Evernorth transforms client experience with the Pega Platform

The Business Issue

As a global health services company, Evernorth is dedicated to improving the health of their members. For decades, Evernorth has collaborated with plans, providers, and patients to find solutions to healthcare’s greatest and most complex challenges. From affordability to predictability to simplicity of care, Evernorth exists to solve the problems others don’t, won’t, or can’t.

However, their existing Siebel-based system could no longer keep pace with the company's growing needs. The aging application had scalability issues, reliability concerns, and mounting technical debt – posing security risks and functional limitations.

These challenges were exacerbated by the system's inability to integrate with newer technologies and accommodate the increasing volume of data Evernorth needed to manage. The application had limited ability to integrate with third-party systems, as well as limited content management capabilities. This necessitated a modernized solution to support Evernorth's dynamic growth and commitment to client service excellence.

The Solution

Evernorth embarked on a transformative journey by developing Polaris, a state-of-the-art Customer Relationship Management (CRM) application, built on the Pega Platform™. The decision to use Pega was driven by its best-in-class workflow automation and exceptional integration capabilities.

Polaris was designed to seamlessly integrate with dozens of internal and external applications, creating a single source of truth for client data. This facilitated the shift from cumbersome, manual processes to streamlined, automated workflows, enhancing both first impressions and overall client experience.

Polaris supports workflows for new client implementations and servicing existing clients, ensuring efficient operations for both internal teams and external users. It also features robust monitoring and tracking capabilities, providing comprehensive oversight and management.

Using Pega Bootcamp and Pega Academy, Evernorth fostered internal talent development and reduced dependence on external vendors. Polaris also integrated crucial tools like Salesforce for sales processes, Adobe for complex form management, and AWS for extensive data storage, ensuring a comprehensive and efficient client management system.

The Results

Evernorth’s implementation of Polaris marked a significant leap in operational efficiency and client experience. Results included:

• 75% improvement in delivery speed
• 50–75% improvement in turnaround time for various processes
• 60% reduction in member call times

Furthermore, they achieved this all while supporting:

• 28% increase in user volume
• 84% rise in case volume
• 20M new members onboarded in 90 days
• 0 outages

Evernorth’s strategic focus on automation and integration continues to evolve, with plans to incorporate more AI and cloud capabilities into Polaris.