PegaWorld 2025: Moments That Matter: How enGen is Changing Healthcare Through Personalization, Automation, and AI

PegaWorld 2025: Moments That Matter – How enGen is Changing Healthcare Through Personalization, Automation, and AI

Good afternoon everybody had a good show today, this week, everything. All the excitement building up, all to get to this moment. This is pretty impressive. I gotta tell you.

Thank you so much for hanging around for this one, but this is going to be the best part of the week, I think, um, as we talk about this particular, um, subject, which is near and dear to my heart, um, we're seeing some advanced uses of CDH in healthcare, and it really does have an amazing opportunity to sort of reimagine how we treat patients, how we deal with people members and whatnot. And one of the better examples of that is what engine's been doing for a couple of years.

And so I have my partner in crime up here, Jennifer Magaro, and she is actually leading the CDH effort at enGen. And so we'd like to share some of the time with you to show you not only what they're doing, but also how they're starting to incorporate Blueprint into their thinking about how do we accelerate time to value, time to market, and able to use this technology in a neat way? So without further ado, I'd like to introduce yourself.

I would be horrible at doing it because, well, I would just glow. Sure. So good afternoon Jennifer Magaro. I am Senior vice president of Experience and Engagement Solutions at enGen. We're part of a healthcare company called Highmark, which is a large insurer, and we support both Highmark, our diversified companies that are part of that enterprise, as well as other health insurers across the country.

And so happy to be with you this afternoon and explain to you what we're doing with Pega CDH around our member experience. And so I wanted to start off with a little story, because I think it's interesting to think about how we think about the member experience and personalization just in our everyday lives. And then how we translate that and what's happening in healthcare. And so what those expectations again as we move about our everyday lives.

And so I was having a conversation with my parents a couple of months ago, and they were talking to me about two things. One was their Facebook feed. And so they were telling me about an article that they got on Facebook and they were like, can you believe what was on their Facebook feed? And I said, well, I don't have that on my Facebook feed. And and they couldn't fathom that I didn't have the same thing on my Facebook feed that they had on their Facebook feed.

And so I was explaining to them about algorithms and, you know, what? How they were getting that content. And first, I should have realized that they have no idea what I do for a living. And I should probably explain that to them because I haven't explained it to them even yet.

Um, but I proceeded to show them my Facebook feed and their mind was blown of what I saw versus what they saw, and they said, all you have to do is search for some cat videos and you'll see a completely different thing than what you're seeing today. Um, and then I showed them, I said, well, pull up your Amazon feed, right. And look at what you're getting suggested for products.

And they they went on to complain about someone in our family that they're sharing their Amazon account with and what they've been searching. And they were buying gag gifts for Christmas and how they were screwing up what was showing up in their feed. So they got it right, like what that personalization could do for them. But they didn't get it when it came to Facebook and what was happening and the content that was being served up to them. Um, so again, two extremes of where they got what personalization could do for them. And yet, when it comes to Healthcare, the expectation around personalization is pretty low when it comes to the payer space. Yet should it be? And I don't think it should. Right. And I think we can do a lot better. And so today when we think about healthcare, um, it's a very fragmented experience.

I think there's really great experiences out there when you think about maybe some wearables that you might interact with or some apps that you might interact with, but when it comes to the payer space, again, very fragmented experience, the way that we interact with you, um, we pummel you with marketing messages. We have operational and administrative things that we might have to message you about. Um, and then you have life changing, um, healthcare events that you have to navigate.

And we make that very confusing. And I think there's a big opportunity for us to improve that overall experience and actually orchestrate that in a much more personalized way. And so that's what we we really look to Pega CDH and a tool called Member Engagement Hub or Hub to do for us. And so I want to look at this through the lens of a health journey. Um, here we're going to look look at a diabetes program.

And so we have three different portions of that journey that we're going to look at it through. So enrollment engagement and care delivery. So when you think about enrollment there's lots of ways that people can enroll in those programs. So one is we could have a care manager reach out to you. So we know that you've had a life event, you've been diagnosed with diabetes. We can have that care manager through that diagnosis code.

Reach out to you and say, hey, we think you should enroll in this program. You could we could serve that up to you through the mobile app. So you come in, we're going to nudge you through a next best action. And we're going to tell you that we think you should enroll in this program. And you actually take that action, enroll in the program. And now you're digitally interacting with us.

