PegaWorld 2025: Prime Therapeutics and Virtusa Accelerate Clinical Reviews to Speed Medically Necessary Therapies for Patients

PegaWorld 2025: How Prime Therapeutics and Virtusa Accelerate Clinical Reviews to Speed Medically Necessary Therapies

Good morning, everybody, and welcome to PegaWorld 2025. And welcome to our panel discussion. Today we're joined by our client Prime Therapeutics. And we're going to talk about the solution that we built for to accelerate clinical reviews to speed medically necessary therapies. It's a mouthful, but it's something, as Amy, when she gives the overview of Prime, will certainly be crystallized because it's all part of our lives all the time.

So great project and we thank you all for joining and joining us here today. Anyone in the audience from Prime today. Excellent. Well, this is your story, so thanks for sharing it with us. So the agenda for today, we'd like to talk about the key tenets that we delivered during the project.

You know, as well as the overview and the business objectives that we're going to talk about delivery highlights, uh, user testimonials, and actually the summary of what we found at the end, our success. And then we're going to talk about primes high level future roadmap, uh, followed by Virtusa giving an overview of the market and kind of where we're heading. So with that I'd like to introduce today's panel. So my name is Dan DeSantis. I'm a vice president with Virtusa.

And I'll be the moderator today. Joining me is Amy Brown. Amy is a vice president of IT innovation at Prime Therapeutics. Hi, Amy. Hello.

Next to Amy is Laura Woods. She's an associate. Laura Marbs is an associate vice president of Solution Products and IT leader. And our program manager, diva Laura. Good morning.

Good morning. And finally, Alok Mandal, who's a vice president of global consulting for Virtusa. Good morning. Good morning. Good morning everyone.

Okay. So let's get started. Um, can you please give a brief overview of Virtusa? Absolutely. So first of all, I would like to introduce Virtusa as a domain led engineering firm.

We are global. We are working with many verticals with Healthcare Life Sciences as one of our pioneer vertical, where we really have a lot of depth into the domain on the payer provider as well as on the PBM side of the business. So we do three things very good. And it all comes with a family of 30,000 professionals, which we have. So the first is working very closely with our customers and leading towards them as a partner.

How do we really elevate the transformation journey, not just from a technology implementation, rather going towards a business outcome based driven, which is more towards bringing in values, uh, to the process which we are implementing towards it. The second part is how we kind of come together with our product partners, whom we work with, be it in the form of AWS, Microsoft, Google and Pega. So Pega is one of our the pioneer partner, which we have been working very closely with for the last 25 plus years. And we take pride on not only being recognized as the partner of choice for transformation, be it on the legacy side of it, um, or onto the under the Constellation. We heard so much about Blueprint.

We are the partner of choice for Blueprint, but on the Healthcare Life Sciences that's one of the verticals where we kind of go too deep and we are recognized as one of the premium partner who kind of support those initiatives out there. And the third angle is more on the analysts. So we work very closely with the analyst groups like Gartner, Forrester's HFS. We take the outside in view, understanding where the industry is trending, not only from a technology standpoint, but also from a domain standpoint, how both of them intersect and we bring the customer and our partners and analysts are kind of things together and build a roadmap which is more in tune towards future leading initiatives for all of our customers. So with that, I would I would like to, uh, kind of, um, give you all a warm good morning.

And this is the first session for the PegaWorld and welcome here. Thank you. Luke. Amy, can you please provide an overview of Prime Therapeutics? Sure.

So Prime Therapeutics is one of the largest private PBM in the US. We are owned by 19 Blue Cross Blue Shields across the US, and we provide their pharmacy benefits management services. Our mission at Prime, because we are privately held, is really about focusing on how do we provide the care that we would expect for our loved ones. So we started out as a PBM for Blue Cross Blue Shields, and about three years ago we acquired a company called Magellan RX and expanded our services. So we now provide PBM services for mid-market accounts as well as state governments, 26 different organizations there.

