Setting the application perspective to payer or provider in Care Management

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Description Customizing data collection for various healthcare uses.
Version as of 8.5
Application Care Management
Capability/Industry Area Healthcare



Use case examples[edit]

  1. U+Health is setting up their Care Management application layer. They want to view their consumer base from a payer perspective. At the time of running the application wizard, they choose the option to view their application from the payer perspective.
  2. U+Hospital is implementing their Care Management application layer. They refer to their consumers as patients. At the time of running the application wizard, they choose the option to view their application from the provider perspective.
  3. U+Health is working closely with U+Hospital. U+Health has decided to use the layer-cake design and build an implementation layer for U+Hospital. In addition to building their own layer from the payer perspective, U+Health also builds another layer to reflect the provider perspective for U+Hospital. For this layer, at the time of running the application wizard, they choose the option to view the application from the provider perspective.

Before you begin[edit]

Before implementing Pega Care Management, ensure that you have installed the necessary dependent applications.

Note: The installation of Pega Customer Decision Hub is optional.

Pega Care Management application design

Selecting your application perspective[edit]

When setting up your application by using the application wizard, select either the payer or provider perspective. This determines how your organization views the data in the system.

However as an organization, you might want to change the perspective.

Example: If a provider organization used an earlier version of the Pega Care Management application and did not customize the labels, for example, changing member to patient, they may choose the provider option. In this case, when changing to the provider perspective, all references to member are automatically changed to patient. For example, member policy number changes to medical record number.

  1. In the header of Dev Studio, click Configure Care Management Configuration.
  2. Click the Other settings tab.
  3. In the Application perspective field, click Provider.
  4. Click Save, and then click Close.

Results[edit]

When a client uses this design pattern, they are able to view the application from the selected application perspective.