Pegasystems, Milliman Integrate Features for Healthcare

Pegasystems Inc. and Milliman Care Guidelines are cooperating to deliver next generation workflow and case management capabilities to help healthcare organizations improve efficiencies and patient care.

Tags: Care, Healthcare, Management, Pegasystems, Workflow, Care Guidelines, CareWebQI,


Pegasystems Inc. and Milliman Care Guidelines are cooperating to deliver next generation workflow and case management capabilities to help healthcare organizations improve efficiencies and patient care.

The tighter integration of Pegasystems' Care Management Framework with Milliman's CareWebQI software aims to improve efficiency and quality of patient services, company officials said.

The integrated solution will also let healthcare organizations better provide members care management services that blend BPM and automated healthcare workflow capabilities with frequently updated Best Practices and Case Guidelines for patient care, officials noted.

"Care Management has been underserved by technology for too long, especially since technology has been adding such value to other parts of the healthcare enterprise," said Elizabeth Hart, Pegasystems' senior director for healthcare solutions said in a statement. "The integration of [Milliman's] clinical content through Pegasystems' rules-based BPM engine is an important step towards fully automating processes, while ensuring the right care is given when and where it is needed," Hart added.

Inside the Pegasystem-Milliman Integration
Pegasystem's Care Management Framework is powered by Pegasystems' BPM technology, and delivers key capabilities to the care management sector, including: Rules-driven workflow automation, Customizable user experiences, Change-aware specialization, and Flex-scale deployment to ease development-to-production for new care programs.

Milliman's CareWebQI is used are used to help healthcare organizations identify ways to best integrate Best Practices across payers and providers. In specific, the package presents 'Care Guidelines' clinical content in an interactive format that allows users to capture and report on real-time clinical data. CareWebQI also enables point-and-click application of evidence-based clinical guidelines, allowing users to measure healthcare performance against national quality standards; track variances from Best Practice; identify inappropriate care; and even detect physician, facility and resource delays.

Gartner vice president Joanne Galimi said the integration of Pegasystems BPM-based Case Management Framework and Milliman's CareWebQI is an important offering for healthcare insurers because it "combines standardized clinical strengths with a rules-based workflow solution."






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