Or you could be sitting in the chair with your primary care physician, and we could nudge him and we could say, hey, we think this person, you know, they have access to this program through their benefits. You should sign them up. They actually go in, enroll them right away into that program. So three different ways that you can enroll in that program. And now once we get you in that program, how do we keep you engaged in that program.

So again, digitally, we can keep you engaged in that program through our mobile app. We can send you reminders again through consent and preference management. We can know how you want to interact with us, and we can start orchestrating the ways that we might communicate with you through text, email, push notifications. Your care manager can reach out to you.

And wouldn't it be cool if we could start sending all of that information over to your primary care physician, and he knows how you're actually interacting with that program through the mobile app. And then when it comes to care delivery, wouldn't it be really awesome if you could start to asynchronously message with your care team?

So your messaging with your care manager who's at the payer, you're talking to your physician right back and forth, and you're connected both again asynchronously, or you're even chatting real time. Now, we know that physicians are busy, right? Our care managers are busy, so they're not always at our beck and call through chat.

But again, asynchronously, I'm sending messages, I'm getting information back and forth, I'm interacting with the mobile app and ultimately, um, living a much healthier life. So the way that we think about, again, what that future might look like, we have four key principles. When we think about what that looks like Knowmy guide me, support me in life changing moments, and then don't fail me in the everyday moments.

Nomi is about how we take all of the information that we have about a member and have that in a connected ecosystem, and so that's payer information. That's health information that we're collecting about you from our provider systems or health information. Again, wearable information. And then I think that there's a missing piece right now that we don't necessarily have good access into, which is consumer information or even event triggers.

Again, how are you interacting out in the world and how do we start to get that information. So again, we know more about you as a person. Guide me, which is how do we think about the journeys that you're on. And every single person that's interacting with us is typically on more than one journey. Hopefully you're really healthy, right? And you are on very simple journeys.

But when you're in those life changing moments, you want us to be there and you want us to be able to guide you through that, that event. And so if you think about anyone in your life that ever has had, again, a diabetes diagnosis, God forbid a cancer diagnosis, right? You want us to be there in that moment so that we can walk you through that moment and again guide you through that journey. And then don't fail me in everyday moments. This is the basics that we have to get right.

And this is where we earn the trust of all of our members. If we don't get it right here. We don't earn the right to be there in those life changing moments because they're going to say, forget it. You couldn't do the basics. I couldn't log on. Right? Or you didn't answer my phone call the way I needed you to when I had a simple question or the letter that you mailed me or the text that you sent me, I couldn't write, I couldn't understand it.

And so these are just the basics, foundationally, that we have to get right. So when we think about all the work that we do around the experience, these are the ways, the lenses that we're looking at it through. So how do we stitch this all together and make it look easy? Again, I think back to my parents and how they don't even know that it's happening. It is not easy. I don't know if anyone has ever said to you like, oh, I can do that in two months. It's really easy. Just deploy it.

It'll cost you like half $1 million. It's not that easy, right? And so when we look at engines, um, ecosystem that we're accountable for, we've got payer systems, we've got provider systems again, we've got dental systems, stop loss systems. We've got to stitch all that together.

We've got our operational systems, our global delivery print, our data centers, right front office, back office, middle office, all of that tremendous amounts of data that we've got to stitch all together in order to bring this to life. So a tremendous amount of accountability and responsibility to get this right for our members. And then lastly, mihoub how we all bring it to life. The picture on the right is really tells the story.

Have you ever gone to an forgive me if you have children that have been at concerts, right? Have you ever gone to, like, a little kid's concert? Okay. And it doesn't always sound so great. Okay. Or have you gone to the orchestra? Warm up. right? And it just doesn't sound so good when they're all, like, swarming. Yeah. Yeah. Okay. That's somewhat what Healthcare sounds like today to our members. Right. It's not in harmony. It's not. The conductor hasn't walked out yet.

When we view Mihoub, I view that as the conductor is out. It's. It's been orchestrated. Right. All those journeys are stitched together. It's personalized. It's simple. It's concise. Right. We've gotten it right. And that experience is really what we're living up to. The promise that we've made to our members. So, Robert, I'm going to turn it over to you to tell us how Blueprint is going to solve the world's problems for us. Yeah. Wonderful. Um, I don't know if anybody has any questions yet.