We currently serve over 25 million members. And um. and we, um, very recently with that Magellan, um, perspective, we also started handling medical pharmacy benefits management for some select clients, which the PCR application actually supports. So if you're not familiar with the PBM, although majority of the people here are because a lot are from Prime. Um, however, I will just explain for those who may not know what it is.

So if you think about if you wake up in the morning, right, and you have a sore throat and you go to the doctor, the doctor swabs your throat, takes a does a test and determines, okay, you've got strep throat. All of those activities go into that physician doing the lab tests. All of that is covered under your medical insurance. However, as soon as the doctor decides, all right, I have an antibiotic I'd like to prescribe with you. What's your pharmacy that you prefer?

Um, that starts to kick in. The PBM process. So that script gets sent to the PBM or like Prime, determine if that script is within. Um, the policies and helps process that right. Price and that script for you as a patient.

You probably don't even know you're interacting with a PBM at that point. But, um, that's kind of like the back part of how we support that member journey in receiving the right therapies. Thank you. Amy, can you please talk about what PCR is and how it supports prime business? Sure.

So PCR stands for Physician Clinical Review. And what that means is a physician clinical review is really a structured process that Healthcare companies like Prime use to determine if a treatment is medically necessary and should be covered, and that that process includes a review from a licensed physician that really determines the medical necessity. And according to the the policy, if you will, for that health plan. So if we think about an example, um, let's say that you go to a physician and they decide that you need a new drug, we'll say that it's, you know, foreign oncology. That physician sends in that request to an intake clinical reviewer.

So that person is in prime. They're determining if that therapy matches the medical necessity quality, um, of the policy. Now, if it does not match the medical necessity, the reviewer will go back to the physician and tell them they they have two choices. They can either select a new therapy or they can request a peer to peer review. So that, um, that there can be a deeper clinical review of that process. So that's when the PCR process really kicks in. And that peer to peer review is where we match a specific specialized physician with that prescriber. And they do a more deep, deeper dive on the clinical necessity, the therapies and how that all comes together. That PCR physician will then make a decision of if that therapy is within the realm, and either approve or deny it. And that's the process that we go through with this PCR capability to make sure that therapies are medical necessity, that they're clinically sound and that they're covered under the health care policy.

So prior to the implementation of Pega, how was this managed within Prime. Yeah. So prior prior to Pega, in this process it was 100% manual. So what happened was the clinical reviewer would review the information and they would communicate with our physicians on staff Off, either through email or through teams. And it would all be a very.

AD hoc dialog content to identify physicians and to manage the. Timeline that occurred as far as making sure that we were able to. Complete the review and process. Obviously as we built out the Pega. Solution, we were able to automate that process and also build in a lot of rules that were inside the clinical reviewers heads so that we could make it a more robust and automated process.

Thank you. Laura. Question for you, Laura Marbs. What is the functionality that's required from a Pega perspective to build PCR? Thanks, Dan.

In order to answer that question, I think we need to understand what. Our user base is. As Amy referenced, we have a lot of different people that are using the tool today. Some of our users are actually physicians that are out in the field. So they're in practice at a hospital or at or their office.

Other users are internal to our office, in our community, at work, or we also have technologists that are also working on the tool. And so looking at that user experience, the first thing we really wanted to consider was something that was extremely user friendly, something that an individual could look at either on their phone or on their laptop, and make a decision and not have to really understand a lot of different steps to to process it. So usability was a big driver. A second driver for us was scalability. And so you think about the Layer Cake.

We wanted to make sure that whatever we built wasn't just for PCR, but how could we take that and continue to build into the future so we could expand the utilization of the tool and then finally, no code, low code environment. You know, we from a technology perspective, wanted to have something that was not terribly customized and that we could turn it around, but we also wanted to offer our business users an opportunity to control the application itself. And so having something that allowed them that flexibility was critical. Thank you Laura. A little question for you.

So what what are the key tenets that are required to deliver a solution from a Virtusa Pega perspective for Prime? Absolutely. I think to build on what Laura said, it has been a very interesting journey. So I must say it has been pioneer from Prime Therapeutics standpoint and the whole ecosystem to experiment Blueprint for the first time at the initial phases. But the more critical part is how do we really bring in the process efficiencies, not only from a process automation, but also bringing in the aspect of bringing the real user base in perspective, right.

