Pegasystems: Why marketing technology is the next big thing in population health

An ounce of prevention is better than cure. There is a growing consensus in the healthcare industry that the best way to bend the cost curve is to anticipate costs by addressing underlying issues such as unmet social needs or gaps in matter of care. This represents a huge opportunity to reduce costs and improve health services, but only if we can do it at scale.

Unfortunately, we lack leading indicators that can give us insight into unmet patient needs. We do not have real-time visibility into a patient’s situation once they have left the four walls of the healthcare system. Only patients and their caregivers know what is happening at any given time.

Moreover, nnursing shortages have made it difficult to extend managed care beyond the sickest 5% of the population, who account for 50% of all healthcare spending. Within this group, about a third experience a one-time health disaster, another third suffer from costly illnesses that will never go away, and the remaining third suffer from one or more largely preventable chronic illnesses. In general, there is not much we can do to reduce the expenses of the first and second groups. Instead, we should focus our energies on the third group and work to prevent preventable chronic diseases.

So how can we reduce healthcare costs on a large scale?

To reduce the burden of chronic disease over time, we need to engage more of the population, identify key indicators of patient decline, and address needs before they escalate into chronic disease. This requires our care management programs to increase their reach by at least 15 times (from a reach of 5% to 80% of the population of all US adults). Given our current shortage of suppliers, we should consider how technology can be a force multiplier.

these digital conversations can provide the insight of and scale required for population health. Pega is a global leader in marketing technology. Our Infinity AI platform powers the digital experience and customer service dashboards of the world’s leading payer and provider organizations.

Pega’s always-on brain interacts with people through chatbots, text, web and other digital channels, uncovering actionable insights such as changes in health, unmet needs or gaps in care . This self-reported data (combined with data from patient records, claims history and other sources) is used by our brain to determine the best action to take, for example:

  • Educate to improve autonomy

  • Sending an evaluation to better understand

  • Orchestrate a response to address an unmet need

  • Engage a clinician to take over the conversation

What does this interaction look like at the end of the day? It looks like technology that automatically identifies and responds to needs and escalates them to clinicians as needed. Here are some examples. A grandfather with known transportation needs is automatically offered a carpool voucher to and from his primary care appointment. Patient recovering from knee replacement surgery is asked about warning signs of infection, reports fever, immediately receives call from nurse. We simply sort, for millions of people at once.

Forward-thinking payers and providers who have piloted programs to proactively address unmet needs have achieved remarkable reductions in emergency room visits and hospitalizations, ranging from 20% to 50%. On a large scale, this approach could equate to billions of dollars a year in medical cost savings.

None of these concepts are new, but the use of marketing technology in population health is disruptive. Marketing, at its best, is more than cross-selling or up-selling. It’s about meeting customers when they need it, showing empathy and offering the right solution. It is our prescription for health care.

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