Case Study

Personalized Care Improves Health Outcomes

The PBM leader deployed two Pegasystems’ healthcare applications, Care Management and Customer Service, to bring agility, automation and mass customization to its market-facing processes and enable it to provide personalized care at all patient touch points. The clinical engagement and personalization engine combines intelligent routing, alerts and notifications with extensible patient workflows and assessments. These capabilities facilitate differentiation, compliance and efficacy by making it easy for the PBM’s experts to author and maintain clinical rules and engagement protocols. Pega senses and responds to patient events, such as claims, survey information and real-time activity with the PBM’s devices and channels; identifies and activates best-fit clinical strategies; and supports patient-centric care through its comprehensive clinical patient composites. The application orchestrates patient-specific clinical counseling and physician-directed guidance including real-time Medication Therapy Management, care gap detection and prevention, adherence, and cost savings programs across all channels such as phone, IVR, email, fax, letter, SMS, mobile devices, ePrescribing and other web self-service portals.


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