Case Study: Healthfirst achieves faster provider onboarding and greater automation with Pegasystems

How they transformed the provider lifecycle, enhancing service quality for nearly 2 million members

Healthfirst, a leading not-for-profit health insurer serving nearly 2 million members, struggled with manual and fragmented provider onboarding and credentialing processes that caused delays, inefficiencies, and limited transparency. During the COVID-19 surge, the company needed a faster way to onboard providers and temporary staff, and turned to Pegasystems and the Pega Platform to modernize its provider lifecycle management.

Pegasystems, working with Virtusa, implemented a Pega-based Provider Lifecycle Management solution that automated credentialing, paperless onboarding, data management, and contract generation. The results were significant: onboarding time fell by 76% from 90 days to three weeks, 98% of enrollment transactions were completed automatically, and Healthfirst was able to improve transparency, efficiency, and care delivery for its members.

Healthfirst