This portal is built for a better customer experience by using the Pega-provided functions for care management, which leverage Pega’s industry-leading customer service capabilities. The Interaction portal is equipped with the latest technologies from the Pega Customer Service application thereby acknowledging that care management is a specialized form of customer service, resulting in a better-informed customer interaction.

The persona-based interaction portal defines work processes and associates the work with the appropriate role. Pega Care Management supports non-patient-facing and patient-facing operations. Pega Care Management organizes all the activities and participants around the patient. The Patient 360 captures detailed information including the following:

• Demographics
• Care gap data
• Predictive scores
• Program enrollments
• Open requests
• FHIR-compliant clinical data (lab results,biometric information, and EMR data)
• Recent claims (medical and pharmaceutical)
• Authorized contacts
• Care teams
• Associated visits
• Associated incidents

Users can view attached documents, notes, recent interactions, and other correspondence. The data in the fully integrated, patient-centric platform can be updated and modified by the care manager or sourced directly from existing enterprise systems, or both. With proper licensing, features that are typically associated with Customer Service (email, chatbots, and IVR integration) can be available in the Interaction portal.

A key flow such as program referral can be started with a call center resource, which provides a Pega Care Management representative who can easily complete the intake process. The control is then passed to a clinical person to manage the case further. Different tasks are available depending on the role of the user as well as whether the person is a patient or provider. The user can initiate inbound and outbound calls, chat sessions, and co-browse sessions with a patient or provider, and can access the Knowledge Management portal if needed during any of the conversations with a patient or provider.

This portal allows a business analyst to configure care templates, define goals, alerts, programs, and problems to build care plans and care programs. The questionnaire allows business users to author, manage, and preview assessment templates prior to making them available to their teams.

The Business Analyst portal also provides a space where elements that need consistent configuration can be delegated to business analysts rather than to low-code developers. This streamlines the ability to launch care for a subset of patients and creates a framework from which care plan and program personalization can begin.