PegaWorld iNspire 2024: The Power of First Impressions and Great Customer Service: Evernorth’s Journey with Pega

All right, folks, let's go ahead and get started. If you could take your seats. Appreciate we had a little technical difficulty here, so we got that solved. Welcome. Uh, this is another great session. I've had the privilege of working with Louis and Devang, uh, gosh, since December, uh, on this. So, uh, very excited about this presentation. I'm Bill Marshall. I'm an industry principal on the Pega Healthcare team.

Uh, thank you all for coming. I appreciate this. Uh, this is another fantastic session. Um, and, well, I think a lot of you have been waiting for this. I know I've had conversations in the Healthcare booth. Uh, a lot of folks are trying to do what this team has done. A couple of housekeeping things. Uh, first of all, again, uh, let's see, I think this is one of the last sessions. There's one more in the series of of of breakout sessions.

And then 4:00 on, uh, we're back to the Innovation Hub, the chess match and all the goodies. They'll break out the bar again. Uh, the other piece is, uh, do expect a lot of questions from you folks, and there are standing mics, but my experience is that no one gets up out of their seat and goes to the standing mic. So, uh, I will be, uh, doing some mic running. Uh, we really do want to get your question on the mic. Uh, all of these sessions are recorded, and what we find is that whether you've been in the session and you want to go back through something, or you tell a colleague about it and then they want to see it, what they hear at the end are beautiful answers to questions that they can't hear. So really, if you could wait and let me catch catch you with a mic or step up to the mic here, I would appreciate that very much. Uh, please join me in a very warm Pega. Welcome to Luis and Devang.

Thank you. You guys hear me? All right. All right. So welcome. Welcome to our session, everybody. Um, it's just a show of hands, uh, for folks who are not in Healthcare just so that we can know the audience. All right. All right, so we are in Vegas.

Um, hopefully you guys did something in Vegas which is supposed to stay in Vegas. Um, did anybody get a tattoo? Oh. Come on. All right, the tattoo doesn't stay in Vegas, you know that, Chris. All right. All right, so, um, we'll get started. So, my Joshi, I've been with the group since 2003. I'm a technology senior director responsible for benefits client and member technologies.

I'm Louis Picone. I've been with the group since 1995. I'm a technology director for client facing technology. And I'd like to thank everybody for coming to my Las Vegas debut. All right, so a bit about us. So we are the Signa Group. Um, we are a 230 year old global healthcare company. Uh, we are committed to need my glasses to read it. Um, so we are we are committed to create a better future through vitality of every individual and community we serve.

The Signa Group has two divisions. One is Signa Healthcare and Evernorth Health Services, through which we are committed to enhancing the lives of our customers, clients and partners. So Cigna Healthcare provides health benefits in the US and international market, whereas Evernorth Health Services is providing solutions in pharmacy benefits and care. Um, we work every day to serve one in every three Americans to solve the complex health care problems that we face. For decades, we have been negotiating with Big Pharma to bring the cost down for drugs. Um, we partner with our our clients, plans and providers to make healthcare more predictable, affordable and simple. Um, in a nutshell, we exist to solve problems that others don't want or can't. All right. So as far as what we're going to talk about today is, um, so you don't get a second chance to create a first impression.

So this. What we're going to present is just our journey with Pega and with our people in creating a world class solution called Polaris to serve our clients. Uh, with that, I'll hand it over to Lou to walk us through some of the great work that he and his team has done over the past years. Thank you. Devane. Okay, so I'm going to talk to you about our journey of transforming our legacy application into into Polaris, using Pega and using our people. But first, before we start the journey, I just want to level set kind of where we are and tell you about Polaris. So Polaris is a CRM application. Uh, except for the sales piece, we use Salesforce for sales, and we're going to talk more about that later on.

As Devang had mentioned, it's our first impression. It's the first impression that clients experience when they come on board after the sale. Um, and honestly, that was one of the names that was bounced around when we were first creating the application. We settled on North Star, and I think that's appropriate. Or I'm sorry, we settled on Polaris. And I think that's appropriate because Polaris is the North Star has been, uh, guiding travelers to safety, uh, for centuries. Two of our primary functions are within, uh, our two separate workflows. One is for new client implementations. So once we get that sale, setting up that client, the new implementation.

