Pega Care Management

JSON twin: https://www.healthaidb.com/software/pega-care-management.json

Company Name

Pegasystems

Product URL

https://www.pega.com/industries/healthcare/care-management

Company URL

https://www.pega.com

Categories

• clinical Care
• administrative Operations
• patient Facing
• diagnostic Support
• care Coordination
• healthcare Management
• patient Engagement
• health Data Analytics
• compliance Management
• Clinical
• Administrative
• Diagnostic
• Health Outcomes
• Compliance
• Automation

Summary

Pega Care Management is a healthcare application by Pegasystems that streamlines care coordination, enhances patient engagement, and improves health outcomes through a unified platform.

Description

Pega Care Management is a comprehensive healthcare application designed to transform care delivery by automating processes, connecting care teams, and personalizing programs. It integrates with various channels, including web self-service, mobile applications, and healthcare devices, to engage members effectively. The application leverages actionable analytics to promote healthy behaviors and coordinates activities across care teams to deliver value-based care. It also automates compliance documentation and referral processes to enhance provider and member satisfaction. Built on the Pega Infinity platform, it enables rapid development of context-aware, tailored care plans that adapt to individual needs. Deployment options include cloud and on-premises solutions, supporting both population health and acute care management.

Api Available

yes

Certifications

• SOC 2
• ISO/IEC 27001
• FedRAMP High

Company Founding

1983

Company Offices

• United States
• Canada
• United Kingdom
• Germany
• India
• Australia
• Japan
• China
• Brazil
• Mexico

Compliance

• HIPAA
• HITECH
• GDPR
• SOC 2
• ISO/IEC 27001
• FedRAMP High

Customers

Data Residency

US and EU regions, customer-managed or on-prem deployment

Data Standards

• FHIR R4 (v4.0.1)
• HL7 v2
• X12 5010 (HIPAA EDI)
• NCPDP
• DICOM
• RxNorm
• ICD-10
• CPT/HCPCS
• SNOMED CT

Deployment Model

• SaaS
• on_prem
• hybrid
• cloud-managed

Features

• Care coordination
• Benefits administration
• Member/patient engagement
• Clinical trial management
• Utilization management
• Disease management
• Health and wellness programs
• Clinical assessments
• Reporting outcomes
• Letter generation
• External vendor integration
• Intelligent appeals management
• Flexible reporting
• Customer Decision Hub integration
• Customer Service for Healthcare integration

Id

SW2005

Integration Partners

Integrations

• MCG CareWebQI
• MCG Disease Management
• Change Healthcare InterQual
• Microsoft Exchange Web Services
• FHIR APIs

Languages Supported

• English
• Spanish
• French
• German
• Italian
• Portuguese
• Dutch
• Japanese
• Chinese
• Korean
• Hindi
• Arabic
• Russian
• Turkish
• Polish
• Swedish
• Norwegian
• Danish
• Finnish
• Greek

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• Product Composer for Healthcare
• Life-sciences orchestration
• PBM automation

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

subscription

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization
• Data residency control

Product Code

SW2005

Product Name

Pega Care Management

Ratings

Regions Available

• United States
• Canada
• United Kingdom
• European Union
• Australia
• India
• Japan
• Brazil

Related Urls

• https://elion.health/products/pega

Release Year

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit logs
• 2FA
• DLP
• DDoS protection
• Intrusion Prevention System
• Continuous security monitoring
• Vulnerability management

Specialties

• Care Management
• Case Management
• Care Coordination
• Population Health
• Pharmacy Benefit Management Automation
• Health Plan Product Configuration
• Member Engagement
• Clinical Trials Orchestration
• Utilization Management
• Prior Authorization Workflows
• Customer Service Automation

Support Channels

System Requirements

Target Users

• care managers
• clinicians
• health plan administrators
• population health teams
• pharmacy benefit managers
• IT/automation engineers
• customer service agents
• government healthcare administrators