Um, before we get started on the next segment, but let's go ahead and get started. So as Jennifer was describing, you know, obviously trying to come up with these journeys, all these actions and things that have to be done to satisfy the needs of the members as we look at it. these are very complicated things to do. I think many people spend months, maybe even longer, trying to understand what these journeys are, what actions need to be taken. How would you define those actions?

How would you publish them across different channels? This is a lot of time and effort that goes into that, and I know that engine has spent months on doing these types of things with partners and whatnot, but if you think about it, this notion of journeys is phenomenal, especially in a patient context. We talked about cancer, we've talked about diabetes, we've talked about that. But in either case, everything basically streams on that top sine wave.

You know, over time, these experiences that these members have trigger everything. And so what we know is that in those journeys is where the magic happens. This is where somebody's going to either adhere to their medication because they just got diagnosed with diabetes or not. This is where if you have cancer and suddenly you're in these this complicated world of referrals and multiple providers and oncologists and radiologists, therapists, all of that, suddenly you're in a whole nother world.

So how do you manage that if you're a person? Well, the idea is you don't really not effectively. And this is where taking the genius that CDH is built for. And Doctor Jeff's over there in the corner has built. But it's an amazing idea of taking this marketing approach to interacting with people and apply it to healthcare. Just those same sort of nudges, those same sort of upgrades. It's it's different than we've experienced in healthcare before.

Up until now, that's been more of a doctor's job or something like that. But what we realize is that the goal of adhering to your medication, or to following up into your appointments, is really the job of the patients. You know, doctors don't do that. You know, payers are about to start doing that because they have the technology. They'll do it under care management programs. But this is where the rubber hits the road. So I always like to start out with this complicated problem.

If you look at a typical journey, and the one I'm showing you up here now is quite typical. It's basically if you've been diagnosed with diabetes, you've now got to go on a program that effectively trains you to take your medication regularly. It's a very simple process. It's called medication adherence. But 50% of people in the world don't do it. You realize that cost us half $1 trillion a year globally, simply because they don't know to take their medications regularly.

It's not a complicated thing, but it does require effort on the part of somebody. Now we've done it with care managers and navigators. That works effectively, but that doesn't scale well. So what we're doing here is we're actually taking that same approach, but now using the AI to actually create those nudges, those reminders, those moments through digital channels, as opposed to having a human always reach out.

So this is the key behind me, hub, that it sits there, you know, listening to activity that goes on stimulus and whatnot, and then it creates these actions around that. So this is where it gets fascinating because once something happens in somebody's life, there might be a case created for that. There may be other actions. And that will feed into CDH to start this dialog that it's going to have with these patients. So it's a pretty fascinating approach.

So if you think about CDH the way it arbitrates, the way it goes through these processes is just a fascinating way to do this in Healthcare. And just one of the best ways to look at is the next best action journey around this sort of cancer care. You know, the goal of this entire process of the journey is to help activate, you know, this particular patient that's just been diagnosed with diabetes, with good medication habits. Those are basically exactly that. They're a habit.

I just take my medication like I brush my teeth, just do it in the morning and I'm done. But I don't forget. But getting there is a whole nother process because basically there's a journey that these people on. And as you go through that journey, what happens is they will start losing track. This is where they're starting to drift into that non-adherent world. And it's at that moment in time that you want to start reaching out to them and saying, no, no, no, this is important.

You might start remembering this. You've got to nudge them. You've got to remind them, you've got to cajole them. Sometimes you got to become a coach and really beat them down. But this is what happens along that timeline. And so with CDH, what we're able to do is create all of these journeys, these actions around that particular journey that basically change as the situation changes. If they're not compliant, then we've got to create actions that remind them to do something.

If they are compliant, we give them congratulatory notes. If something else happens, we maybe create an action that launches something else, maybe a care manager intervention or something along that line. So when we get down to these points, though, we realize it's not just an action message that tells them to do something. They're maybe nudges. There may be nurturing messages.

All these are critically important for medication adherence program to actually work, because you're now dealing with behavior, behavior of people that don't want to necessarily do what you've been told to do by the doctor, I mean, nobody's ever heard of not taking doctor's orders is a common thing, but it is quite common. And here it becomes very problematic when we do that. So this is really what we're trying to do with CDH when we get here and we create these actions, suddenly magic begins.