And the second is for servicing those existing clients. So our our thousands of clients are serviced through Polaris. Polaris using Pega seamlessly integrates uh dozens of internal applications, uh, external software. And I'm going to talk more about that later on. It's our single source of truth for client intent data. And also later on on that journey, you'll see where we started with our legacy application and where we are now. And those integration points, uh, including uh, internal applications where we store all of our benefits data and other data. Polaris replaced. Dozens of manual, cumbersome, uh, flawed processes that were with our legacy application.

Uh, some processes that were partial manual and partial automated. Uh, we support internal and external users and, uh, obviously monitoring and tracking, etc.. So where we started, our legacy application was first built back in 2003. Uh, so I like to think about this. My first son was born in 2003, and now he's a sophomore in college. It's an old application. It was built in in Siebel. Uh, it was Pre-cloud. Cloud didn't exist back in 2003.

Uh, it served our purposes for years. But over time, as our our company grew and more and more functionality was being asked of us, uh, we started to develop scalability concerns, uh, for user growth and, and case volume. Uh, there was reliability concerns, tech debt piling up. It's probably a similar story for many of you. And security risks as well too, that we needed to manage proactively within our our Siebel application. Uh, there was limitations with the functionality that we could support. Like I mentioned, a couple of here and there's literally dozens of examples, but couldn't integrate with software like ServiceNow and Kafka and our internal systems. We had limited content management capabilities for file attachments and emails, etc. um, and over time, the storage of those files grew and grew until we got into the two dozen terabytes or somewhere around there, um, as far as some of our tech debts and some of our, our limitations, uh, it only supported Internet Explorer.

Uh, we couldn't integrate with, with the latest version of Oracle. So, uh, as these, uh, as these issues mounted up, we started to look towards another solution. This is kind of the crux of our journey. And this is going back several years, uh, back to the mid 20 tens of the period that I'm talking about. So we knew we needed to modernize. We. Looked into other software packages. We looked into Pega. We looked into building.

We looked into internal applications that we can leverage internal applications and kind of mold them to fit our needs. Uh, so we did an evaluation proof of concept, and we looked at many different areas. But obviously I'm summarizing. We looked at functionality. We looked at pricing, scalability and reliability. Uh. After going through this proof of concept in this, uh, in this exercise, Size. We made a decision and it's kind of a spoiler alert. We decided on Pega.

Why? We decided on Pega on Pega two big reasons. One was there were best in class workflow, so their workflow engine was superior to anything else we've seen. And obviously their best in breed. Their also their integration capability, the ease of integrating with other software applications with internal applications. So then we went about building once we made this decision and went through internal reviews, etc.. Um, so there was a partnership with Pega. We worked with uh, with the Pega organization. Uh, we had several vendor partners that we worked with, and frankly, we had some, some trial and errors along the way to, uh, and you can see that from our, from our 18 month, build out.

Uh. The critical point here is that from working with Pega, from working with vendors, from utilizing their Pega bootcamp or Pega or Pega Academy. What our strategy was over time was to shift from vendor partners and using Pega expertise, which was critical. We couldn't have done this without them to shifting this to an Evernorth led application. And I think that's what's really critical that in addition to the technology, it was the people, too, that helped us along this journey. Um, so we had started off with embedded lsas from vendor partners until we, uh, developed our own lsas. And we have some folks here in the audience that we're going to introduce later who are part of the organization that have been critical to our success and part of our team. Um. It also wasn't just a developer led effort to because there was a lot of challenges with our legacy application after so many years and SMEs who had left the organization, uh, a big challenge for us was finding out the requirements from the old application.

So, uh, it was a real partnership within the organization with our technical product owners, our Tpos, as well as our development organization. Uh, so when it comes to people, I'm not just talking about developers, I'm talking about technical product owners as well as as many other areas within the organization. Oops, sorry, I jumped ahead there. Uh. Our deployment, uh, it lasted about 18 months for deploying, uh, to get our first version out there and it was interesting listening to the keynote this morning. Uh, some of their journey kind of echoed. It sounded, uh, really resonated with us. Obviously, that 18 months of build out, like I mentioned, there was some some trial and error in that, uh, this was also a cross-functional effort to this wasn't anything we can do in a silo and do on on our own. We worked with organizations or worked with other, other areas, uh, throughout the enterprise, uh, because of those, uh, of the integrations, it's a very, uh, uh, deep cross-functional application.

