Healthcare Services Sector
CASE STUDY #1 - Enterprise Data Strategy
Business Objective: AmeriHealth Administrators (AHA) is a highly profitable and forward-thinking administrator of successful health benefit plans for employers or other organizations that choose to self-insure their members. AHA’s success in the marketplace caused them, over time, to outgrow the capabilities of their legacy information technology (IT) systems. For this reason they decided to invest in a far-reaching and ambitious IT re-engineering effort - designed to eliminate IT as a constraint on future growth, and to provide the organization with differentiating IT and product flexibility in the marketplace.
AHA asked a2c to lead in the definition and realization of a state-of-the-art Enterprise Data Strategy - designed to supply their new suite of IT applications with the best and most current information, and to establish an information framework for greater organizational agility in an increasingly dynamic marketplace.
Approach: a2c architects and AHA’s senior management quickly settled on share vision for an AHA’s enterprise data strategy that established a framework of enabling capabilities - including Data Warehousing (DW), Master Data Management (MDM), Data Virtualization (VODS). These data assets were also leverage to support a robust suite of shared Data Services that enabled the adoption of SOA (Service Oriented ) and ESB (Enterprise Service Bus - rendered in MS BizTalk) architectures.
a2c utilized a method based on its Agile Data Warehousing methodology that captured AHA’s “to be” vision as a set of detailed business process meta data. This repository became the basis for design specifications for the entire IT solution - including OLTP / operations, DW, MDM, VODS, and the collaboration portal (SharePoint). The meta data model was extended as needed to include IT components for realizing the vision (applications, platforms, interfaces) - all traceable to the shared vision of business process capabilities.
Benefits Realized: Work continues on the realization of AHA’s new IT vision. But the agile a2c method is allowing parallel advancement of data, application, and technical architectures that work together and adapt to change. a2c is completing designs for the AHA Dimensional Data Warehouse, Master Data Management systems for Benefits, Providers and Members, shared Data Services, and BizTalk Enterprise Service Bus.
CASE STUDY #2 - IBC-Highmark - Unified View
Business Objective: The advance planning for 2008/2009’s potential merger between Independence Blue Cross (IBC) and Highmark was extensive and thorough - organized around several themes: business processes, information technology, business intelligence and analytics, etc.
Solution: The “Unified View” initiative was tasked with (a) identifying commonalities and differences in the capabilities, approaches, and architectures of the “Informatics” environments within both IBC and Highmark, and (b) rapidly designing, building and deploying set of new and extensible Informatics capabilities that would support reporting and analysis services across a logical physical and/or physical view of unified foundational data assets of both companies – combined for true cross-company reporting.
a2c provided overall technical leadership for this initiative. This included organizing and designing due diligence tasks to identify and quantify commonalities and gaps between the organizations’ informatics capabilities, and mentoring and driving the design of a new and contemporary “Unified View” data warehouse architecture that would combine the strengths of IBC and Highmark’s independent legacy data warehouse environments, while preserving some measure of organizational autonomy, and supporting a complex and iterative multi-year conversion / migration process.
Benefits Realized: The following key objectives and goals were accomplished:
- IBC / Highmark were able to identify commonalities and gaps in their Informatics technical architectures – including Server, DBMS, ETL, SAN, and reporting technology stacks.
- IBC / Highmark were able to architect a new DW that retained the strengths of each organization’s legacy DWs, while addressing shortcomings and positioning the new DW for graceful extension of functionality over time.
- IBC / Highmark was able to prioritize the new DW’s deliverables, and create a roadmap of continuous delivery of business value and insight to the new organization.
