Pega Care Management
Pega Care Management: A broad care-management suite for health plans with configurable clinical and operational workflows. Ranked #1 of 18 in Patient Case Management by our editors (9.2/10); pricing: Pricing on request; best for health plans needing configurable care management.
At a glance
- Editor score9.2 / 10
- PricingPricing on request
- Best forHealth plans needing configurable care management
- Care plan managementYes
- Founded1983 · Cambridge, Massachusetts, United States
- Facts checked24 Sep 2026
Where it wins
- Unifies patient 360 profiles with clinical, claims and authorization data
- Covers assessments, referrals, care plans and utilization workflows
- Supports cloud or self-hosted deployment plus offline tablet visits
Where it doesn't
- Pricing requires contacting sales
- Broad workflow coverage may exceed the needs of teams seeking a narrow tool
- Integrations and support information are centered on enterprise operations
Our verdict on Pega Care Management
Pega Care Management coordinates patient and member care across health-plan programs and clinical workflows. It brings together patient profiles, personalized care plans, assessments, referrals, utilization management, authorization and discharge planning, alongside care-team collaboration and population-health programs. Its breadth makes it a fit for mid-market and enterprise health plans that need to manage both patient-facing and operational work. Teams looking only for a focused case-tracking tool may find its wider workflow scope unnecessary.
The product's breadth extends from patient 360 profiles combining clinical, claims and authorization data to health-risk and clinical assessments, referral routing, scheduling and case conferences. It also covers prior authorization, discharge planning, disease-management and wellness programs, with configurable dashboards and operational reporting. Integration options include HL7 FHIR, clinical guidelines from MCG and Optum/Change Healthcare, Microsoft Exchange, Pega Customer Decision Hub, and healthcare and IoT devices. This range is relevant for organizations coordinating across data sources and care programs; prospective buyers should map their required workflows and connections to the product's scope.
Deployment can be in Pega Cloud or self-hosted, and mobile visit support includes offline tablet use. That combination may suit organizations with different deployment needs and care teams working in the field. According to the vendor's pricing page, pricing is not published and buyers must contact sales. The listed support channel is documentation, so teams weighing a purchase should consider whether that support arrangement fits their needs. Pega Care Management is best suited to health plans seeking configurable, broad care management; buyers who prioritize a narrowly scoped product or published pricing should consider alternatives.
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Pega Care Management pricing
Pega Care Management fact sheet
| Free plan | Not verified |
|---|---|
| Paid from | Not verified |
| Care plan management | Yes |
| Patient assessments | Yes |
| Referral management | Yes |
| Patient portal | Not verified |
| Mobile access | Yes |
| HIPAA compliance | Yes |
| Deployment | Cloud, Self-hosted, Mobile |
| Platforms | Web |
| Compliance & security | HIPAA |
| Support | Docs |
| Built for | Mid-market, Enterprise (editorial estimate) |
| Integrations | 6 integrations: HL7 FHIR, MCG clinical guidelines, Optum/Change Healthcare clinical guidelines, Microsoft Exchange, Pega Customer Decision Hub, Healthcare and IoT devices |
| Pricing | Pricing on request |
| Website | pega.com |
| Facts checked | 24 Sep 2026 |
Pega Care Management integrations
Pega Care Management lists 6 integrations on its own site.
- HL7 FHIR
- MCG clinical guidelines
- Optum/Change Healthcare clinical guidelines
- Microsoft Exchange
- Pega Customer Decision Hub
- Healthcare and IoT devices
Alternatives to Pega Care Management
- Conduent Care ManagementEnterprise care-management workflows for coordinating plans, assessments, and referrals.9.0
- Foothold AWARDSConfigurable case management, billing, outcomes, and compliance tools for multi-program agencies.8.7
- MediSked ConnectConnects care plans, service records, claims and field-visit workflows for HCBS organizations.8.5
See all Pega Care Management alternatives →
Pega Care Management vs the competition
- Pega Care Management vs Conduent Care Management
- Pega Care Management vs Foothold AWARDS
- Pega Care Management vs MediSked Connect
- Pega Care Management vs CommCare
- Pega Care Management vs GuidingCare
- Pega Care Management vs MHK Care Management
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Reviewed by iTechGuides Editors · Editorial team · Updated Oct 2026
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