Most leaders think about AI as a tool to analyze data or assist with tasks. But what happens when your AI becomes an autonomous agent, not just providing insights but actively orchestrating complex processes on its own?
Today, we are at PegaWorld 2026 at the MGM Grand in Las Vegas, and, we’re going to talk about moving AI from a theoretical concept to a practical, value-driving reality. Specifically, we’ll explore:
- The transition from predictive AI to agentic AI, and what that means for orchestrating complex customer journeys.
The architectural and data foundations required to successfully deploy autonomous AI agents at an enterprise scale.
How this approach enables a new level of proactive, personalized engagement that improves outcomes and drives business value.
To help me discuss this topic, I’d like to welcome Richard Rutkowski, Director of Product and Technology at enGen.
About Richard Rutkowski
Richard Rutkowski is Director of Product and Technology at enGen, where he leads the development of clinical care management solutions designed to improve patient outcomes, streamline administrative processes, and reduce healthcare costs. With a background in computer systems technology and expertise in product strategy, agile methodologies, and technology leadership, Richard works across cross-functional teams to develop and scale innovative solutions that address complex healthcare challenges.
enGen is the technology, operations, and services company of Highmark Health, one of the largest integrated health organizations in the United States. The company provides technology, data, and business solutions that help health plans, providers, and care teams modernize operations, improve efficiency, and enhance healthcare experiences. enGen focuses on leveraging emerging technologies, including AI and automation, to simplify complex healthcare processes and drive better outcomes across the healthcare ecosystem.
Richard Rutkowski on LinkedIn: https://www.linkedin.com/in/richard-rutkowski-35063410a/
Resources
enGen: https://goengen.com/
Pega provides the leading AI-powered platform for enterprise transformation. The world’s most influential organizations trust Pega’s technology to reimagine how work gets done by automating workflows, personalizing customer experiences, and modernizing legacy systems. Since 1983, Pega’s scalable, flexible architecture has fueled continuous innovation, helping clients accelerate their path to the autonomous enterprise. Learn more at Pega.com
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Transcript
[00:00:00] Greg Kihlström: Hi. I’m Greg Kihlström, host of The Agile Brand, and here’s a question for you. Most leaders think about AI as a tool to analyze data and assist with tasks, but what happens when your AI becomes an autonomous agent, not just providing insights but actively orchestrating complex processes on its own? Today, we’re here at Pega World 2026 at the MGM Grand in Las Vegas, and we’re gonna talk about moving AI from a theoretical concept to a practical value-driving reality. Specifically, we’re gonna explore the transition from predictive AI to agentic AI and what that means for orchestrating complex customer journeys, the architectural and data foundations required to successfully deploy autonomous AI agents at an enterprise scale, and how this approach enables a new level of proactive personalized engagement that improves outcomes and drives business value. To help me discuss this topic, I’d like to welcome Rick Rutkowski, director of product and technology at Enjen. Rick, welcome to the show.
[00:01:57] Rick Rutkowski: Hey, Greg. Thanks for having me today.
[00:01:59] Greg Kihlström: Yeah. Yeah. Looking forward to talking about this, and- and great to be here at, at Pega World. before we dive in, why don’t you give a little background on yourself and your role at Enjen?
[00:02:09] Rick Rutkowski: Sure. I’m the clinical product director at Enjen. we are a wholly owned subsidiary of Highmark Health, which is the third-largest Blue Cross Blue Shield plan in the country. my background’s about 28 years in healthcare. the last 10 have been in the clinical space, and I have to say, this is, an explosion, I think, in an area, that I’ve never seen before in the 28 years. It’s just… Clinical is just where it’s at if you wanna make a difference.
[00:02:35] Greg Kihlström: Yeah. Yeah. So, I know you touched briefly, but l- let’s talk a little bit more about Enjen and, you know, what’s the company’s core mission and the types of organizations that you primarily serve.
[00:02:47] Rick Rutkowski: Yeah. Enjen’s a health tech company. we support other health plans on their journey to improving the way they manage care, deliver care, things like that. we focus on the underpinnings of that, the, the platform, the systems, the capability. But for me, my focus is predominantly predictable, that I help them with their clinical journeys.
[00:03:07] Greg Kihlström: Got it. Got it. So yeah. Let’s, let’s dive in here, and certainly, we’re gonna talk about a few things, but I wanna start with the, really the strategic approach here and the strategic shift to agentic AI. Certainly, lots of people talking about it. but in extracting value from it, a lot of organizations are running into challenges, and certainly, there’s a lot of headlines about things like that. from your perspective at Enjen, how do you define agentic and, you know, what’s the fundamental strategic shift required for an organization to move towards it?
