Case Study

Highmark Health Services improves customer experience at enterprise scale with Pega

Partnered with Pega to create Health Solutions Platform

Improved efficiency and scale for frontline employees

Unified touchpoints with omni-channel intelligence

"HMHS is very excited to be on this journey with our partners at Pega. We think we have an exciting and very relevant opportunity to change how customer engagement is designed, deployed, and executed in our industry."

Chris Atkinson

Vice President of Product Development and Engineering, Highmark Health Solutions

The Business Issue

HM Health Solutions (HMHS), which recently rebranded to enGen, provides a commercialized health plan administration platform to health plans and payers across the United States. In total, HMHS has partnered with 12 health plans serving 11 million members.

The company had two large-scale customer engagement challenges. First, frontline customer service employees typically lack long-term industry experience. This gap meant that many were not experts in the products or benefits that they support. Second, disconnected channels were causing a fragmented and complicated customer experience.

HMHS needed a solution that would simplify the work of frontline employees, while also providing coordination and intelligence across channels for far better customer experiences.

The Solution

HMHS partnered with Pega to create its Enterprise Health Solutions Platform guided by Pega Customer Service™ and the Pega Customer Decision Hub™.

Now, when a customer contacts a service channel, the Pega Customer Service platform calls on Customer Decision Hub to surface what is known about that particular member. Customer Decision Hub then prompts the advocate through products and services that the member is eligible for. The prompt not only includes information about the opportunity, but also contains specific scripted dialogue for the representative to use in the interaction.

The Results

HMHS is actively working with Pega and its internal health plan partners to continue to improve capabilities and services. The following are benefits and outcomes the organization hopes to achieve soon:

Increase overall satisfaction and NPS
Accelerate the maturity of health plan customers in coordinated channel-agnostic engagement
Reduce the training time for new customer service advocates
Provide more self-service opportunities for health plan customers to create channel-agnostic engagement journeys
Create a fully integrated platform architecture that enables Customer Decision Hub to connect to customer specific data sources and desired engagement channels