PegaWorld iNspire 2024: Cigna’s Journey to Transform Client Acquisition and Retention

So welcome to all of you and thank you for joining us today. I'm Bill Marshall. I'm an industry principal on the Pega health care team. It is my pleasure to have helped bring this session to you. A couple of couple of things. Um, one, there's actually a sister organization, the Evernorth Cigna team is actually presenting in a premier ballroom at 215. So we've kind of got back to back stories here, uh, on the Express Scripts Evernorth Cigna umbrella of companies. So just so you're, you're aware, uh, let's see one housekeeping thing. So as we, as we reach the end of the session for Q&A, first of all, if you could leave your your questions to the end, that would be great.

And then second, there are mics here up front. Uh, and my experience is that no one gets out of their seat to use the mic, but instead I'm going to grab a colleague and we've actually got some handhelds. We really would like to get your questions on mic. All of the sessions are recorded, and we find that a lot of clients afterwards want to either see something that they missed or go back through a session that they saw. And by having the handheld mic, when you ask the question that actually gets recorded. Otherwise, you wind up with a video where there's great answers to questions that no one knows. So if you could hold off, I'll have, uh, mikes and we'll run with those. Um, without further ado, it is indeed my pleasure. I appreciate the work that, uh, Rajesh and Abhishek have put in in their teams with all of this.

So it is indeed my pleasure to welcome Rajesh Patel and Abhishek Bhowmick. Gentlemen. Yeah. Thank you. All right. Thanks, everyone. As Bill mentioned, my name is Rajesh Patel. I lead the architecture practice for the US employer front office technology. It's a mouthful of Cigna healthcare.

Um, I've been with Cigna for probably about 23 years in various business and technology roles, and I appreciate everybody for taking the time out today to hear a little bit of our story. I am here with Abhishek, as Bill mentioned, and he'll introduce himself in a second. Uh, so today what we're going to do is we're going to take you through a little bit of our, our story. Right? So we'll go through a little bit of what is Cigna. Um, our partnership between Cigna and TCS, uh, the business challenge that was put in front of us and what we have done so far to to solve that. So that includes the approach and technical solutions. Some of our outcomes, in terms of what people are saying about the platform and systems that we are built, and then we'll talk a little bit about what we think is, you know, the future. So what is Cigna?

So Cigna Healthcare is a global health benefits provider. We are made up of three core divisions US employer or US commercial, which is our employer sponsored health plan and solutions. Uh, US government, which is our Medicare and individual family health plan solutions, and international health, which is obviously our global individual and employer sponsored health plan solutions. As mentioned before, we are part of the Cigna group, which also includes our Evernorth division, and our mission is to help improve the health and vitality of everyone we serve. So that's over 178 million customers in over 30 countries and jurisdictions, right? So pretty, pretty large impact. We have over $180 billion in revenue and over 2 million relationships with providers clinics and other care facilities. And lastly, we are headquartered in wonderful Bloomfield, Connecticut. So I will give it over to Abhishek and talk a little bit about TCS.

Thanks, Rajesh. Good afternoon to everyone. Thank you Pega for having me here today. My name is Abhishek Bhowmick. I serve as the client partner at TCS for Cigna Healthcare, TCS, Tata Consultancy Services, is an organization that provides IT services, consulting and business solutions, and we have partnered with many of the largest companies in their transformation journeys over the last 55 years. We believe that innovation and collective knowledge could transform our futures in a meaningful way. We are part of the Tata Group, India's largest business conglomerate, and we have more than 600,000 consultants across 55 countries. In the last fiscal year, the company generated a revenue of $29 billion. So, uh, we are proud and grateful for the partnership that we have forged with Cigna over the past two decades.

Our partnership has been based on a purpose and belief to drive positive change. It's a partnership that is built on transformation. collaboration and success. We have been able to meaningfully impact communities that we operate in. Here's a little a small video that depicts our partnership. What we have been successfully been able to do is challenge the status quo, push the boundaries of the future, and and think about how do we relentlessly innovate to become a successful, uh, in our own business and deliver value to our customers? Right. So let's get on to the, uh, business case that we wanted to look at today. So, employer sponsored health plans is a complex ecosystem between clients or the employers, uh, the producers or the brokers?

The members or the employees and payers like Cigna. What we have realized is 99% of the brokers today prefer the ease of doing business when choosing a health plan to recommend to their clients. And technology is the number one reason they recommend a carrier to their customers. What do you 1% of the employees? When we looked at it, 41% of the employees believe that their insurers could do more to explain their benefits to them. And 47% of the consumers would like or would expect their health insurers to recommend personalized solutions based on their current situation. What this highlighted was that there was a gap in user experience that was expected across the partners within the ecosystem. Today, employers and brokers expect faster, easier and quality user experience while quoting and purchasing health plans. While, uh.