Training Options

Type

product

User Reviews

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Pega Care Management",
  "company_name": "Pegasystems",
  "product_url": "https://www.pega.com/industries/healthcare/care-management",
  "company_url": "https://www.pega.com",
  "related_urls": [
    "https://elion.health/products/pega"
  ],
  "product_code": "SW2005",
  "summary": "Pega Care Management is a healthcare application by Pegasystems that streamlines care coordination, enhances patient engagement, and improves health outcomes through a unified platform.",
  "description": "Pega Care Management is a comprehensive healthcare application designed to transform care delivery by automating processes, connecting care teams, and personalizing programs. It integrates with various channels, including web self-service, mobile applications, and healthcare devices, to engage members effectively. The application leverages actionable analytics to promote healthy behaviors and coordinates activities across care teams to deliver value-based care. It also automates compliance documentation and referral processes to enhance provider and member satisfaction. Built on the Pega Infinity platform, it enables rapid development of context-aware, tailored care plans that adapt to individual needs. Deployment options include cloud and on-premises solutions, supporting both population health and acute care management.",
  "categories": [
    "clinical Care",
    "administrative Operations",
    "patient Facing",
    "diagnostic Support",
    "care Coordination",
    "healthcare Management",
    "patient Engagement",
    "health Data Analytics",
    "compliance Management",
    "Clinical",
    "Administrative",
    "Patient-facing",
    "Diagnostic",
    "Care Coordination",
    "Healthcare Management",
    "Patient Engagement",
    "Health Outcomes",
    "Compliance",
    "Automation"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "care managers",
    "clinicians",
    "health plan administrators",
    "population health teams",
    "pharmacy benefit managers",
    "IT/automation engineers",
    "customer service agents",
    "government healthcare administrators"
  ],
  "specialties": [
    "Care Management",
    "Case Management",
    "Care Coordination",
    "Population Health",
    "Pharmacy Benefit Management Automation",
    "Health Plan Product Configuration",
    "Member Engagement",
    "Clinical Trials Orchestration",
    "Utilization Management",
    "Prior Authorization Workflows",
    "Customer Service Automation"
  ],
  "regions_available": [
    "United States",
    "Canada",
    "United Kingdom",
    "European Union",
    "Australia",
    "India",
    "Japan",
    "Brazil"
  ],
  "languages_supported": [
    "English",
    "Spanish",
    "French",
    "German",
    "Italian",
    "Portuguese",
    "Dutch",
    "Japanese",
    "Chinese",
    "Korean",
    "Hindi",
    "Arabic",
    "Russian",
    "Turkish",
    "Polish",
    "Swedish",
    "Norwegian",
    "Danish",
    "Finnish",
    "Greek"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States",
    "Canada",
    "United Kingdom",
    "Germany",
    "India",
    "Australia",
    "Japan",
    "China",
    "Brazil",
    "Mexico"
  ],
  "company_founding": "1983",
  "deployment_model": [
    "SaaS",
    "on_prem",
    "hybrid",
    "cloud-managed"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Care coordination",
    "Benefits administration",
    "Member/patient engagement",
    "Clinical trial management",
    "Utilization management",
    "Disease management",
    "Health and wellness programs",
    "Clinical assessments",
    "Reporting outcomes",
    "Letter generation",
    "External vendor integration",
    "Intelligent appeals management",
    "Flexible reporting",
    "Customer Decision Hub integration",
    "Customer Service for Healthcare integration"
  ],
  "optional_modules": [
    "Product Composer for Healthcare",
    "Life-sciences orchestration",
    "PBM automation"
  ],
  "integrations": [
    "MCG CareWebQI",
    "MCG Disease Management",
    "Change Healthcare InterQual",
    "Microsoft Exchange Web Services",
    "FHIR APIs"
  ],
  "data_standards": [
    "FHIR R4 (v4.0.1)",
    "HL7 v2",
    "X12 5010 (HIPAA EDI)",
    "NCPDP",
    "DICOM",
    "RxNorm",
    "ICD-10",
    "CPT/HCPCS",
    "SNOMED CT"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "HITECH",
    "GDPR",
    "SOC 2",
    "ISO/IEC 27001",
    "FedRAMP High"
  ],
  "certifications": [
    "SOC 2",
    "ISO/IEC 27001",
    "FedRAMP High"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit logs",
    "2FA",
    "DLP",
    "DDoS protection",
    "Intrusion Prevention System",
    "Continuous security monitoring",
    "Vulnerability management"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization",
    "Data residency control"
  ],
  "data_residency": "US and EU regions, customer-managed or on-prem deployment",
  "customers": [],
  "user_reviews": [],
  "ratings": [],
  "support_channels": [],
  "training_options": [],
  "release_year": "",
  "integration_partners": [],
  "id": "SW2005",
  "slug": "pega-care-management",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/pega-care-management.json"
  }
}