[00:03:43] Rick Rutkowski: Yeah. So with AI, you’re taking information and analytics that a, that a human will then step in, interpret, and act upon. With agentic AI, you’re kind of replacing that human, okay? Not that a human’s not in the loop, but you’re replacing that human when you’re making that determination or decision.
[00:03:59] Greg Kihlström: Huh. Yeah.
[00:04:00] Rick Rutkowski: The driving need to shift, though, to move to an agentic world, I think, is really scale, and that sounds a little odd, but if I talk about a few of the, I’ll say, storms that are out there in the healthcare world, you’ve got aging populations with chronic illness on the rise. We’ve got clinician burnout to levels we haven’t seen before. So there’s a work shortage. regulatory policy with CMS ratcheting down SLAs means more faster, and again, clinicians are burning out, right? And rising costs and those other items. But if you want to scale, you can’t go with traditional care management, which is fragmented, disconnected. So you have to move to something that’s a little bit more orchestrated or interoperable, that utilizes data. It’s modular,
[00:04:45] Rick Rutkowski: can connect to other systems, other vendors, other data sources, and then you gotta layer AI and add intelligence on top of that to be effective.
[00:04:53] Greg Kihlström: Yeah. Yeah. And, you know, healthcare being a highly regulated and complex industry to boot, you know, what, what are the strategic considerations and stakeholder buy-in necessary to make the case for doing something like the age- you know, again, AI, it can sound, you know, intimidating or, or things like that in, in such an environment?
[00:05:18] Rick Rutkowski: Yeah. Especially in healthcare, right?
[00:05:21] Rick Rutkowski: So regulations, we have to be extremely thoughtful with how we advance, with, with all the privacy concerns that are out there and security concerns. but we’ve, we’ve established governance, that includes measures, clear measures, dashboards, results, auditing, traceability. You have to have a full picture of each and every agent that you put out there, or even if you’re, thinking about AI, you have to understand the data. Um-
[00:05:48] Greg Kihlström: Mm-hmm.
[00:05:48] Rick Rutkowski: Then you gotta align the buy-in. You need your operations team, and you need something that’s gonna bring them value. And I like the u- I tend to start with, or have started with, use cases that are there today that you can maybe scale, right? Right in the workflow. again, they’re a part of fully testing and piloting, and then, you know, I think the desire from their side is those pressures I talked about. They don’t really have a choice (laughs)-
[00:06:13] Rick Rutkowski: … but you do have to kinda get on board. I think that’s the way to go.
[00:06:16] Greg Kihlström: Yeah. Yeah. So now I wanna t- talk a little bit more about, you know, how we take that strategy and implement it. So, one of your colleagues, had a session de- describing, you know, building the architectural chassis, of the, of the operations on Pega to leverage this agentic AI. Can you break down what that means from a tactical perspective? You know, what are, what are the core components, things like data integration, process automation, or, or other things that need to be in place for something like this to work?
[00:06:50] Rick Rutkowski: Yeah. That’s a good question. So th- that chassis is what makes it possible, right, for agents to, to work across the entire ecosystem, not even just in Predictal.
[00:06:59] Rick Rutkowski: and this is embedded in the workflows, the AI summary, the decision-making, et cetera. Agents can react to data events. I guess a good example would be… I’m trying to explain before I tell you why we did it. A discharge event is a data event that comes from an EMR, letting you know that somebody was in the hospital for something urgent potentially, now they’re being let out. What we like to do is several things. An agent can look at that, find it, determine the criticality of it. I wasn’t just in because I went because my arm hurt, I was in for maybe a cardiac event. Then it would update the authorization in one system. It would start a case for care and schedule it with a skilled case manager in another system, and it would send a nudge to the member via digital means,
[00:07:45] Rick Rutkowski: maybe it’s a text, maybe it’s their portal, their applicate, their app, whatever it might be. that’s all orchestrated through this architecture. So to get to that, okay, to get to that, you have to hit several core capabilities, and what we did was we focused on diverse data. There’s structured, unstructured data, monitoring data, claims, all your traditional datas are out there, but you have to bring ’em in, organize ’em, and have ’em available to the entire ecosystem.
[00:08:13] Greg Kihlström: And… But, I mean, what, what you’re describing, I mean, not only are there a lot of moving pieces in there that are, you know, automated, but they’re… It’s critical that they’re, they are right (laughs). Right? As well. I mean, it’s, I know I’m stating the obvious here, but, you know, we’re talking healthcare. We’re talking about, you know, these are pretty mission critical systems and the right data. It needs to go to the right place for the right person, so on and so forth. So getting that right is, you know… That, that’s, that seems like the, the key challenge, right?