But how do you create all these actions? There's thousands of these potential actions in a customer's life, especially if you're in the medical world of chronic illness like diabetes or God, for, you know, for cancer or something like that, it becomes very problematic. So what we thought we would do instead of power pointing you to death, is we're going to show you Blueprint in the case of an engine situation with Mihoub, we thought that would be an excellent way to go about this.

So if you don't mind, I'm going to switch over, assuming I can use my PC. Well, and this is Blueprint. So what we've done here is a little different. We've taken the blueprint, but we've now created it for engine. So it's a hub version of this. So it actually looks at what we're doing within this framework to basically create not just simple journeys, but complex journeys that sort of match up what Jennifer just described in her particular situation.

So what I've done is I've built this out and we have better versions of it here. Um, we want to show that later, but this is when it that sort of takes this prompt and describes what mihoub is, what we're trying to do with it. What's the context of this, how we try to do this very simple prompt. Um, but what starts happening is it creates really in my mind, just just magic, um, as it starts walking through.

So if you watch the presentation this morning, um, or yesterday actually that we walk through this, you saw the actual details. I've pre-built this one, of course, but it starts looking at mihoub within the Healthcare context, looking across all of the various domains that we could enter in, because we want to do all sorts of things with these people. We want to remind them, we want to nudge them, we want to nurture them. We also want to coach them in some cases.

So this is an area that we really get into. Well, and the thing I keep wanting to point out is how many months you might spend doing this any other way. But with Blueprint, suddenly it has a way to accelerate that which gets us to the testing phase, the interacting with people phase. So going to the next level, what we will see is that it starts looking at the personas, the members that we have to build these actions for. Because remember, at each stage along the way, the member changes.

You know, up to now they're compliant. When they got prescribed the medication, they're probably compliant for about two weeks. Then all of a sudden they start forgetting and they start dropping off and they start dropping away. Now's the actions start changing now. We start to get in a better way. So what does it look at these different personas and how can I build action plans behind these personas? They will change based on who they are. Some people are just scared to death of this.

Others are healthy and they want to do the right thing. We want to figure out how we help everybody the most that we can here. So this is the the reason for going by that way. And so what Blueprint does is it starts looking at the methods that we interact with these people, the voice we call it in the marketing terms. But in healthcare the same thing, just maybe a little bit different. It's more of a care manager, a navigator that might be helping you through these moments.

That's the concepts there, but very familiar to most people in healthcare. As we look at this, then we start getting into some of the views of this. How could we look at examples of these experiences? Because remember, we all have brands that we're trying to promote out there in the real world.

And the methods that we do it remind these people, create that that sense of trust that we talked about earlier to do that is how does it express, how is the brand expressed, how do people interact with that? Because what you want to do is reinforce these messages through these these channels. Right. You want to be that person that they turn to in these moments because that's really, you know, the whole goal here, especially in health care. So as we move across this, um, it started interesting.

Here's the piece that I just love about this particular thing because many people don't really I don't know if understands the right word. I'm pretty sure everybody in this room understands this one pretty well. But this whole notion of arbitration, you know, how do we look at all of these actions? And with CDH, you know, it's not just picking an action and arbitrating to what a conclusion is, either one of those personas would have completely changed what that would have looked like.

Those actions would have been completely personalized to that individual at that moment in time. So it's a pretty fascinating way to go about it. This is what care managers try to do natively, but this is something that actually takes that on a whole nother level. So if we were to go across this particular use case, it goes through the first step that we all are aware of. You know, this is member eligible for these actions or something. We can start whittling it down pretty quickly. Is that applicable to their particular situation? You all know these. And then it starts getting down into the more defined areas. You know, is it suitable for this moment in time? Where are they on that that that line of medication adherence in this context. And then it starts picking up the constraints and starts whittling it down even further until it gets into the actual arbitration phase. And here it starts getting interesting.

Now it's whittled it down to a very small set of actions that can be done. And again, I'm not trying to educate you on this, but I'm showing you in healthcare. This is an amazing sort of moment to realize how do we get to this point for this particular person? So in the case of wellness windy here, we can see that what has happened is that they've looked at it.

CDH has looked at as rehab has looked at this and it realizes that, well, we need to give you a prompt, a good nudge here that shows that, you know you're doing well. In this case, it's getting them to enroll in the program. We talked about that earlier. How do you get people on board in these sort of things. So these kind of messages go out.

