List of Pega Care Management Customers
Waltham, 02451, MA,
United States
Since 2010, our global team of researchers has been studying Pega Care Management customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Pega Care Management for Customer Support from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Pega Care Management for Customer Support include: HCA Healthcare, a United States based Healthcare organisation with 226000 employees and revenues of $70.60 billion, Healthfirst, a United States based Insurance organisation with 5800 employees and revenues of $2.50 billion, Engen, a United States based Healthcare organisation with 6000 employees and revenues of $600.0 million and many others.
Contact us if you need a completed and verified list of companies using Pega Care Management, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The Pega Care Management customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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Engen | Healthcare | 6000 | $600M | United States | Pegasystems | Pega Care Management | Customer Support | 2019 | n/a |
In 2019, Engen built its Predictal clinical platform on Pega Care Management to deliver integrated utilization, case, disease, and provider service management for payer clients across the United States. The deployment positions Pega Care Management within Engen's Customer Support tooling to centralize care coordination workflows for payer customers.
Pega Care Management was configured to support core modules including utilization management, case management, disease management, and provider service management, with orchestration for automated authorization processing and next-best-action member engagement. The implementation emphasized rule-driven clinical pathways, configurable care plans, and case worker workflow automation to scale member outreach.
Operational scope covered payer-facing services across the United States, embedding Predictal workflows into payer operational processes for utilization review and case assignment. The deployment surfaced member records and authorization status within Pega Care Management to support coordinated member and provider interactions.
Governance changes included standardizing authorization and case escalation workflows to support automated authorizations and next-best-action engagement, with centralized configuration in Pega Care Management controlling clinical rules and routing. Vendor reported outcomes for the Predictal implementation include $17 million in annual medical cost savings and a 2.5× increase in members served with case management.
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HCA Healthcare | Healthcare | 226000 | $70.6B | United States | Pegasystems | Pega Care Management | Customer Support | 2017 | n/a |
In 2017, HCA Healthcare implemented Pega Care Management to build a unified care navigation platform across perinatal, pediatric, oncology and multi specialty navigation in the United States. The deployment used Pega Care Management in the Customer Support category to centralize case intake, routing and care coordination for navigation teams.
HCA configured Pega Care Management with specialty aligned case management modules for perinatal, pediatric, oncology and multi specialty navigation, implementing rules driven workflows, care plan orchestration and task automation to streamline nurse case navigator workstreams. Functional capabilities emphasized include case creation and lifecycle management, automated task assignment and role based work queues to improve clinician workflow efficiency.
Operational coverage focused on navigation services across HCA Healthcare sites in the United States, standardizing processes across specialties and consolidating clinician facing workflows under a single application. The platform centralized case handling and navigation orchestration for cross specialty care coordination and patient routing.
Governance centered on standardized workflows and process alignment across navigation teams to improve clinician productivity and consistency of patient handling. Reported outcomes from the Pega case study include a 35 percent increase in productivity for nurse case navigators and over 40,000 patients navigated since go live using Pega Care Management in the Customer Support category.
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Healthfirst | Insurance | 5800 | $2.5B | United States | Pegasystems | Pega Care Management | Customer Support | 2018 | Virtusa |
In 2018, Healthfirst implemented Pega Care Management from Pegasystems within its Customer Support technology stack in the United States. The deployment targeted automation of provider lifecycle management, pre-authorization workflows and claims-related case handling to support care management staff and provider administration functions.
Pega Care Management was configured to support case-based pre-authorization processing, provider onboarding workflows and claims adjudication orchestration. Configuration emphasized case management, rules-driven decisioning for authorization determinations, task routing to care management users, and automated status tracking to reduce manual handoffs and accelerate workflow throughput.
The implementation was executed with partner Virtusa and aligned Pega Care Management with Healthfirst operational groups including care management, provider relations and claims operations across its US operations. The project instrumented automated provider lifecycle and pre-authorization case flows into Healthfirst claims and provider administration processes, centralizing orchestration and exception handling within the Pega case architecture.
Governance instituted centralized case governance and rules change management to enable business ownership of care management workflows. According to Pega case materials, the deployment reduced provider onboarding time and improved claims first-pass rates, while shifting manual approvals into automated, auditable case workflows used by care management staff.
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Buyer Intent: Companies Evaluating Pega Care Management
- Southern Earth Sciences, a United States based Construction and Real Estate organization with 120 Employees
Discover Software Buyers actively Evaluating Enterprise Applications
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