more consumer-centric, quickly respond to a global pandemic (Covid-19) or create new categories of reimbursement for managing a patient’s care, the need to embrace digital transformation is at the core.
Integrated care management strategies include a comprehensive consumer-centric view that connects navigation, case, disease, and utilization management programs to improve the communication and collaboration of all the participants in the care journey. Pega Care Management’s inherited capabilities from Pega Customer Service for Healthcare makes it uniquely positioned to support organizations that are focused on digital transformation, and driven to improve their engagement, clinical, financial, and operational performance.For payers
- A comprehensive approach includes end-to-end utilization management that is integrated with certified industry leading guidelines
- Program Management that covers referral, intake, and management through program closure
- Care team collaboration that keeps the member at the center of all care
- HL7 FHIR integration to break down care silos and share data between EMRs and the payer
- Compliance with regulatory standards, such as timeliness to action, HIPAA-compliant data usage,and other standards
- Identification and reduction of care gaps and Social Determinants of Health
For providers
- HL7 FHIR integration to break down care silos and share data between EMRs and navigators
- Navigation Management includes referral, intake, and management through program closure
- Assist in addressing Social Determinants of Health
- Regulatory compliant Discharge management process
For Life Science
- Program Management that covers referral, intake, and management through program closure
- Configurable site-specific workflows
- Questionnaire development to support baseline and ongoing trial experience
Pega Care Managements consumer-centric focus delivers the ability to crush the complexity of comprehensive patient car and rapidly configure and deploy agile and diverse solutions. This enables healthcare organizations to act proactively, manage the rising costs of healthcare, and improve the overall quality of care and outcomes.
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