SOURCE: Pegasystems


March 29, 2010 09:00 ET

Pegasystems Unveils New Healthcare Solution to Meet Fast-Growing Demands of Individual Market

Drives Faster Membership and Revenue Growth Through Process Automation and Delivers Improved Customer Experience

CAMBRIDGE, MA--(Marketwire - March 29, 2010) - Pegasystems Inc., (NASDAQ: PEGA), the leader in Business Process Management (BPM) software solutions, today announced the availability of Individual Sales Process Manager for Healthcare (ISPM)™, the latest in a growing suite of solutions that increase efficiency and speed innovation for healthcare organizations. A multi-channel sales and enrollment solution supporting both direct-to-consumer and agent-driven activities, ISPM streamlines and tailors the entire acquisition and on-boarding process for individual healthcare insurance consumers. By using ISPM, healthcare organizations can boost sales while driving down their sales costs.

The non-group market is emerging as a major growth opportunity for health insurers. Increasingly, consumer-driven healthcare, value-based benefits and other incentive-based strategies are spurring market growth. Furthermore, pending healthcare reform would quickly add nearly 25 million new individual enrollees to the market and make non-group business critical to overall healthcare payer success.

Built on Pegasystems' award-winning SmartBPM® platform, ISPM combines powerful process automation with intelligent decisioning that enables healthcare payers to provide a streamlined, end-to-end sales and enrollment experience for consumers, regardless of the channels -- such as web, email or phone -- they choose for interactions. ISPM provides real-time rates and quotes, automates the underwriting process, guides application submission and instantly updates all back-end systems with accurate enrollment data. ISPM's automation of individual sales activities creates greater efficiencies to handle increased volume and speeds up on-boarding activities for quicker sales attainment. Using goal based and business-driven technology across all channels ensures consistency and continuity for consumers, and greater retention for healthcare organizations.

Highlights/Key Product Facts:
ISPM joins a suite of proven healthcare-specific solutions offered by Pegasystems, including Group Sales Process Manager for Healthcare (GSPM)™, Pegasystems' sales and enrollment solution for employer group business. ISPM's key features include:

  • Multi-channel support including fax, PDF and email capabilities as well as Web and desktop portals for consumers, agents, brokers, sales representatives and sales management;
  • Intent-led user experience including persona management to drive right-fit product promotion and improved user experience;
  • Intelligent risk scoring to automate instant issue and finalize more sales at point of contact;
  • Streamlined, intent-led enrollment with minimized data entry for individuals and families;
  • System-driven data transfer and updates to legacy membership and billing systems;
  • Flex-scale deployment capabilities that simplify the piloting of new sales programs and approaches by supporting quick and secure rollout of changes to specific audiences.

Pegasystems' BPM solutions are widely used by major healthcare organizations including the three largest US health plans, two of the four largest pharmacy benefit managers, several leading healthcare delivery systems, and US government agencies at the state and federal level. Healthcare transactions for more than one of every two Americans, including members from over 90% of the Blues network, are processed with Pegasystems technology.

Supporting Quotes:
Elizabeth Boehm, Principal Analyst at Forrester Research, Inc.
In speaking on how technologies will transform digital healthcare experiences, Elizabeth Boehm, Principal Analyst at Forrester Research, Inc., said: "Today's consumers use multiple channels to interact with healthcare firms. They need: 1) appropriate channel choices that suit their specific needs; 2) consistency in the information and brand experience; and 3) continuity so that they are not forced to start their tasks from scratch at each transition point."

Elizabeth Hart, Principal, Healthcare Solutions at Pegasystems
"The individual market is markedly different than the employer group market, and much more like the retail space. For several years, leading financial institutions across the globe with far greater consumer experience have been using Pega's SmartBPM solutions to improve sales and on-boarding with exceptional results -- such as a 400% increase in new accounts with a corresponding 60% decrease in costs. ISPM can do the same for individual healthcare."

Supporting resources:

About Pegasystems
Pegasystems, the leader in Business Process Management, provides software to drive revenue growth, productivity and agility for the world's most sophisticated organizations. Customers use our award-winning SmartBPM® suite to improve customer service, reach new markets and boost operational effectiveness.

Our patented SmartBPM technology makes enterprise applications easy to build and change by directly capturing business objectives and eliminating manual programming. SmartBPM unifies business rules and processes into composite applications that leverage existing systems -- empowering businesspeople and IT staff to Build for Change, deliver value quickly and outperform their competitors.

Pegasystems' suite is complemented by best-practice frameworks designed for leaders in financial services, insurance, healthcare, government, life sciences, communications, manufacturing and other industries.

Headquartered in Cambridge, MA, Pegasystems has offices in North America, Europe and Asia. Visit us at

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