And now for this particular persona we're able to generate an action for that moment in time, in this case early on into the process that they would have been able to, you know, enlist in that program, enroll in it and get those things done. Another interesting way about looking at Blueprint is if you simply change the personas to Carl, for example. Now you see the actions have completely changed some set of actions, same set of things, prompts and whatnot.

But now it recognizes this particular individual. It moves into that, that area. So this is what it does within Blueprint itself. Um, now if we get through this, I'll just exit out of this for a moment and show you where the real power is in the time to the speed, the time to market kind of thinking, and that is the actions that it starts creating.

Just in the case of Blueprint here, we had it generate literally dozens and dozens of actions that are very applicable to this particular case and this is what Blueprint did automatically. So it just takes a few seconds. And then as you move across and go into the journeys themselves, this is where it gets to me, just ultimately fascinating, because now you're starting to look at what is that series of actions that have been launched at this moment in time for that particular individual.

So now we can go across for that original thing. We talked about the warm welcome. We want to welcome them on board. We want to get them enrolled in a program. Potentially, once you're enrolled in the program, you may have to get health insights assessments and things like that. You want to understand more about that person, that individual at that moment in time. This is something that continually goes on, by the way, in the background. This is one of the things I just love.

What they're doing at enGen is that it bases on a whole bunch of things, but a lot of data is coming together, so these decisions can be made very effectively and catch a lot of information we wouldn't normally see at all. It just would go by a health insights. Let's say we did an assessment now that may change the actions completely. Again, we realize this person doesn't just have diabetes. They've also been diagnosed with hypertension. So only got two medications they got to start taking.

You got to start reminding of it and cajoling and separating the two at that moment in time. And this is what this technology has been designed to do. You know, literally in the world of marketing, but in a Healthcare, it's the exact same problem that we're facing with in this situation. So why not use the same technologies, the same ways as we go through this particular area? So as we go through these onboarding experiences, we, um, go into many different journeys.

Like I said, I just picked a few here, um, that we can create again, done by AI. So it actually creates an interesting sort of perspective as to how we might do this with these individuals. And again, this is stuff that we spend hours and hours of time in meetings and things like that trying to figure out now this is going to cut that down significantly. It's still going to take the work that we have to do, but it actually takes that front end.

And I think everybody that does projects know you lose momentum the longer you go. And so one of the things is, is catch it while it's hot. Make sure you're on top of that. And this blueprinting concept really does allow that to accelerate quickly. So now you can actually see something as opposed to planning and planning and planning and doing that sort of thing. And we know we've been through this now. It's not painful. It's actually quite exciting.

But, you know, it doesn't do what we need to do. It's even just as exciting to sit around a Blueprint and talk about these actions. And what we could do is that the right action, should we modify those actions. So it actually accelerates the discovery process as we talk about.

But in this case, it's a very natural way to start showing and pushing things out there and using them, learning from these experiences that these members are doing and starting to to modify and change that, which is really what we want to get to, right? We want to be able to prove these things out, modify them, and making sure that we're getting the best outcomes. And that's what this environment really does put us in the position to do. So. This is Blueprint.

Um, in the summary areas, you can start seeing these things just stack up and you realize that this is a pretty amazing process. A number of these actions imagine how long it would take us to just identify all these and start building these things out. But now with Blueprint, you know, they're pretty much there, um, waiting for it to to germinate and to grow and to be put out there in the marketplace. So from my perspective, this is magic on top of Healthcare.

This is something that Healthcare has never been able to do before effectively, which is to understand what people are doing in their lives enough that we can actually take some sort of action or understand what that is. To know me, to support me, to guide me and not fail me. That's not going to happen if you don't know what's going on. And so that's what this particular piece does now, combined with the predictable piece, which is the care management piece underneath.

And Blueprint, these things become very tightly integrated. So you can look at very complicated problems, like a cancer patient that might have multiple treatment options, multiple requirements. You know, suddenly you're starting to bring in I can speak of throat cancer actually fairly well. And you know, you're dealing with, you know, basically infusion therapist. You're dealing with radiology, radiology therapist.

You're dealing with speech therapists, you're dealing with a whole world of people suddenly in this particular moment and you are lost. Let me tell you from experience that you have no clue what's going on. If you're a cancer patient, except for, you're going to die. Well, that wasn't in question in my mind. I didn't want to talk about that, but it is a reality of it.