In this case, the physicians, how do we do a peer to peer review with the right routing, have the right matching algorithms in place. Which case goes to what physician? So all of those were being automated within the tool. And that has been a really power of the tool which was brought in, and for sure with the great, uh, requirements which were being laid out, telling how the future should look like. Now, coming to the scalability part, uh, Laura, uh, briefly spoke about, uh, the Layer Cake hierarchy, right. And what it really means is that whatever we build, it's a foundation which has been built out. And anything which goes from here, it goes both on the breadth as well as on the depth of it. How do we really expand the capabilities? And also from an infrastructure standpoint, I think, um, one of the very few PBMs who are into the industry have really embarked a journey, being such a scalable and secure way of executing it and getting into the cloud. Right, and getting into the Pega cloud, which does not really mean to have any scalability, to have hardware requirements being put in?

It just automatically scales itself based on the need, based on the users which get in. And one of the things which I would like to add here is the acceleration on the whole implementation. And that's we from Virtusa take pride on being part of the journey is Constellation. So we did leverage Constellation end to end for accelerating the whole implementation associated with it. And while it was not just a user experience part, it is more around how do we have minimal clicks being done?

How do we really have the right data being put forward instead of putting all the data, whatever is available to the end user, right. I mean, from from the right decision to be made. And last but not the least is how do we really make it more configurable, have it adaptive, kind of bringing things together while those who are into this Pega ecosystem for long, I must say, all the basics were being taken care of and elevating to the next level how it was really being adaptive. And I truly feel that the system which we have built here is future ready, with the newer things all coming around us, bringing in the seamless user experience for all of us. Thank you.

Look, Laura, a question for you. How did you engage the business community during this journey? Sort of show them the art of the possible and guide them through the iterative phases of agile development towards this ultimately nirvana state. That's a good question, especially considering the variability of our users. And so again, kind of going back to the audience that we were working with, we had individuals that were not accustomed to thinking, creativity, creativity.

We had to really put them in that framework of saying, you know, step away from what you do today and try and figure out what it wants to look like tomorrow. On top of that, we were not Pega familiar, so we didn't have a foundation to build from. We weren't taking a tool and modernizing it. We were building from the ground up. So there were a couple of key components that helped us get there.

I would say first was the partnership we had with Virtusa and with our Pega advisory board to help our users really understand what could happen. Um, really push them to describe the problem we were trying to solve and not fall back on. Well, this is how we do it today. That was really core critical. I think the second part of it was a lesson we learned as we were moving past the discovery into the development.

When you thought about our original plan, if you will, of implementation, we had our user acceptance testing built in the end, with some conversations with our product owner and with our application owners, we realized that that probably wasn't a good idea and that we really needed to get that user community in there as quick as humanly possible, so we could really test out what was happening and then react to their feedback. And in doing so, it helped us catch some things where you think you're describing a problem, but you're really not. You know, you think you want a box with four walls, but when you get into the box, you realize you wanted a door to get yourself out of it. We wouldn't have been able to get there had we not had those users in the tool. And there's also the ongoing challenge, especially during the early phases of users seeing it one way and wanting to customize and then are trying to stay as close to out of the box as possible. How did you manage that during the project? So it's important to have a really good team leading your initiative. We had a super strong product owner who's sitting in the audience. We also had a very strong application owner that's also sitting in the audience. We leaned on them to really set expectations for what could be done.

And so you think about what I really want to make sure that I have that end all in state. But what do you need when you first go live? What's going to really deliver that value? And you have to consistently challenge your user base to make sure that you're focusing them on that critical point of what's kind of the bear that we need to go forward. And then also showing them, again the art of the possible of Pega out of the box.

We have to remember these users were not familiar with anything, and so we had to steer them away from customization by showing them what the tool could do and help them understand and connect the dots. How that out of the box functionality would actually solve the problem better than what they think they needed to solve the problem. Thank you. Excellent. So, Amy and I'd like to go around the horn here on this to the team to talk about some of the challenges that were faced during implementation.