While it has been a pretty much a focus of the industry to look at a direct to consumer model, brokers still today spend a drive 95% of the landscape in employer sponsored health plans, specifically for the lower market segments, where we classify them as the under 500 or the select market segment here at Cigna. What we also believe is, uh. What we also have seen is employers demanding the need of an integrated benefits platform, as opposed to point solutions. That's where we started focusing on a transformation that allowed us to meaningfully impact the stakeholder experience with an intent to impact client acquisition, with a goal of doubling our new business sales and client retention by improving our renewals by 50% . Our approach focused on a four strategy where we wanted to simplify the technology solutions. We wanted to streamline the business processes and meaningfully impact or lower the response times, while we also looked at standardizing the customer outreach for a consistent user experience, while being able to scale the platform and the solution within and across business segments. This is a multi year enterprise level investment that is focused on the client, their touchpoint, their experiences across the journey, ensuring that we can deliver them experiences of faster onboardings as well as efficiencies where they look at China as a market leader in operational efficiencies. When we started this transformation journey, what we intended to do, we intended to build a connected platform that will alleviate the problems that we have today. So the platform was intuitive.

The platform was intended to replace the need of using to do to having to use multiple systems and manual workflows by replacing them with a connected enterprise platform that is cloud native, allows you to process workflows digitally, collaborate across business units, and deliver results more accurately and on time to clients, brokers, as well as internal operational stakeholders. Okay. So what I would like to do is I would like to turn it over to Rajesh, who will walk us through the solution and the transformation outcomes going forward. Thank you. Thank you. All right. So that was a lot about you know, sort of the setup. Right. And then now we talk about, um, what we actually built or what we will build.

Right. So with any transformation, as most of you are probably aware, there's a lot of marketing, right? A lot of marketing, a lot of branding, a lot of internal sales, even for us in technology. Uh, so internally right now, you know, I won't lie, we've gone through multiple brandings, uh, to keep things fresh and keep people engaged, but we currently operate under the contour internal brand. Right. So a little bit of a play on molding with the business capabilities and sort of going with the going with the flow. So as Abhishek mentioned, when this transformation, we have a lot of legacy systems, a lot of complexity, right? So what we try to do is try to simplify as much as possible for our end users. Right.

So for core applications and they are basic, we literally call them intake quote build and install. Right. Nothing. Nothing too fancy. Nothing too complicated. So each employee in that specific section understands what is their work and where it's going to go. So interestingly enough, we've built four applications. They are all very similar but also very different. Yet we've been able to connect them together.

Right. Using the the approach that we will talk about a little bit more technically. Right. And inside each one of these there are various efficiencies that we've undertaken. Right. So if you think about intake, we look to digitize documents and a lot of manual processes. You look at quotes for underwriting users, and we try to find efficiencies in their rating process. And then build and install is getting us ready for call and claim. Right.

So one of the biggest things our customers want is as soon as they purchase our products, and as soon as they get our ID card, they want to be able to, um, you know, file a claim and get it paid. Right. But are we ready for that? Typically the answer is no. Right. So the and what we try to do here is simplify that point of sale all the way to installation. So that first claim that comes in we are ready. So what does it mean a little bit more technically. Right.

So many many of us and Cigna is no different. Every technology you can think of we own a license for. We operate it somewhere. We have a lot of acquisitions, we have a lot of legacy systems. And what we've done is using that Center-out approach. Right. And that architecture is built an orchestration layer connecting these four applications together so you can see them there across the top, and then you have the different users or the personas that are going to then interact with all these areas. And all of these business lines are siloed today. right?

They should talk to each other, but they don't. They have different leadership. They have different processes. And so the idea is to try to bring all of it together with this layer. We still have our complexities and our issues organizationally. That makes it challenging because we build this unified system, but we haven't unified the business, for example. So you still have those challenges, right? But we built all of these Pega applications on the cosmos framework. We use as many out of the box technologies that we can.

So I mentioned digitizing digitization earlier. Right. And so one of the things we do in our intake space is use the email listeners right out of the box functionality from Pega. We listen to we monitor mailboxes, hundreds of mailboxes. Emails come in a day with attachments, 5060 attachments. We ingest them, automate them, put them on the screen for a user. Right? So no more dragging and dropping emails to a named folder or anything like that. So just an example of trying to automate for them and try to connect things together.