So there was all that coordination that needed to take place as well. Another critical point was, uh, this wasn't a lift and shift. This wasn't just taking screens from the legacy application and then moving that functionality those screens into our Pega application. Uh, this was an effort to understand how the old application worked and make it better into our into our, uh, our Polaris application. And again, one of the challenges was after so many years trying to determine what those requirements are, how people were using the application, especially when there was these manual, automated hybrid processes that were out there, too. And there was a lot of there was a lot of prioritization that took place because there was functions that were critical that were, uh, used every day by many of our users. And then there were those, uh, what I believe someone might have called low impact cases where there weren't that many users. They weren't using it that often, but they were critical and they needed to be migrated as well. So our migration took about five years to do the migration.

And, uh, a couple of, of situations, I won't call them challenges, but a couple of situations that we faced along the way are we needed to once we put our first version out there, we kept building that version. So we were adding new functionality to Polaris as we were migrating old functionality from Houston. So we had that kind of juggling act going on. Uh, also, there was a question of priority, uh, where maybe other projects were taking priority because because the legacy application still worked. Uh, so we had those challenges of dealing with prioritization. So I'm going to talk about some of these integrations. Uh, our branding area didn't give us the green light to use logos. So you'll have to, uh, you have to forgive this slide. Uh, in Allen's keynote yesterday, he mentioned, uh, or he made reference to a center out vision in his keynote.

And that kind of resonated with me as I was thinking about, uh, the way that Polaris is designed. And again, there's, uh, probably several other areas might have, uh, similar designs as well, but I'm going to kind of go through some of these different areas and talk about how we use them. Uh, so for Salesforce, as I mentioned, uh, Salesforce is after the sale is made, we use Salesforce for sales. And we we had looked into using Pega for sales and had determined that for us, uh, Salesforce was really better equipped as, as a sales tool, and the rest of the CRM process would reside within Polaris, within Pega. We use Adobe and this is something that's relatively new. We're integrating Adobe into Pega. And again this is one of those examples where we had investigated using Pega forms. Uh, but for the extremely complicated use case that we have, Adobe forms worked out better. But Pega integration with Adobe Forms has worked out very well.

We use, uh, Kafka for integration, uh, and communication to, uh, to internal systems. Let me just, uh, seem to have lost my mouse here. Is it there? Here it is. Internal applications. This is really key where, uh, we're able to integrate with dozens of internal applications, and we use our Pega application as kind of a spoken hub where and this really gives us that power to be the point of truth for our client intent data, because we have the most recent, most accurate versions of data from our benefit systems eligibility rebates, client guarantee systems, billing, reporting dashboard, etc. the list goes on. We use Amazon Web Services for uh uh, for file storage. We have an S3 integration for Cmis, and we use it for file storage.

And again we're talking about terabytes worth of file storage. Uh, much of that legacy information from, uh, from our legacy application, we still needed access to that information. So AWS helps facilitate that. We use Boomi Bhoomi for external user authentication and security provisioning. ServiceNow allows us integrating with ServiceNow, whether external users or internal users are able to open and manage requests and issues directly from Polaris. So, uh uh, if anyone was in the previous session, uh, Rajesh and Abhishek had mentioned that previous users would have to go into hundreds of applications, and we had that same situation on the Evernorth side too. So Pega using Pega allowed us to integrate all of those applications to to facilitate this seamless experience and give our operations users the best data at the right time, uh, when they needed it to, uh, to make their decisions. What I think had been called NBA, we don't use that term or I haven't heard that term, but. But next best action.

Uh, and then finally workday we use and again there's, there's many other examples I wanted to highlight some of, of the more important ones that we use. Uh, but workday were used for people information. Um, so we're able to, uh, to access email when people are on PTO. So there's someone else, there's a backup contact that, uh, that they should use, uh, the roles, their access, their names, etc.. This is like the second best slide. Uh, I think the next best slide or the best slide is coming next. But the second best slide is our success stories. Kind of broke out these success stories into, uh, two columns. And on the left we have our business success stories and numbers don't tell the whole story, but regardless, they're pretty remarkable.

The success. We've had approximately 75% improved speed to delivery. We're getting our work done faster, we're getting it done better, and we're able we have increased capacity for doing more work because of that. Uh, our business users love the fact that there's more configuration over development. They need to come to us. They need to come to the development team for less changes because they're able to do it on their own. Just within the last year, uh, Polaris has been able to support a 28% increase in user volume, as well as an 84% increase in case volume. Turnaround time, an increase of anywhere between 50 to 75%. And I'd like to give I'd like to just drill down on that one just a bit, because there's a really good example.