And so you realize you're on your own as a patient, especially as a cancer patient, no matter how good the doctor is, because they're not there with you, they don't live with you. They don't understand the emotional support your family needs and everything else. But what happens is you just don't know you're in the dark.

And so this type of an approach to me was magic, this notion that you mean, somebody would have sent me a text to remind me, you know, to speech therapists, speech pathologists. I had to visit, you know, to make sure I knew how to swallow again. Those sorts of things are very important, very critical. But you don't know these things. So suddenly you miss your appointment, so you're not going up there. They will not call you to tell you that your annual exam is coming up. That's not done.

That's your responsibility as the patient. Well, how many patients do that? Probably close to half the other ones, you know, they'll ignore it. They'll move on and maybe it'll work out. Maybe it won't. But the problem is, is that we have no way of changing that, especially if you're the payer and responsible for the outcomes of these things or the provider. This is where this steps in and starts changing that paradigm a bit so we can say no. Now we know you, we can see you.

It might not be all the data that we collect because we don't collect all the data. But suddenly through these nudges and these interactions, we're going to learn more. So what they're going to do is they're going to maybe respond to something. Maybe we send them over to a website, maybe we send them somewhere some new information is going to come in that's going to wind its way back to the brain, and that brain is going to take additional actions on that.

So suddenly we can do what I used to call seeing in the dark. How do we know that something's happening in somebody's life, that I could do a simple action and actually change the outcome for doing that? And this is where we get those moments that don't exist. So we talk about, you know, trigger events and stimulus and things like that that occur in the world. It comes through this infrastructure and suddenly we have a way to identify it, to recognize what to do about it and to act on it.

And that becomes magic in the Healthcare world that we've not seen before. So this is really a paradigm shift. Um, I'm an old man, and I've been doing this for a long time. I've been dreaming this for years, and now I pretty much need it before I really need it. So we got to get working on this stuff, guys. We got to get this stuff done. Um, I'm counting on. I'm counting on you. We got to pull this off. But that's what this is all about.

This is this notion of taking technology and applying it in such a way that it actually helps the humans deal with their issues. So it's not about making technology smarter. It's not about making doctors smarter. It's not even really about making payors smarter. It's about making patients smarter. Um, because let's realize that in healthcare, the problems with healthcare aren't technically healthcare problems. They're people problems that just don't know what to do.

And so they impact the healthcare system, you know, like a bullet. And then just causes the angst that we see today. So that's pretty much a presentation. Unless we want to dive down deeply. We have experts in the room. In fact, I think this room is consisting of nothing but experts, but we'd love to open it up for some questions. Um, any ideas about that? Or we'll just keep talking and you're going to be entertained. But I want to make sure that we get as much as everybody can out of it.

If you do have a question, please step up to the microphone because this is being recorded and they will ask you to do so. So any questions about how this works or maybe some options or things like that. Hi. Hi. Um, this is really great. And I'm a care coordinator. Ex-nurse. Um, so I really see the value of this 100%. And also having aging parents and not them not knowing how to journey through this.

But I'm just curious from a data and analytics perspective, like how are you measuring the success of this over like a standard care coordination program? And are you is it there's a blend together and are you seeing the like the monetary value and improvement of health care by, you know, these constant sort of, um, notifications to the patients. They're taking their medicines more. They're, they're staying out of the hospital. So just curious on how you're measuring the success of it.

Yeah, well, we know that if people adhere to their programs, right, that there's inherent value in that. And so we measure that through our care to value programs. Um, and then, you know, when we think about so, so that we measure through, not necessarily through the Pega tool itself, right? We measure that through the care program. Um, when we think about the uptick on the the nudges that we give, we really then look at the pull through of the actual message.

And so we think about, um, you know, and I think this is I was just in a conversation earlier this week about, um, you know, less messages but higher uptick. Right. And that feels counterproductive to I think, some people, right, where they're like, just blast people with messages. And so when you, you talk to people and it was a Kelly I'm looking at you because it was you were in that conversation. Right.

And we were um, again, it feels counterintuitive, but it's really about getting the right message to the right people through the right channel. And so that this tool will help us do that. And then that governance conversation that we have to have with the various stakeholders within the organization.