Then that also flows all the way through the rest of the system. The other thing we've tried to do with the utilization of of AWS, of course, we have deployed Pega into ECS environment, um, in order to take advantage of the scale, right? We know the ebbs and flows of our business. We have downtimes, we have busy seasons. So we try to utilize the scalability of the AWS. Brings us to ensure, um, the performance is optimal right for the business throughout the time frame. Now, one of the other things we try to do, especially from an architecture level, is ensure these are reusable patterns, right? So especially in an enterprise as big as ours, we want to try to combat this legacy, um concept. Right.

Its legacy will exist forever. But is there a way we can kind of stop it? Can we fast track, uh, new applications? Right. So in in this program, we've built four applications. But recently with the foundation that you see here, two new applications have spun up. One has already gone live within nine months on this same stack, and another one is in progress. So they're not part of the contour brand, but they fall under the technology stack and ecosystem. So it's not just us being able to transform the end to end client acquisition retention, but also help transform other applications, other business lines, right?

So whether it's an authentication pattern or whether it's the utilization of Postgres with Pega, right ? We we try to set the foundation for that reusable pattern. So what people saying, um, you know, there was a lot of skepticism in a program like this. It's one of those things where people think, is this program ever going to end? And I don't know if systems or programs like this ever really do end. Your business is constantly changing. We're constantly getting enhancements and constantly changing. But I think what we're seeing is we're hitting some of what the business was looking for, right? So we have business teams that are using the system that can take on more work.

So they haven't added more people. They can take on more work. So more volume that comes in, more sales that we can get, the better off we all are, right. You can see some of the quotes here. You know, the a little bit of shock from some users on being able to see advanced systems like this, seeing features turned around quickly. Um, and that has a lot to do with the design and architecture that we have. We have set up, um, and then also, you know, it's not just smoke and mirrors. And I think some of the skepticism comes from that. Right?

So if you're a user who's been at Cigna for a long time in this ecosystem, you see the application and it does feel like smoke and mirrors, right? It feels like we just slap something on the front and we're doing something behind the scenes. And it's sort of what we are doing, so to speak, right? With the orchestration layer. We are still integrating to legacy systems. We are still bringing everything together. But you can see by one of the quotes here, someone said, you know, we don't have to go to 100 systems there in one screen the entire time, right? So it's our responsibility as a technology organization to make sure those integrations that we are building, you know, are not one, one and done. And we're not building more issues or more problems, but the goal that we set out for is is proven.

Um, when we get comments like that, right, and feedback like that, and then ultimately everything is about, you know, going back to what Abhishek all the way in the beginning. Right. Satisfaction. So are we installing quicker? Right. So we are selling and we're getting our cases in and we're getting call and claim ready. Right. So that is ultimately what we need more broker satisfaction. So they want to buy more of our products, sell more of our products.

Um, so what does where do we go from here. Right. So I mentioned, um, to me at least it feels like we're never going to end, um, you know, every year I, I start I think this program is on its third year or fourth year. And every year around this time, somebody says, are we going to run another year? And I say, no, two weeks later we're going to run another year. So if you think about our transformation, we're somewhere in the middle here, right? Delivering accurate results faster for stakeholders. So we we take it all back to the beginning. We started with looking at the workflows.

What kind of intelligence can we bring? What kind of automation can we bring. The orchestration layer brings everything together. We start almost forcing silos to collaborate by building those connections with those applications, integrating things, removing manual steps. And then you start to see some of your results. Right. But what's next? So my team we're talking a lot about data analytics insights. I think we've heard nothing but talk of AI right, for the last two days and every single, every single day.

Um, so now we're on that phase, right? What can we get with all of the data we've now collected and interconnected? Everyone. What can we do with it? What can we give to the business? What additional solutions can we bring? Um, to turn off some of these legacy systems permanently? And what else can we do in the cloud? Right.

And what else can we do to help the business to pivot? So this is, you know, one of those iterative sort of transformations or outlooks, um, that I think can change on a dime. AI has actually impacted us from thinking about some of our solutions. Right. Do we continue to keep going down the road? We do. Or can we accelerate? Can we go faster? And maybe you do come to an end, you know, of a of a program because the I can finish it for you.

Um, so these are all the different types of conversations that we have and things that we're thinking about as we're sort of looking towards the future. And then at the end there, it's, you know, ultimately, um, singular goal, right? ROI drive, operational efficiency, there's ROI there and unlock new business values. There's ROI there, right. Um, and then, you know, hopefully with the platform that's built, the patterns that are built, uh, this starts to move and connect to other areas of organization. So we talked about client acquisition and retention. We have claim we have call um, many, many other areas as well. So I think that uh, pretty much wraps up, um, what we wanted to take you through in terms of our transformation. So I don't know if anyone has any easy questions.

