The US Food and Drug Administration approves approximately 40 to 50 new medicines yearly—about one weekly. Managing the distribution of these new medicines and the 20,000-plus prescription medications approved for marketing in the US is a huge responsibility, one fully appreciated by Sudipto Dey and Roberto Camara at Evernorth, the pharmacy benefit management subdivision of the Cigna Group.
As senior principal and senior staff engineer, respectively, Sudipto and Roberto develop the IT ecosystems that help channel new medicines to the right patients through the Cigna Group companies Express Scripts, Accredo, Freedom Fertility, and CuraScript SD.
In New York City at the 2024 CamundaCon, they shared how Camunda’s platform for end-to-end process orchestration is supporting Evernorth’s mission to improve the health and vitality of the people they serve.
Streamlining pharmacy processes from 7 days to 1 day to deliver better outcomes
For some patients, new therapies offer a chance for better health outcomes. For healthcare companies and pharmacy benefit managers, new therapies are an opportunity to provide safer and more affordable medicines to their members. In the healthcare industry, the coordination of care to get the right medicine to the right patient at the right time is critical and can be very complex.
For example, Evernorth’s IT environment includes multiple components that support different types of users, such as web and mobile patient applications, physician portals, and internal applications accessed by technicians, pharmacists, and patient care advocates. These components need to interact with each other in an orchestrated way to create a seamless journey.
Imagine the stress on an oncology patient who cannot get the medication they need because authorization has unexpectedly become invalid or a prescription has expired. These are the types of real-life scenarios Evernorth’s team is continually seeking to improve through better technology.
“In a situation where a patient is going through this kind of a disease, we are with them together every part of the way, and we are here to support them in their journey,” explained Sudipto.
In Evernorth’s previous systems, it took six to seven days to get a response from a doctor. By modernizing Evernorth’s systems with APIs and microservices, and using process orchestration to automate the journey, Evernorth reduced the time to communicate with the doctor to just one day.
“As engineers, we feel a sense of pride,” said Sudipto. “We feel a sense of accomplishment that we are able to help the patient when they need us most.”
Modernizing a complex tech stack
Sudipto explained how over the past six to seven years, they’ve built composable APIs with defined bounded context that each do one thing and one thing really well. However, their team’s more significant challenge is the complexity of their tech stack, which is made up of legacy and modern apps integrated using messages or exchanging messages across Kafka topics.
As Sudipto described, “Our world is pretty complex. There are multiple domains. There are multiple products. Multiple technologies are integrating with each other to produce a desired outcome.”
The goals Evernorth targeted with modernization were to enable end-to-end processes, support a composable architecture, and improve flexibility.
To improve the architecture, Evernorth’s team introduced an end-to-end process orchestration layer with multiple, different components developed over time.
“End-to-end is not about one scrum team. It’s not about one execution team. It’s across all the teams from an enterprise perspective,” explained Sudipto. “End-to-end means from when you receive the notification within the enterprise boundaries to when you dispense the drug outside. That was what was missing in our ecosystem earlier.”
Now, Evernorth’s end-to-end workflow layer provides seamless communication between the frontend and the composable APIs downstream.
Externalizing business rules for flexibility
Because the pharmaceutical market is very dynamic, flexibility in creating and modifying business processes is very important. The Evernorth team knew they needed to improve flexibility to support the business. They took an approach that externalized the business rules.
Sudipto explained the reasoning behind the approach: “The moment you externalize the business rules, what you have is an ability to invoke these business rules from the APIs and also from the workflows. What it gives you is the same experience to the end user, whether they are building a composable architecture just on APIs or using the workflow to analyze their work products, or if they’re even using the topmost layer of applications. So, it doesn’t matter which level you are using the components or which layer of applications you’re using for composability—your reusability still is adhered to by externalizing the business rules to a separate layer.”
“What we have achieved,” added Sudipto, “ is reusability and composability.”
Evolving from proof of concept to more complex processes
As a proof of concept, Evernorth initially began using Camunda to automate batch processes. The company’s batch processes typically ran at night and consumed their infrastructure. Plus, the turnaround time for batch processing was high. By converting the batch processes to event-driven architectures, Evernorth was able to deliver new value with Camunda.
Next, the team tested Camunda’s capabilities to solve complex challenges and problems. Two of the use cases redesigned in Camunda include orchestration for claims submissions and biosimilar medications.
Use case: Claims submission
Claims submission is very complex in the pharmacy benefit management industry because it’s highly regulated. Evernorth’s team needed to ensure their processes aligned with compliance requirements so they could deliver accurate services to patients and customers. The existing process was an inefficient combination of human tasks and different applications, so they rebuilt the process in Camunda to improve efficiency by automating the entire process.
Roberto credits the collaboration between their business partners and engineering as an important contribution to the project’s success. “We found the BPMN tool very effective, because when we use the BPMN tool during the design part of the process, the same design is going to evolve to the development phase and then to the execution phase. And whatever our business partners help us to build, they are going to see that it is executed.”
Use case: Biosimilars
A biosimilar is a medicine that is very similar to another medicine already in the market. They are important because they expand the ability of patients to get access to expensive therapies. However, the business process of managing a biosimilar is very complex—once started, the process could be interrupted in the middle, go back to the beginning, and jump from the first step to another flow.
Roberto admitted that he had wondered if a business process with highly complex requirements could be built in Camunda. The biosimilars use case was the test. “It can be done,” he told the audience.
The outcomes of the use case proved to the team that Camunda is the right tool for handling complex business processes. Now, when the Evernorth team is determining which solution in their tech stack should be used for a new project, they ask, “Is it a complex business process? Is it a long-running business process? Do they need process orchestration?”
If the answer is yes, the project is a good fit for Camunda.
“Where we have found Camunda to be a real good use case and giving us bang for the buck is anything which is headless. And by headless, what I mean is a process orchestration that’s required, which is complex, and does not need a user… That’s where we have seen Camunda kind of give us really huge value in terms of automation, speed to deliver, and cost-effectiveness.” –Sudipto Dey, Evernorth
Lessons learned
Throughout their presentation, Sudipto and Roberto shared insights and lessons learned along the way. Their advice includes:
- Share the ownership of the business process with your business partners.
- Keep the business process 100% business oriented. Avoid trying to put any technical steps in the process that may confuse business partners. That way, when a business partner looks at a BPMN model, they can understand what is going on.
- Build a business process with the intention that it will change over time, multiple times. When you have the right implementation behind your business process, you can easily change it using drag-and-drop tools in Camunda’s Modeler.
- Visibility is very important. Having visibility of the process is key to finding opportunities for improvement. This is important during the design of a business process so that the business understands the milestones for each step in the process and what actions or data are needed to meet them.
- Take advantage of tools like Cockpit to see and handle incidents so you are continually adapting and improving your processes.
- Consider decoupling your backend code from the business process to create extendability, reusability, and a framework to plug and play your backend code.
They also attribute success in building and orchestrating complex business processes to visibility, simplicity of tools, synergy to adapt to the existing tech stack, and collaboration between IT and business operations but also between the organization and Camunda.
Watch the replay of this presentation to learn more about Evernorth’s experience evolving their Camunda implementation, and connect with an industry expert to learn how Camunda can help you modernize your tech stack to deliver better patient experiences.
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