And I call that like the organizational arm wrestling around, telling different parts of the organization where today we might just say, well, there's a marketing team that's going to say, well, I just want to pull all the people that should get this message, and we're just going to blast out that message. And they might get a 7% open rate, not a great open rate. But if I actually sent 10% of those messages and got a 90% open rate, we're going to get a much better pull through, right?

So that's going to be a paradigm shift for us. Yeah. And so that's something that I think organizationally that will be a shift. Yes. Hello I'm Jen. I'm actually also a nurse and a former employee and was actually on the engine project. So I was on there for 18 months. And we remember five Sprint Sprint teams we had. I mean, it was a huge project and if we would have had this back then, it would have been a game changer for sure.

Um, but my question is, I'm now working for a Pega partner, and, um, I'm on a project right now where we are, um, doing gaps in care and the data and everything. And I'm seeing value in using Blueprint for them. And I was just wondering if you all have used Blueprint or even CDH for gaps in care and hiatus. Yeah. Do you want to answer? Oh, sure. I know that gaps in care was one of the first things that you did at enGen to push that, push that project forward.

I think in this one, what it is is that, as before, Blueprint, I think everybody was doing the same thing. Should. You want to answer this one? Yeah. Microphone. Just put the experts talk to the experts and we'll just mix up here. Uh, yeah. Yeah. So, um, gaps in care were definitely one of the first things, um, that we use CDH for. Um, and the interaction we have, um, we have a tight end with our ID and stratification team and the analytics that come out of that as well. Um, but giving our case managers a chance, you know, the insights, um, to have that conversation when they're engaged with the member is you can't, you know, you can't put a price tag on that. It's like super important to to help them close those gaps. Of course, you can't close the gap until the claim comes in. But we you know, we kind of are able to say, hey, we think we got this one on good footing. You can update that. So if a customer service rep or somebody.

So it makes its way back to CDH, you're orchestrating the same message across anybody that's going to have a touchpoint with that member. So that's usually appreciated by the member as well. And are you doing the dashboards and everything as well? I remember this was like in the beginning stages when I was there. We're not using the Pega dashboards, we actually. So there's a separate we'll call it Mecca gap word. So there is a dashboard on the gaps that we have access to.

It's not built right into predictable. And then we also have a business intelligence tool that sits on top of all of our data. So you can report out there, but there is a dashboard we haven't pulled it directly into predictable at this point. Okay. Thank you. Thank you. Any other questions? Yeah I'm sure you're going to stay there. So this question will come up next. No. Um, hello. Thank you for the presentation.

Uh, you show us at the beginning, you use a Blueprint and, uh, give them a lot of information, I fear. And it designs a 20 or 25, uh, persons. Mhm. Can you adjust this after if you learn. If you. Is it possible to, to, um improve after. At the beginning you use Blueprint you, you put you settle. Then if you need to improve after with new data or, and so on, is it possible to do it also with a Blueprint? I would think so. I mean again what data goes into Blueprint?

You could add that to it, but it's AI itself. So you're prompting it again with additional information is going to create better output. So that's the way I use it all the time is that, you know, you may have an idea or discovery thing and then you want to change that. You want to alter that and improve that. A lot of times it comes down to deeply within it, within the actions themselves. So you may find a lot of work down there, but yeah, it's designed not to be a rigid thing, right?

It's AI you prompt it, you can build things, right. What we spend all of our time is making sure the prompts can be turned into live, you know, components as opposed to just, you know, a CAD system, a computer aided design system. So, um, but that's built in behind it. This is where the beauty of it is, I think, is the maturity of the product right now. And this is the earlier Blueprint from what we're doing on the platform side. But it's just it's phenomenal for what it does.

But yes, absolutely. It's not a static sort of output that's creating the PDF is. But you know, that's the only piece that's static about it. But everything else is dynamic and it will regenerate these things. In fact you can do it within the structure itself. So case levels and other things I believe that's correct. Right, Vince. Yeah, I was going to just add to that. Um, so it's a great question.

And what we're doing is we're working on sort of making a full round trip is what we're calling it. So what you're seeing here is might be the beginning of an inspiration for the actions, the journeys that you would use for these various use cases. What we've already just released is the ability to import this into 1 to 1 ops manager and CDH. So then you get it in there, and then of course, you can govern that with what you really want to approve and move into production. But then coming soon.