So maybe starting with you also including the complexities around the physician scheduling, which I thought was particularly fascinating. Yeah. Thanks, Dan. So, you know, initially thinking about this, you look at it like, oh, this is just a process, just a workflow, right? I think our challenge is where we went from a manual process, where information was in people's heads was was not well documented to really building out not just a process, but actually a, a rules based engine.

And so the challenges were really being able to figure out the complexities that came with not only the workflow, but ensuring that we were thinking about the regulatory needs, the physician schedules. Right. What was important to them? And we built that process to really it's more of a rules based, but also sets us up to be able to add another physician now really easily gives us the flexibility Ability and that rules engine that's going to allow us to to scale appropriately. Thank you.

Laura how about from your perspective? I would approach this probably in two different directions. The first one would be the integration points with our internal systems. Um, so we were building an application that wasn't a standalone application. This actually had to connect up and down stream, and I think we underestimated the impact those connections would have when we first went out of the gate.

I mean, it's just data. No big deal. Always, always the long pole. Yeah, it's always the long pole. That is correct.

And trying to figure out how to make everything connect together again. It's not that the application we built was challenging. It was getting the data we needed in both directions to ensure that we were hitting that goal. And that, again, ties back to those requirements. If we don't know the data needs to be there, we don't know to connect the data.

So it was all kind of that trial and error. So integration points was probably a big one. The second one again goes back to that user community. We had individuals that were just not really accustomed to this type of technology. And getting them engaged and involved and at the table, helping to us to really understand what we needed to do and get through the end to end process was critical. It was also really important to manage expectations and to ensure that our users were thinking about this. Like I said, not what I do today, but the art of the possible. I keep going back to that because if you just build what you do today, you're not really moving forward. You have to really push your users to think creatively out of the box and get them moving into the right forward direction. And that was, I feel, a bit of a challenge.

We had to really get them to stretch their imagination. Thanks, Laura. Look, how about you? Any final thoughts on challenges? No, I would I would strongly agree with the two key points which was brought up right.

One envisioning the future. We were fully manual during the start of the journey, and we were trying to build something which never existed. It's not a replacement journey. It's a visualizing the art of possible and building it out. So the biggest critical success factor, I would say, was to have a much more frequent show and tell.

Um, we planned a later phase of UAT, we learned it really fast, and we went in a quicker cycles of show and tell with our business users, got their early feedback, and we course corrected the way how it should be and envision the future state application. The second, I think both of you spoke about the integration, I would I would really put, uh, my thoughts as well into it, that it has been one of the most critical juncture to make sure all of them work in conjunction with the existing systems. How do we integrate? It's not about just the technology. It's about how do we bring the right teams into how do we collaborate with them?

And, um, I would like to thank Prime Therapeutics on how all the enterprise groups came together and we kind of were able to build, build the final state system. Thank you. So when we talk about program delivery, especially something of this complexity, we have to talk about governance and cohesion. So Laura, your thoughts on governance. Governance really played a strong role with this initiative.

And we approached it in a couple of different layers if you will. So we had our overarching umbrella, our senior leadership governance, which was a combination of prime individuals, Virtusa individuals, as well as Pega individuals that came together on a routine basis. And they were really there to block and tackle for us, help us move obstacles out of the way, help us make strategic decisions that the team was stuck on, but really help keep us on that guiding path. Then we had the program layer governance, which was more of that day to day. Do we have enough work?

One of the challenges we faced was we were doing a lot of just in time on our sprints, which is not really a good way to work. And so really leaned on that program governance to get us moving. And then our user governance, they had to really hold us accountable to make sure that we were building a tool that would help them do their jobs during the course of something of our initiative, which happens when you have these initiatives of this size. We went red. We were having a lot of challenges from a delivery perspective.

And, you know, going red is not a bad thing. You know, there's there's some taboo when you go red as a project. And it shouldn't be considered taboo unless you go red when it's too late to course correct. And we actually went red after a very passionate discussion of if we were red or not, we decided to go red and our governance team held us accountable. Um, we couldn't just go red without a mitigation plan.

