This section describes the support features that are no longer being developed.

When using the pre-8.7 UM Manager or Care Manager Portals, Pega Care Management provides a toggle switch that allows you to switch between an application perspective that is preferred by either payers or providers to meet the needs of either organization type. This capability provides each organization with the data that they use, the data that they enter, and the data that they need. New organizations can choose this option at the start of implementation, or existing organizations can update the perspective from the configuration page.

The Care Management portal allows for the management of patients who are either enrolled in a program or being managed outside a program, thereby providing a complete picture of the patient’s current and past health status. The portal provides a full 360 view of the patient and allows for the customization, tracking, and management of problems, goals, interventions, barriers, and programs. It allows the aggregation of data to present a full 360-degree view of the patient in a single system.

The Utilization Management portal allows the utilization management professional to enter and review proactive or retrospective referrals, authorizations, and admissions with concurrent review with discharge and transition planning, while maintaining visibility to urgency and next work. Integrated clinical vendor guidelines are available for seamless embedded medical necessity review. Attachments are easily managed and easy to find.