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Program referral

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Updated on March 19, 2021

Pega Care Management provides a stage-based program referral process that can be initiated through the Interaction Portal or from the Care manager portal.

To create a program referral, in the Patient 360, click ActionsNewProgram referral.

For more information, see the Pega Care Management Business Use Case Guide.

The following list describes items that are related to the Program referral Microjourney:

  • Configuring the work group for program referrals or outreach
  • Configuring the default assessment for the HRA program
  • Data model
  • Extending your program enrollment case
  • What not to do in Program referral

Configuring the work group for program referrals or outreach

To ensure that the outbound requests for program referrals or outreach are routed correctly, assign the work group, for example CarePrograms@MyHealthPlan, in Pega Care Management.

  1. Click ConfigureCare Management Configuration.
  2. Click the Work queues tab.
  3. In the Care programs work queue field, enter the name of the work queue that the application uses to route program referrals or outreach.
  4. Click Save.

Configuring the default assessment for the HRA program

You can choose the questionnaire that will be part of Health Risk Assessment (HRA) when a patient is referred to a program. Configure this setting on the Care Management Application configuration page.

After you configure the assessment setting, the program referral for patients is associated with the specified assessment at the time of referral and is run if the patient confirms the enrollment.
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Other settings tab.
  3. In the Default Assessment for HRA list, click the assessment to associate with the HRA programs.
  4. Click Save.

Data model

In App Studio, you can view the data model for Program Referral in Case Types.

Click the Data model tab on the Program Referral page.

Extending your program enrollment case

You can extend your program enrollment case to avoid duplicate enrollments.

  1. In the navigation pane of Dev Studio, click Case types
  2. Scroll down to Program referral and click it to open the case
  3. On the Workflow tab, in the Referral stage, click +STEP to add a step.
  4. Click MoreUtilitiesDuplicate search.
  5. Adjust the flow according to your case. For more information, see Case types.

What not to do in Program referral

Do not override rules for customization. Instead, use the extension points and configuration points.

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