Pegasystems Inc., (NASDAQ: PEGA), the leader in Business Process Management (BPM) software solutions, today announced..."/> Pegasystems Unveils New Customer Acquisition Solution to Meet Reform-Driven Growth of Individual Healthcare Market
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Pegasystems Unveils New Customer Acquisition Solution to Meet Reform-Driven Growth of Individual Healthcare Market


Drives Compliant Sales, Faster Membership Growth through Intelligent Process Automation and Improved Customer Experience

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.

ebizQ received the following:

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 deftly navigate increased regulation and align quickly to the growing individual healthcare market to capture sales while driving down costs.

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With far-reaching healthcare reform signed into law on March 23, the individual healthcare market has become even more critical to the overall success of healthcare organizations. The new law will add coverage to more than 30 million Americans, effectively tripling the individual healthcare market. Healthcare payers must act quickly and obtain new tools and competencies to capitalize on this unprecedented opportunity.

Built on Pegasystems’ award-winning SmartBPM platform, ISPM is uniquely suited for the individual healthcare market. It combines powerful process automation with intelligent decisioning that enables healthcare payers to provide a streamlined, end-to-end sales and enrollment experience for individual 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 according to business and regulatory policies, 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 on-boarding activities for quicker sales attainment. Using goal based and business-driven technology across all channels ensures consistency and continuity for consumers, and increased customer acquisition and 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;
  • Rules-driven decicioning for policy adherence and regulatory compliance;
  • 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:

Robert Booz, Analyst at Gartner, U.S. Healthcare Reform Bill Would Require Insurers to Modify IT, September 28, 2009

"As Gartner predicted in June 2007, universal healthcare coverage would present healthcare insurers the opportunity to expand their direct-to-consumer markets by legislative action rather than via price-based competition for commercial membership. In doing so, it also would offer insurers the potential to lower member acquisition costs. However, changes in technology and business operations infrastructure —- especially for eligibility, benefits configuration and medical management —- will be necessary for insurers to meet universal coverage requirements."

Elizabeth Hart, Principal, Healthcare Solutions at Pegasystems

"The individual market is markedly different than the employer group market, and is further complicated by new unfolding regulations. Healthcare payers must not only obtain and master consumer-focused capabilities; they need powerful technology that provides agility for them to handle new industry realities. For decades, leading global financial institutions have been using Pegasystems’ SmartBPM technology to improve consumer-driven sales and on-boarding. The technology has delivered exceptional results –- such as a 400% increase in new accounts with a corresponding 60% decrease in costs, and increased compliance. ISPM and Pegasystems’ SmartBPM can do the same for individual healthcare."

Supporting Resources:

For more information on ISPM and all of Pegasystems’ healthcare-focused solutions, go to

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