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Life cycle management in Pega Product Composer for Healthcare

Life cycle management is the process of managing benefits, products, and plans throughout their natural life cycle from inception, through configuration and production, to service, and finally retirement.

Pega Platform provides customizable, stage-based life cycle management. This feature gives you better control over the business process and improves consistency, effectiveness, and visibility of process handling, thereby decreasing cost and improving quality.

In Pega Product Composer for Healthcare, entities such as benefits, product templates, products, and plans undergo the life-cycle process. Typical healthcare benefit configuration experiences many transformations from the time that it is created until the time that it is retired. In Pega Product Composer for Healthcare, the maturity of that transformation is tracked in stages: Development, Implementation, Production, and Retirement. Each stage can be versioned so that you can identify what was effective at a specific point in time.

Stages

The life cycle process of entity configuration is not linear. This process consists of many other processes, tasks, policies, and supporting content. The context of an entity determines the elements and how the work flows. Furthermore, an entity, such as a benefit, continues to change throughout its life cycle due to both internal and external events. Life cycle management includes managing those who configure the benefit, product managers, and other internal and external parties who collaborate on the configuration.

Development

An entity, such as a benefit or product, is created, reviewed, and considered by the organization as a potential offering. The product developer creates a concept for the benefit that is based on the market need or regulatory requirements. Then, the product manager reviews the concept and rejects or approves it, or sends it back for rework. When the product manager approves the concept of the entity, it is promoted to the Implementation stage for further configuration.

Implementation

In the Implementation stage, the approved concept for the entity needs further configuration and review by the product manager.

There are no specific review and approval steps that are defined in the workflow, but you can define steps in this stage to seek internal reviews and approvals before sending the configured entity to the product manager for approval. For client-specific scenarios, you can configure changes in the implementation layer, based on the site-specific requirements.

After you finish the internal reviews and approvals, you can send the configuration to the product manager for approval.

Production

In the Production stage, the benefit or other entity is further configured and is in use within the health plan organization. It can be supporting sales, benefit inquiries, or even driving benefit determination and benefit calculation.

You can also configure steps in this stage to notify the Sales and Sales Operations teams of the new offering that is ready for sale or service.

Retirement

When an entity will no longer be available or reused for new products, you mark it as retired so that no further consumption of the entity is allowed. In the Pega Product Composer for Healthcare application, entities with the Production-Approved status are moved to the Retirement stage to complete the retirement process. You can still use benefits and products that are retired to support operations for grandfathered products or events that occurred on dates of service prior to the object being retired.

Rejection

Rejection is an alternate stage in life cycle management. During the approval process, the manager can reject an entity. The rejection action is available for managers in the Development, Implementation, and Production stages. The status of the entity becomes Resolved-Rejected. The entity is no longer available for consumption because it was created in error or some internal or external event has occurred, which forced the manager to reject it. The manager can capture feedback while rejecting any entity.

Customization

Life-cycle stage configuration, such as changing the stage names, skipping the stages, and skipping approvals, is business-friendly.

You can customize your configuration. For information, see the following topics:

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