And so far we've kind of talked about the success or the benefits for our operational partners and uh, for, uh, for, for the development teams and our partners as well. But this example really focuses on the benefits that, uh, that Polaris using Pega with our people has provided for, uh, perhaps our most important persona, which is our members. Nothing matters more obviously than our members. So when a member calls with a with a problem, perhaps it's, uh, it's a claim problem. Using Polaris, call time has been reduced by 60%, and resolution has been reduced by approximately 85%. Time to resolution. From the development side, uh, we're able to leverage the out of the box capabilities from Pega out of the box capabilities such as Pega, Pulse. So messaging within the application, uh, email channels. And I know that's something that Rajesh had spoken about earlier to, uh, uh, to monitor hundreds of emails.

Our Kafka Kafka integration using dataflows, uh, box for reporting queue processors for asynchronous communications, the dashboards, the widgets, uh, for for better visibility of our data. It's a low code tool. So that's been advantageous. Uh, once that training and that learning curve. Uh, uh, we've found it. Ease of development. And we're looking forward to exploring Socrates as well to, uh, for, for, uh, training perspective as we bring on new talent, uh, which we constantly do. Uh, availability and stability. This is something I kind of hesitate to say out loud, but within recent history, we've had zero outages.

Uh, so extremely reliable, uh, extremely stable. The advantage of the Pega diagnostics center. Uh, we had an example of that just recently, a couple of months ago, where we had, uh, longer than expected page load times. So we were able to use the PDC to really zero in, uh, to use the monitoring to really zero in on those longer times and able to quickly target where that's happening and, uh, and able to resolve that problem quick. Guardrail. We've embedded guardrail into our teams goals, so I really can't think of another software package that will give that much immediate feedback that developers are able to act upon using guardrail. Uh, and then finally, we've we've gotten great support from, uh, from the Pega organization, including our client success manager. So a shout out to Rex Wang. I think he's right here in the audience.

Thank you. Rex. And now let me turn over to the Vang. All right. So, like Lou said, uh, this was the second best slide. And I get to do the the best slide. And I know I had to pull rank to, to be able to talk to the slide, so. All right. So Pega and people that's the journey that we've been talking about.

And I if I had Karim's slide that he showed yesterday. For us, it's people, people, people. And so it so happens that some of them are here. Um, so I'll just call out your names, please stand up. Um, so Randall roots, um, Swedish candy Kirin. Uh, and the only man who got a tattoo in Vegas, Chris Ahlheim. And the rest of them who are, um, in Morris Plains right now. And some of we are co-located everywhere, but it seriously, we wouldn't have done what we did without you guys. So a big round of applause to you all.

All right, so the future. Um, so the amount of times that we heard Jen AI over the last three days, two days, I'm sure we would have become millionaires if we had a dollar for each time we heard GenAI. So definitely GenAI. Um, we are looking at more users, more case types, more capabilities, more integrations, more automation and more GenAI and more developer productivity. So, um, what we saw with Socrates and some of the other capabilities around Blueprint, um, and our buddy Knowledge Buddy, um, so those are certainly some of the things that we will be exploring to see if there are opportunities for us to integrate into Polaris. Um, our motto, as it says there, whenever there is an email or Excel workflow we want to automate with Polaris. It's kind of like Ghostbusters. We are going to go after emails and Excel workflows looking at Cloud upgrade too, so that we can leverage some of the AI capabilities, um, and chatbot. And again, that's why we are at PegaWorld to just network and be able to see what else Pega has to offer.

All right. So that was the end of our presentation. And thank you very much. Um, just in case you guys want our autographs, we will be here. Um. Okay. They want the autographs. They don't want to waste time with questions. Well, I'll throw out.

So you talked a little bit about the AI, and I'm curious about Knowledge Buddy because you guys seem to be. And you were, you mentioned. So I really appreciate what you mentioned about that one stat that it really hits the member. Uh, are you looking at Knowledge Buddy from a member standpoint or staff standpoint or both? Just curious what you're thinking about that. You know, there's a lot of different ways to think about how to use Knowledge Buddy. The one thing, uh, When I was speaking about AWS and speaking about one of the issues with our legacy system is that, again, we have dozens of terabytes of data, and to be able to use a tool like Knowledge Buddy, it sounds like it's a great opportunity to be able to kind of zero in on that piece of data that you're looking for, or on that answer that you're looking for. So I think there's great, great possibility with that. We have an AI COE that's a critical partner of us at Evernorth.

So it's something we're really looking forward to to speak with them about. Questions from others. You guys are all looking forward for the drinks and the cheese and whatnot. Again, please join me in a huge thank you to both Devang and to Lou.