[00:08:44] Rick Rutkowski: Yeah. You’re 100% right, and, you know, the business operations, they’re not gonna buy in unless you actually prove this out. And we, we all hear some of the horror stories that are out there. Most of what I described has a human in the loop, or on the loop depending upon what the situation may be. So generating summaries, still requires clinical acumen to review it, but before, when a clinician had to go look in three different systems to find data and try and bring it together, it’s now presented with insights that they can confirm or deny.
[00:09:15] Greg Kihlström: Yeah.
[00:09:16] Rick Rutkowski: And then that’s all part of the process, right? So human in the loop is a good way to gain their trust.
[00:09:21] Rick Rutkowski: it’s also less about replacing… Y- you know, there’s always the worry about jobs, right? It’s, it’s less about replacing the individual, more about supplementing their ability to do what they do best, which is their clinical acumen, and free them up to actually work with the member. So-
[00:09:37] Rick Rutkowski: … tho- those are the types of things I think you have to get the business on board with.
[00:09:41] Greg Kihlström: Right. But I, I think also on the flip side of that, there’s so much that a human h- has to do. You know, in the, in the pre-automation part of that, there’s so much that a human is responsible for that they have to get right as well. You know, so it’s kind of… It’s critical that the automation gets it right, but the human, the cognitive load on a human to get all of those things right and route it to the right place, it’s… There’s a… It seems to me like there’s a huge opportunity for AI to, kind of to what you just said, get the human focused on the right thing, not just overburdened with all the things they have to-
[00:10:18] Rick Rutkowski: Yeah.
[00:10:18] Greg Kihlström: … put in the right buckets, basically.
[00:10:19] Rick Rutkowski: The, the non-clinical events are just burning out the clinicians and-
[00:10:23] Greg Kihlström: Right.
[00:10:24] Rick Rutkowski: … you know, you can just… You can’t scale that way is what it comes down to. And like I said, when you’ve got chronic illness on the rise and CMS ratcheting down SLAs, it’s just not gonna be possible.
[00:10:36] Greg Kihlström: Yeah. Yeah.
[00:10:37] Rick Rutkowski: so plans have to get on board.
[00:10:41] Greg Kihlström: (instrumental music) So let’s talk a little bit about, how we measure success here. So with a system designed for earlier clinical detection and optimized prioritization, how do you measure success?
[00:10:57] Rick Rutkowski: So, success for us is, focused on, how we’re enabling, I guess, more care faster. didn’t say that well. the way we’re freeing up the clinicians to do more. We’re not necessarily positioned to run specific outcomes yet. We’re doing a lot of piloting and proof of concepts. We do have ambient listening in production, so we are seeing some results there. I think in, in th- in that front, we actually do a bit of a traditional measure, because when you can do more and gain more engagements, it’s proven over the years that you’re gonna have better outcomes, less ER visits, or revisits I should say, which allows you to save X amount of dollars because their outcomes are better, right? So you’re helping the member, the health plan benefits by
[00:11:42] Rick Rutkowski: saving money, right?
[00:11:44] Greg Kihlström: Yeah.
[00:11:44] Rick Rutkowski: This type of engagement, even when I explained before with the ambient listening, is, is what’s allowing us to scale that. So those numbers are gonna go up. outside of that, we haven’t done a lot of measures yet, but we are seeing, increased value when you talk to the clinician about, “Wow, it is great that I have this summary and I can actually look at it and, and interpret it,” okay? ‘Cause not everything’s agentic. But then, some of the actions that come out of that could be automated in the future, once you see the results are- are functioning well.
[00:12:12] Greg Kihlström: Well, and I would say, you know, those things that you just mentioned are- they’re proof points, right, of, you know, some- somebody listening to this that may be a little behind the curve on things but needs to get started, you know, are- are those the types of proof points where, you know, you can… i- i- it’s anecdotal, but it’s still powerful, right?
[00:12:30] Rick Rutkowski: It is. It’s very powerful, especially if you’re in a clinical space. I would say on the case management side is a good place to kinda wean into that a little bit-
[00:12:38] Greg Kihlström: Yeah.
[00:12:38] Rick Rutkowski: … or lean in there, you know, from a utilization management standpoint. Doing it responsibly, I think, is what’s important if you’re a- if you’re out there thinking, “How do I do this,” right?
