HealthChecks

Inspiration

Everyday, there are people in need. Everyday, healthcare organizations design programs to help people in need. Too often, the people and the programs fail to connect. Organizations spam members with offers and reminders. Information gathering is often cumbersome. Results are often aggregated, failing to solve the immediate needs of individuals. The lack of trust created by these practices makes members less likely to reach out to healthcare organizations when they need them. And, organizational silos mean they sometimes don’t get what they need when they do. Global challenges like the COVID 19 pandemic make the need to solve this problem urgent.

We wanted to design a solution that would allow healthcare organizations to reach their members proactively, gain understanding of their context, and take action immediately. The solution had to be simple on its surface, low effort for the member, and scalable. And most importantly, it had to be meaningful. We wanted to design something with the potential to save a life.

What it does

The solution we designed was HealthChecks. Healthchecks sends a message (SMS, Facebook Messenger,etc.) to a member regarding a relevant topic and then asks the member to rate themselves using a 5 point scale. Based on the member’s response, Pega kicks off processes to solve immediate needs, provides information, and collects data to inform analytics and AI. Using Pega to manage the outreach and intervention until direct human engagement is required allows us to provide meaningful interaction at scale with minimal effort costs. Using simple messages in an interactive channel allows us to avoid PHI concerns and cut through the noise, reaching members where they are.

In our video, you will see us check on the mental health of members during the COVID crisis. A low response results in immediate action, connecting a member with a behavioral health specialist. A high response results in a simple message. A neutral response engages an adaptive model to decide between a follow-up message or direct intervention.

How we built it

Our solution was built on Pega platform 8.4 and Pega Marketing 8.4 following agile development methodology with collaboration between a product owner, LSA, and CSSA. In less than 4 weeks we went from concept to what you see in the demonstration.

First we installed Pega Marketing and built the design components such as the Context Dictionary setup, Customer class, and data model design. Then we defined the structure of the Business Issues and Proposition Groups, taking the time to imagine the full context of a healthcare payer implementation. Following that we developed the happy path components such as the data sets and flows, decision strategies, and data models, including creating data sets to drive our processes, such as on call lists, benefit data, and customer data. This was done in small iterative cycles with in-line testing and daily reviews. Finally, we incorporated the AI and behavior controls that provide proactive contextual actions according to the customer’s propensity, context and other factors.

In addition to building these core features, we also created a case manager portal to follow a full process to completion instead of stopping at message delivery and response. We also designed revision management features to allow business users to manage data. By doing this, we created a product that could be piloted in a real world environment and ensured that we didn’t miss any features that would be required for implementation.

Challenges we ran into

Since Pega 8.4 and Pega Marketing 8.4 are new releases, faced several issues a. in running the Context Dictionary b. setting up D-Nodes c. running the Segmentation rules and Campaigns d. other petite issues concerned with both inbound and outbound pega marketing To alleviate some of these issues, we've requested and installed several hotfixes.

Accomplishments that we're proud of

A healthcare organization could decide to run our COVID BH healthcheck tomorrow with minimal configuration. We can see the path to saving a life through reacting to an indication of mental health crisis. We reimagined marketing as a driver of wellness.

What we learned

We learned how Pega Marketing capabilities can be applied in the healthcare space to drive wellness by automating outreach and connecting it to process, much of which may already exist. We also learned how to use AI-powered decisioning to improve our responses to member needs.

What's next for HealthChecks

We envision a full suite of healthchecks. We have designed but not yet built checks for food insecurity and medication understanding. On the horizon are healthchecks for new moms and cancer patients. We need to take our vision to reality with a healthcare organization, gathering enough real world data to truly apply the power of the AI and refine the offers. From there, we’d like to expand our healthcare vision for PegaMarketing, continuing to apply the power of its features to the management of health and wellness.