Case Study: Alere achieves 96% member satisfaction and 63% HEDIS gap closure with Pegasystems

Alere Closes Gaps In Member Healthcare

Alere, a global leader in point-of-care diagnostics and personal health support, launched CareAlerts to help nearly 4 million members identify and close gaps in medical care—such as missed screenings, medication errors, and preventative needs. The challenge was to increase member engagement, speed delivery of care-gap solutions, improve health outcomes, and reduce healthcare costs while making complex clinical rules manageable for non-technical users.

Using Pega’s business rules engine and analytics, CareAlerts composes more than 10,000 personalized messages from about 100 rules and delivers them across multiple channels, allowing health plans to tailor interventions quickly. The program has achieved strong outcomes: 96% member satisfaction, 63% closure for HEDIS gaps, 56% closure for medication adherence gaps, 83% of members reporting better chronic condition management, and substantial operational efficiencies from shifting control to the business.

Alere

Sameh Ebeid

Vice President of Application Development