enGen Transforms Healthcare Through AI-Powered Member Engagement
See how enGen revolutionized healthcare member experiences with personalized, AI-driven care journeys.
reduction in medication non-adherence
next best actions across service, sales, and engagement
40%
reduction in clinician prep time, with GenerativeAI “Member Snapshot”
The Business Issue
enGen, part of healthcare company Highmark, serves as a large insurer supporting both Highmark and other health insurers across the United States. They faced the challenge of transforming fragmented healthcare experiences where members were overwhelmed with marketing messages, operational communications, and confusing life-changing healthcare events. The healthcare industry lacked the personalization that members expected from other digital experiences, with 50% of people globally failing to adhere to medication regimens - costing half a trillion dollars annually.
The Solution
To improve engagement, enGen created "Member Engagement Hub” (known as meHub) powered by Pega Customer Decision Hub. meHub was built with the goal of supporting four key principles for their members: Know me, Guide me, Support me in life-changing moments, and Don't fail me in everyday moments. enGen built comprehensive member journeys around many life-changing conditions like diabetes, creating personalized engagement across multiple touchpoints - from care manager outreach to mobile app nudges to physician integration. With real-time ingestion of data from claims, EHR (electronic health record), pharmacy, and call-center feeds the AI models can better predict risk, gaps in care, and propensity to churn. Using Pega Customer Engagement Blueprint, enGen accelerated the creation of complex healthcare journeys, generating dozens of personalized actions and treatments that adapt based on member personas and health status.
The Results
enGen now successfully manages the complexity of healthcare experiences moving from chaotic, disconnected interactions to harmonized, personalized member journeys. They achieved comprehensive coverage across payer, provider, and member touchpoints, with the ability to proactively identify and respond to health events in real-time. The platform enables seamless communication between care managers, physicians, and members, supporting everything from medication adherence programs to complex cancer care coordination.
Give every customer exactly what they want – before they know they want it – with every interaction.
AI-powered engagement strategy design.
"The customer brain is our way of using everything we know about our customers in every channel so that every time we're talking to a customer, we're able to have the best possible conversation with them."