Case Study: enGen achieves $17 million in annual medical cost savings with Pegasystems

enGen streamlines care for better member outcomes

Engen needed a way to deliver personalized care and coordinate complex cases at scale while reducing costs and improving the member experience. As a subsidiary of Highmark serving more than 11 million members, Engen faced disconnected systems and rising expectations for more efficient, member-centric care. Pegasystems, using Pega Customer Decision Hub and Pega Care Management, helped address these challenges.

Pegasystems implemented an omni-channel Member Engagement Hub and Predictal clinical platform to unify data, automate manual processes with AI and NLP, and enable timely outreach and self-service. The results included $17 million in annual medical cost savings, a 2.5X increase in members served with case management, an average Net Promoter Score of 80, and a reduction in unnecessary emergency department visits by over 1%, all without adding staff.

Engen

Gloria Romeo

SVP of Product Development