Um, you challenged us. The governance team challenged us. We were like, well, we're just going to be yellow until we go live. There's just no way. And you're like, no, we don't think so. You really need to have the go to yellow plan and then to go to green plan. And that governance group, from the users to the program to the senior leadership. I mean, they really held us into that accountable phase to ensure that we ended up going where we needed to. And we actually went live green, which honestly, at the beginning of the process, I didn't think we were going to do when we went red, I was pretty skeptical and the team was able to get us built out, and the governance group really held us accountable and kept us on the on the right path. Thank you.

Agree. And I think it can't be overstated that governance is three way. So prime in this case was the customer, Virtusa was the delivery partner. Pega is the technology. So Pega is in our projects, is always at the table with us as part of governance, as part of delivery.

Joe Louis, the Terre Loussier, leads our advisory services. We have a customer success manager from Pega. We have solutions consultants. We're all in this together, you know, learning and adjusting and figuring out along the way to make sure that it's successful. So that to us is a best practice and something that we always do.

Okay. All right. Let's talk about success. So Amy, over to you. Sure.

So when we started off this project, we started off with three simple goals. Um, one was to maintain the level of patient safety and making sure that the decisioning was clinically sound. Second was to improve our operational efficiency. So if you remember, we went from a manual process to some automated. So we we needed to get some efficiencies there.

And then the third was really about remaining compliant both with our clients like turnaround times and expectations as well as, um, all of the various state federal regulations to ensure that we were doing this properly. Um, and, you know, the the team identified goals specifically around what they wanted to measure. And you can see here I'm not going to go through them all, but we, uh, hit the efficiency goals pretty clearly. Um, we were able to create a lot of effectiveness and reduce not only the time it took to process these initiatives, but also really it set us up to become a more scalable platform going forward. Some of the other opportunities that we recognized was with the automation.

We actually feel that we are able to improve some of our compliance, uh, concerns, especially around turnaround time. So we now have visibility so we can tell, um, if we're staying within the turnaround times that our clients expect us to do to complete these physician reviews. We've also are able to reduce any impact of manual errors. Because we've put all of this into the system. We've got a rules based engine.

We now believe that we can also ensure that our compliance meets the marks that we need to, because we've reduced that. As a result. There was also a lot of soft benefits, which are always hard to measure. Um, but from a provider experience, you can see that we actually were able to reduce the time it took to do the peer to peer review by a significant event. So we're seeing from our providers a improved user experience because they know that when they work with us.

Sorry, my watch is going off there. When they work with us, they will get the turnaround a time that they expect. I would say also the employees or the users of the system have really benefited from the ease of use, the ability to kind of control some of these things within their own hands from a configuration perspective, things like that. And our ability to add a new physician to be able to build in some more rules. All of that is set up. The foundation is there. So it's really going to, I think, continue to drive value going forward. Excellent. Thank you. Luke talked earlier about how the users were engaged early on.

We had a lot of show and tell. Thank you Laura, what are the what's the feedback from the user community? What are they saying? Thanks, Dan. A couple of things to call out on the screen.

You see a lot of highlights. I'm not going to read them for you. I do want to call out we we face some skepticism. When we first started down this path with our user community, they were not necessarily drinking the Kool-Aid of what it was we were doing and how we were going about it. And so while it's not highlighted on the page, I do want to call out that that turned around pretty fast.

We were able to get our users on board with our approach, and with the way we were managing the expectations relatively quickly, they actually admitted that they were a bit wrong with how we were going about the process, and they actually ended up enjoying the way we were doing it. But as Amy highlighted, you know, our users are our most important factor in this tool. And if you didn't really highlight them or consider them first, you were not going to be successful. In just a couple of key points, I want to call out definite improvement. Useful tool.

I love it. Time saver. Efficient. All of these things. And again you go back to the community.

The main users of these tools, these are physicians. They're in the field. They're in the hospitals. They're in their offices. They're seeing patients.