So stay tuned in. Our 26 release will be the ability for Blueprint to read CDH. So that's the full learning loop that you're talking about. Because what happens when you get these things into production? You start to get, you know, responses and you start to learn about which ones are, you know better than others and which ones are performing. And then Blueprint can pull that back in and you can sort of go through that loop. So that's the idea longer term.

So turning it from a very complicated system into something that's quite valuable. And I think we just heard it earlier. Is that, you know, if we had tools like that, you know, we can actually create things faster. And to me, from my perspective, it's that acceleration of momentum. You know, when you get people excited about these things and you can show them these sorts of things, and by compressing that timeline, it's a really amazing sort of effect it has on people. So any other questions?

This is the last meeting of the day of the week. Oh, yes. Here we go. Thank you. Yeah. So it's the last question of the meeting, I guess. How do you kind of start on this type of journey? Getting patient engaged. Right. So, uh, like monetizing this type of system, like, if I as a as a patient, I know there is a value in it, right? But how do I get motivated to use systems like this? Is this for the buyer or the payer? How do they monetize it? Or the. No. Just for the patient.

So this is patient centered care management right? Yeah. But there are multiple parties involved in like throughout the whole journey. The providers, the payers, everybody. Right. So just to build a system like this. Right. And getting it adopted by the patients. Right. How do you kind of like go about this. And then there are many other journeys within the payer provider. Are patients like things like say revenue life cycle management? I think Blueprint could probably be another.

It can be expanded into those things as well. Absolutely. Can we take this one because. Yeah. So yeah, to me it's you're right. There are providers. There are payers there. Member patients out there. It's a very complicated system. So groups like Engine and Highmark, they're what we call a provider right. So they basically have that natural network of providers and that relationships that are already there. So they didn't have to really overcome that one.

What they needed was a way to accelerate it. So that's sort of the ideal starting point. So if you have an environment where you're working closely with the providers, if you happen to be a payer, my belief is that it's the payer technology that this will probably be behind and the providers will take advantage of it simply because they interact with it. So providers aren't really responsible for continuity of care.

You know, they actually their office, you know, they're responsible for their piece of it. But most patients are more complicated than that. So what happens is it's really the payer that becomes that entity that manages that journey of care as that member crosses those various provider segments. And so having that in already there makes it easier to learn from. And part of the process right now is learning, you know, how to do this more effectively to roll it out there.

We do this stuff with people, but we haven't done it with technology so much yet. And the value, um, in my mind to the you said everybody can see the value of it. Where does it hit the bottom line? Um, what it's going to happen is if you look at the major issues, the biggest one out there is cost of care, right? Single biggest item out there, 70% driven by chronic illness. That's where the impact is going to be felt. If we can reduce 10% of medication adherence, have them adhere.

That's going to have an enormous impact on that bottom line number. Especially now that we're being hit by an aging population. I'm sorry. Just contributing. But that's also accelerating this value. So you've got two sides of it. One is the cost exploding. Part of the value is tamping down on that cost, not letting it accelerate much further. Then how do we bend that curve downwards. And that's what this technology is designed to do. It won't be a silver bullet, but it's going to be those pieces that accelerate what we can do. Because right now we would hire higher care managers to work with individuals like that. But that gives us a limited group we can work with. What, one 2% of the population. What this technology allows us to do is expand that out to literally 100% of the population, but at least the 50% that the rising risk and the the mid-tier risk as opposed to the full population.

But this is where I think the magic is. We were working on a project recently. That's patient activation, right? That's obviously one of the more common things that you do. It's a perfect use case of this because adherence is part of that. But are you learning how to care for yourself? Does your family know how to care for you? That's where the magic happens. If we can convince them to do that and use the system as an auxiliary support as opposed to primary support, is what we want to get to.

So this is the future, but we're we're racing toward it right now. And it's almost like the inverse of the value model. Right. Because right now it's the penalties of not doing that have as much impact as the value of achieving it. Right. So return on investment is less than what am I going to do to stay alive in this new, changing world of healthcare right now? Got it. Thank you. Hope that helps. Um, any other questions? This is fun to me. I like to do this stuff all day long.

So I hope everybody's getting some value out of it. Um, well, if not, we've got two minutes left. I can give you two minutes of your life back. I'm not sure what that amounts to, but, you know, you do a lot in two minutes. Thank you so much.