The 2019 Healthcare Innovation Innovator Awards Program entailed four product categories that solution providers could submit toward: Value-Based Care, Patient Engagement, Data Analytics, and Data Security. Earlier this year, the team at Healthcare Innovation announced the winning companies in each of these four product segments, and in this September/October issue, we profile the Patient Engagement category winner, Pegasystems.
As healthcare reform continues to shape the industry, leaders at the Cambridge, Mass.-based Pegasystems believe that via their patent engagement platform, they are positioned to change the way patients interact for their healthcare experience. The company, whose Pega Care Management application—a unified platform that aims to enable care teams to deliver patient-centric programs across case, disease, utilization and wellness management—correspondingly has a core belief that customer service is a key component of care management, and thus set out to develop technology that enables care teams and patients to automatically track and coordinate all interactions across all patient engagement channels.
“When you think about the challenges in healthcare, there is so much clinical expertise that is working so hard to achieve terrific health outcomes, but [that] often gets mired in the difficulty of navigating through processes,” says Kelli Bravo, vice president, healthcare and life sciences at Pegasystems. “So we saw an opportunity to bring forward the automation and engagement capabilities with clinical capabilities to help practitioners better server their patients.”
Indeed, company executives point to a 2018 Accenture report revealing that 52 percent of healthcare consumers in the U.S. do not understand how to properly navigate the healthcare system, and that low healthcare system literacy is creating an estimated $4.8 billion annual administrative cost burden for payers. And, on average, health insurers and employers spend $26 more on administration for every consumer with low healthcare system literacy. Meanwhile, consumers with high healthcare literacy contribute to $1.4 billion in administrative costs and cost roughly a quarter less than those on the other end of the spectrum, according to the report.
As such, Pegasystems has taken to improve these inefficiencies by innovating through the intersection of customer service and care management in a single application. Bravo gives an example of a high-risk pregnancy patient who is trying to understand and navigate a complex healthcare system. “You [want] to have a program in place to identify which steps this person needs to take, which specialists she needs to see, and the timing of everything. It’s really a process, and not a random series of events—but rather a sequence of activities that need to be coordinated.”
While previous, outdated approaches might have involved spreadsheets with steps to check off, when a health system is dealing with hundreds or even thousands of individuals, “It’s best for these highly-skilled nurses to have prompts to help them move through those stages so they know when to call someone, when to address a gap in care, when the next follow-up is, and when a step was missed by a patient, if it was,” says Bravo.
Tying customer service to care management
Company officials note that the Pega Care Management application is tied to its Pega Customer Service for Healthcare platform and provides access to the many customer service workflows and functions that healthcare organizations need to more efficiently service patients and improve their overall experience. Bravo offers another example of an individual calling into a health system without knowing much about the process of phoning in. “You want that [responding] customer service agent with the right permissions to have access to the right information about that patient so they can direct them to the right place,” she says. “And maybe that’s to the patient care team or maybe it’s a question that the agent can answer. So if you tie those capabilities together and add our engagement, outreach and personalization to put the right information in front of the right patient at the right time, it creates a very personalized experience so that the patient doesn’t get unrelated or untimely information.”
Speaking to the benefit of having a unified platform, Chip Warburton, senior product manager, healthcare care management at Pegasystems, believes that while many applications and vendors speak about a holistic view of the patient, their applications continue to support siloed interventions. “With Pegasystems’ ability to integrate our built-on customer service, we have the capability of bringing a great deal of more information in to make a truly informed patient and truly informed caregiver,” he attests.
While some might assume that electronic health records (EHRs) should be the technology platform that can perform these care management and customer service capabilities—given that most providers have them deployed anyway—Bravo says in reality, that’s not the case. “EHRs are great at capturing information at a point of time, but they aren’t designed to deliver a workflow and a process. So if you need to take an [initial] step for a pregnant patient, and if that step isn’t carried out, you will get a reminder or a ‘task’ is created to follow-up, or that a second step will need to occur. That’s not something an EHR does,” she says.
However, Bravo contends that Pegasystems’ platform will identify that gap in care and will remind the care coordinator or nurse to reach out to that person, or that the coordinator should escalate that task to someone else, if appropriate. “The [application] works to ensure those gaps are closed. Rather than seeing after the fact that five steps were missed, we are anticipating the patient’s needs and getting to the patient before the problem escalates. The ability to intervene earlier is the essence of what a care navigation process will do.”