And then they're also doing this work on behalf of Prime. And to be able to give them an application and to have this type of feedback, and then also with the individuals that are teeing up the reviews to where they really feel like that this is a win for them and helping them do their job? That's it's really satisfying. Um, just as an individual engaged in the program. Thank you.

Laura. So, Amy, what's the future look like at Prime for PCR and for Pega and beyond? Sure. So we've been a big user of Pega for a long time. We've got lots of applications currently running on Pega with this PCR application, though.

It was the first application that we built Cloud first. Um, we really leveraged the situational Layer Cake and tools like Constellation to really kind of help us build a strong foundation for the future. So, uh, the project itself was very time bound, um, and very focused on MVP. So for us, the next major, uh, the roadmap items for PCR in general, is to continue to build out some more advanced features that we didn't have the chance to the first go around. But then also more importantly, is the ability to take this tool and leverage it for other lines of business.

So we're looking into how can we use this for our PBM business as well? As an example. But beyond that we're also looking at really how can we leverage the cloud this situational Layer Cake for more applications. Right. So can we leverage Orchestration hub for some of the activities that we do between our medical and pharmacy capabilities?

How can we build out those care management capabilities for some of the work that we do, not just reaching out to providers, but also the work that we do that reaches out to our members around medical opportunities. We're also looking at I, um, the contact center is looking at using that Voice AI and Knowledge Buddy and building that into our our programs here going forward. And then lastly, another opportunity for us that we'll be looking at is really that process, mining opportunities, where we can look at some of the processes that we need to build out, like regimen based Preferencing as an example, and how process mining can really kind of help get us started as we look to build out future applications within Pega. Thank you. And finally, I look to you, if we were to step back and kind of open the aperture a bit.

What is a future state look like for prime and connecting the dots with what Amy and Laura were talking about, and kind of beyond. Sure. So as we said in the start of our conversation, we work very closely with Prime Therapeutics as well as on the other side with the analyst groups, with other customers. So based on the trends that we see, there are four key trends. One is the interoperability.

How do we bring the data together. And in this case we've talked about integrations. How do we really connected all the dots within the Prime Therapeutics. That's the heart of it. But when it comes to the entity level interoperability, that is where we have the payer and the provider talking PBM and the payers talking, and the member getting the final outcome as a 360 degree.

Instead of looking into three different portals, they have a single unified view of the interoperability coming in. So that's the trend, one of the biggest trend which is happening around the industry. Um, the second is with the data coming in, how do we empower the members and the providers? Right. Because unless we have the right data, we won't be able to empower the end users who are serving the members and the providers.

And that is one of the areas where we are seeing a lot of task allocations, a lot of things which are more aligned towards, um, member satisfaction and provider satisfaction coming in. And one of the Elevance on the Prime Therapeutics implementation, which we had with PCR, is the right mapping, which we had. Right? I mean, instead of having any physician picking up any of the task or any of the cases which needs to be worked on, we had an algorithm to find who is the right provider by the demographics, by the specialty, by where that particular provider is located. And what comes next is the interesting part, right where data can be leveraged for the AI.

We briefly talked about the roadmap which we have ahead of us. So that's where the AI and the data are really coming and putting into action. How do we have the clinical decisioning getting powered with the right data? So say for example, I have a registered nurse or a medical director who is reviewing it, or even a physician who is reviewing a particular authorization. And, um, what if we had a propensity score telling that with exactly this configuration of the benefit and the medical condition of it, medical necessity of that particular patient, 95% of the chance, you may want to just approve it.

So the physician who is on the other side makes a much more conscious decision, accurate decision based on the data which they are seeing in front of them. And last but not the least, is more around going ahead of the curve. Right. Doing preventive care. And um, that comes with closing the gap in care.

So proactively reach out to a cohort of population and identifying that someone who is having a particular issue. Can we really target them in a way, uh, to, to kind of have it being closed proactively instead of it really getting into a situation that it escalates itself? So summing all of them together, uh, what I would say is, um, starting with the data, right? Data connecting it with the ecosystem, using the data for the right engagement, bringing the whole connectivity with the power of AI, GenAI, Agentic AI, whatever we might call it comes in. And most importantly, how do we mitigate the risk which is ahead of us to minimize the cost of the care for the members and for sure, for the PBMs and payers? Thank you. This was a very personal journey for us. So you've heard about our our challenges, our objectives, how we achieved those. We had a lot of fun along the way as well. So we thank you for hopefully you get a sense of that and we thank you for sharing time with us today.