So. What version of I think the question was what version of Pega we on? We're on 24 one Infinity. Correct. 23 point. This is the guy that I asked those questions to. And the reason I don't know the answer to that question right away is I think every week he calls me this is Abdul on my team. Every week he calls me and says, hey, we need to upgrade Pega. So, like, I can't keep track.

Yeah. Check, check. And if you said this, I apologize. How long was, like, from ideation to actually production. Like to actually start getting some of the value adds that you all were talking about. Like, how long did that take? So, uh, we ideated on this for four months, and we started the way we started this program was through an innovation use case where we wanted to see if we can bring in some innovation to the current process. But what we were given as a challenge was that, uh, how quickly can you deliver value? And we're very honest.

Our funding was very contingent on that. So the first thing that we went live was we built in three months. And for the fourth month you saw a capability called intake. We were live in production with the first MVP of intake on month four. Beyond that, we have been starting iterating on the capabilities and building the foundation and each of those capabilities, one after other and connecting them together. Yeah. And just to add to that, like one of the one of the things from ideation is something like intake. There was an idea and I think interestingly, in the way we've done this and built this platform is it was and maybe many systems are like this. It was pretty much when it went live is when especially our business users realized, oh yeah, I want actually ten more things, right.

So typically, whether you want to say you're an agile waterfall or whatever it is, you know, we think we're building complete systems with this approach. It was try to build something as quickly as possible and then see what it is. Let them see what it is that they want. And that's why it feels like we're never, ever ending. Thank you. We've heard a lot throughout the last couple of days around Blueprint. Do you think that you talk about acceleration? Do you see Blueprint as something that is, um, you know, a capability that you can utilize as part of driving that second half of the program you described? Yeah, I think myself and our team, I mean, we spent maybe 45 minutes of Blueprint yesterday.

We've probably been talking about AI and Blueprint, but maybe more than Blueprint. Um, mainly because, you know, one of the things we see is you get these workflows from your business users, right? Um, and they're never right. They think that's what it is, right? And then, you know, you go into production and they say, no, you got it wrong. But we look at the workflow and they say, no, that's not how it works. That's exactly what's in production. So we've been talking a lot about well, you know, if you take something like a blueprint and you're not just putting in our hands, but collaboratively, maybe even in their hands or together, and then you're accelerating with what it spits out, right? So that you can just get to a POC or you can go live.

You can start to work through that much, much faster. So we do feel like for a lot of our new use cases, it's probably going to be a foundational starting point. What we're very interested in is the potential for reverse engineering. Right. And I think a lot of people talked about that. What can we do an import in there, you know, what can you do with Process Mining to really figure out what is actually happening in production so we don't get duped? I think we're talking to someone yesterday. I feel like I get duped a lot, um, by the business and you all might as well, um, where they'll say, oh, no, I'm not just lifting and shifting. The next thing you find out, that's what you did.

Um, and that's a lot of what we're trying to combat, right? So actual operational efficiency versus just getting convinced that this is a process. So we do think as a lot of potential. Um, first of all, congratulations on your journey and progress. Um, at the very end of your journey, you talked about enable new digital solutions that could drive revenue. I was wondering if you could give a few examples of what a digital solution is. Yeah. So, um, one of the examples we've talked about is in terms of sticking in lines with brokers. Um, providing intelligence, um, for internal teams, right.

Especially the teams that work with brokers. Um, you know, it's very difficult to collect a lot of data in terms of what you want to push a broker to, um, letting a broker know how close they are to a certain incentive or a point. Right. So there's different products on the market. Um, but one way that we're looking to add, you know, additional capabilities by digitization is trying to bring something like that in, maybe getting off of some vendor product, connecting into this ecosystem. You have all the sales content, you have all of this data, and you can plug it in to something like that. There's another aspect to the tool as well, where we actually have an external component that we call portal. So within the ecosystem you can create, you know, all different kinds of platforms. And so we've created an external platform, um, for our brokers and clients to actually access their documents and things like that.

Um, so in terms of benefit, there are some self-service. It's not a lot, a ton of it. So just different things like that to try to help the bottom line from that standpoint. And then we were also looking at capabilities where a lot of healthcare requires you to sign a lot of documents. Right. How do you expose them to your customers on a digital platform and have like something DocuSign help them sign it. Any other questions from folks? All right, well, please give a big round of applause for Rajesh and Abhishek. Thank you so much, gentlemen.

Thank you.