[00:12:47] Greg Kihlström: Yeah.
[00:12:47] Rick Rutkowski: when you make a utilization management determination today, it’s always a clinician. It’s always a- a nurse and a medical director. With Agentic AI, you can now take all the clinical data you have, everything you know about that individual and the auth, and compare it to the medical policy and render a decision. But it can be done in parallel to what the medical director’s doing till you feel comfortable enough that, yeah, they’re aligned all the time, or to a certain percentage that you say, “Yeah, the risk of it being wrong isn’t really something we would worry about at that point.” So, you can shift it left, if you will, from that parallel processing to putting it right in front of the medical director, that human in the loop, to saying, “You know what? We’re just gonna let that go because it makes sense. We- we approve it in 95% of these situations.”
[00:13:33] Rick Rutkowski: And the- and the agent knows that type of thing.
[00:13:36] Greg Kihlström: Yeah, yeah. Th- and, I mean, in that c- in that shift left approach, it’s not getting rid of the- of the approval and/or the- the verification. It’s just moving it-
[00:13:46] Rick Rutkowski: Right.
[00:13:46] Greg Kihlström: … left (laughs), right?
[00:13:48] Rick Rutkowski: Yeah.
[00:13:48] Greg Kihlström: Yeah, yeah, yeah.
[00:13:48] Rick Rutkowski: Yeah, 100%. Yep.
[00:13:49] Greg Kihlström: Yeah, definitely. So, you know, looking ahead a little bit, you know, how does a platform-based approach, like the one that you built with Pega, you know, what does that look like from a future innovation standpoint?
[00:14:04] Rick Rutkowski: So, I think it’ll better support, your flexibility in the future and your ability to scale. We talked about that. I think I’ve said the scale word several times-
[00:14:12] Greg Kihlström: (laughs)
[00:14:12] Rick Rutkowski: … today.
[00:14:12] Greg Kihlström: It’s important, yes (laughs).
[00:14:14] Rick Rutkowski: Right. So, you know, understanding- being able to orchestrate, from a platform perspective, the entire care journey, right, as seamless as possible is important. So you’re unifying the data, the workflow, and the AI, that intelligence, in there, right?
[00:14:28] Greg Kihlström: Yeah, yeah.
[00:14:29] Rick Rutkowski: it’s easier to evolve other capabilities over time, meet the changing needs, regulatory needs, and just the needs of the population, because, like I said, chronic illness is on the rise.
[00:14:39] Greg Kihlström: Yeah.
[00:14:39] Rick Rutkowski: But if you’re staying put in traditional systems and you’re nervous about getting into this, I think you’re gonna be left behind, and you’re not- probably doing a bit of a disservice to your- your members. I’m not saying you go full force into AI. AI can be a dangerous thing. But if you do it responsibly, it can be really effective.
[00:14:57] Greg Kihlström: Yeah, yeah. I mean, it sounds like, you know, starting with a measured approach and, you know, watching it and adopting slow. I mean, that’s what I’ve heard from other- several others here as well, is just, you know, yeah, it’s not- it’s not go- go all in, but it’s at- at- at, you know, at the beginning, let’s say, but, you know, but taking those initial wins and building on them and learning, right?
[00:15:19] Rick Rutkowski: That’s 100% right, and I- I, again, I think we’ve seen- we’ve seen value, again, not necessarily quantifiable yet in our pilot stage for some of these, but we’re- we’re seeing a lot of value, and we’re seeing clinician buy-in, which is important.
[00:15:33] Greg Kihlström: Yeah, yeah. Love it. Well, Rick, thanks so much for joining today. two last questions as we wrap up here. First, you know, we’re here at Pega World in- in Las Vegas. what’s been a highlight for you so far?
[00:15:46] Rick Rutkowski: Oh, Alan’s a great speaker, as always, but I think just- just where AI’s advancing. We’ve been talking about AI for the last few years, and it just seems like it’s finally really moving from theory to practice. The more people I interact with around here, I’m starting to find that out too, and it’s across all industries. So, I think that’s- I think that’s important.
[00:16:05] Greg Kihlström: Yeah, yeah. And last question for you. What do you do to stay agile in your role, and how do you find a way to do it consistently?
[00:16:13] Rick Rutkowski: To stay agile in my role, I try to stay flexible and open-minded. I try to build good relationships with my peers and stakeholders and understand where the industry’s going. and when you think you have it figured out, you should keep looking because there’s always something else, and there’s always something new that’s gonna advance, you know, case management or- or utilization management, for me specifically.