We're now going to open it up for a Q&A. So if anyone has any questions, please either sing out or you can also step up to the microphone. Hey guys, I actually have two questions. One, you mentioned this was Cloud. First, did you did you natively build this in Constellation first or was it migrated?

And my second question and maybe more towards Virtusa. Um, you mentioned some speed bumps you had during this implementation, but I'm curious about the speed bumps you might have had building in Constellation. And did you have anything there? I'll take that. So for sure, uh, the first part of the question, it was a new build out.

So it's not a migration from an existing app to a new app. So it was a relatively easy journey. I would say. We all are aware of the older cosmos and the Pega UI kit and various other aspects. To move from one UI kit to another UI kit is a big challenge.

So advantage which we had here was it was brand new, built out and we took the best practices which are there for the latest and the greatest version of it. So overall, from a constellation standpoint, I think, uh, we uh, we had uh, we had some hiccups. We had our product team coming in to help us on, on understanding how best to mitigate those things out. But overall, um, this being a fresh implementation, um, technologically, we didn't face that challenge here. So the second part of the question on the technology side of it, um, I mean, one of the biggest challenges that we had was the integration.

How do we connect, what are the right protocols to kind of get in? Is it a Kafka based integration? Is it a JSON based integration? Right. So those kind of complexity really came in.

There were certain standards which were also set up by the enterprise telling that these are the best practices. So we had to abide by it. So I won't say it's it's a, So it's a challenge. Challenge. It's more like a brainstorming to find the right solution towards it.

With the fact that Pega was used for the first time into this space. The only thing I would add to that is, while it wasn't a challenge, it was an opportunity for a bunch of individuals that think differently to come together to solve a problem. And that was really the core critical success of it is, you know, if we tried to formulate an opinion for the team, we would not have been successful by allowing the team to think independently and to brainstorm and to be creative. We were able to overcome any of the challenges we had. Thank you.

Any other questions? So my question is to Amy and that you are serving up, let's say, 19 of the bears, and they have a mandate on value based care and interoperability. So in that context does this implementation is giving you some kind of roadmap or strategy to implement that. Um, so this this particular application is focused really on our medical pharmacy business, which is a little bit different than the PBM side of the business. Uh, however, it as mentioned, it does really set us up for extension and the ability to not just have this as a standalone application, but really be able to provide both of the data insights that come with that as well as the interoperability.

Right. So we talked about things like being able to extend the connections with our members and leverage this more from a value based from a care management perspective. And that member 360 perspective, which I think will give our clients a lot better visibility and information, um, to meet their needs. And if I may add Amy, to that, right, I would say there is no direct CMS guideline at this point of time for PBM, but I would say Prime Therapeutics went one step ahead. What payor is supposed to do to make sure prior art that denials are electronic?

So this is a for sure a good step and a bold step towards that. Thank you. Other questions. I think you answered it, but I want a little bit more clarity as a blue plan. We're deep into Judy and the launch of Judy.

This is talking about case management. Judy is the ecosystem and case management is a part of that. So is this separate from what I'm hearing you say, or is it a part of Judy? So just maybe from a terminology so this is not a part of Judy, the rollout from a PBM perspective. Sure.

Today. So this is for medical pharmacy carve out business that some of our clients have. However, a future opportunity could be the opportunity to integrate with Judy. As we get into, from a PBM perspective, the the PCR process that exists today. I think that would be very helpful to wrap that together.

Thank you. That is our goal. Thank you. Other questions. If there are no other questions going once.

I'd like to thank the panelists today. Amy Browne Laura Marbs Alok Mandal. Thank you for sharing this story. Thank you for taking the time. Enjoy the rest of PegaWorld and come visit us in booth 16.

Thank you. Thank you.