CASE STUDY #3 - Operations Optimization & Continuous Improvement
Business Objective: As a leading provider of decision support solutions that promote informed healthcare decisions affecting more than 150 million U.S. lives, Thomson Reuters Healthcare (TRH) experienced a rapid expansion of their Product Portfolio in a short period of time. TRH needed to ensure supporting business and operational processes were capable of scaling with the anticipated customer growth and resource demand while maintaining the same level of world-class customer support. a2c was selected perform this analysis to include:
- Identify current Critical-to-Quality (CTQ) measures
- Baseline process performance metrics
- Identify potential capacity, resource and/or performance risks
- Perform Causation Analysis for risk areas
- Provide short & long term recommendations that would mitigate/eliminate risks while promoting customer value and satisfaction
Solution: a2c’s Business Architecture & Optimization Practice leveraged a Lean Six Sigma approach to capture, analyze and produce the quantifiable facts and recommendations Thomson Reuters Healthcare desired. Process data from Business/Technical Operations, internal Key Performance Objectives (KPOs) and Product Support structures were gathered and evaluated to ensure capabilities were in line with Critical-to-Quality requirements and the anticipated production increases. Based on this assessment, a2c identified 17 potential process enhancements and/or redesign efforts to meet incremental growth assumptions while promoting tighter quality-driven controls and improved process monitoring through calculated Key Performance Indicators.
Benefits Realized: TRH not only gained a project portfolio that outlined requirements to meet specific growth scenarios, but a clear view of how these work efforts satisfied specific customer CTQs by product. Additionally, a2c discovered common operational synergies that contributed to the foundation of “best practices” that would be implemented across all product lines. Thomson Reuters Healthcare and a2c continue its partnership to seek and promote continuous improvement in process efficiencies.
CASE STUDY #4 - M&A Project Management Office
Business Objective: Implement a Project Management Office for the potential merger between Independence Blue Cross (IBC) and Highmark to facilitate: workstream progress, issues and risks, and expedite communications through the workstream to the leadership team.
Solution: The Project Management Office was the hub for all progress using the latest project management tools: M/S Project and a Microsoft Sharepoint site/repository developed by a2c. In addition a2c created a “Clean Room” environment for sharing of information between the parties and provided over 20 personnel to assist with project management, business analysis and process re-engineering.
a2c provided overall Project Management leadership /partnership with IBC and Highmark, including external vendors for this initiative. This included the selection of resources, project management template development and overall cadence for the management of the merger and planning. Key methodologies include: process integration, resource planning and project estimates based on a large scale integration model.
Benefits Realized: The following key objectives and goals were accomplished:
- IBC / Highmark were able to plan and estimate providing a dynamic view of the project schedule, costs and resources.
- IBC / Highmark were able to leverage key technologies to enhance communications and decision making throughout the integration.
- IBC / Highmark was able to prioritize and resolve key risks rapidly using key tools developed to support the merger.
CASE STUDY #5 - Accumulator Data Mart
Business Objective: IBC engaged a2c to assist in reviewing their legacy in-house support systems that identify and perform Claims Adjustment operations - specifically related to Member out-of-pocket Accumulator capabilities.
Accumulators consolidate and aggregate claims from many diverse sources, deriving a complete picture of all patient out-of-pocket costs. Imperfect or incomplete accumulators result in members sometimes being asked to pay out-of-pocket expenses for claims that exceed their benefit package norms, driving a need for claims adjustment transactions, and negatively impacting member satisfaction. IBC has a sophisticated and ever-evolving network of trading partners which can sometimes exceed their production system’s capabilities, and required the creation of an equally sophisticated and flexible Accumulator framework - one capable of providing an accurate and timely picture of their Member out-of-pocket expenses.
a2c partnered with an IBC team that was already servicing frequent ad hoc requests for deriving accumulator totals and processing claims adjustments, using semi-automated tools and procedures that were showing signs of strain under escalating workloads. Accumulator inquiries were being tracked and serviced in queue, with occasional delays when demand was high. A better and more pro-active solution to derive member accumulations was needed quickly, in order to reduce claims adjustments related to accumulator errors, and maintain high member satisfaction.
Approach: a2c and IBC agreed on an approach that would leverage and extend the existing ad hoc accumulator code base - by proactively running it daily for all Members with claims activity, and capturing the results in a Member Accumulator Data Mart. This data mart was designed for high-performance and simple reporting, and would contain a full history, in monthly historical snapshots, of each member’s total claim out-of-pocket expenses. A complete library of reports, dashboards and web services we built to leverage this and serve a diverse set of constituencies within IBC.
Benefits Realized: The solution allows IBC to rapidly deliver pre-computed and accurate accumulator numbers for any IBC member, and is serving important and growing roles in a number of business processes within the organization - both proactive (e.g. Claims Processing) and retroactive (e.g. Customer Service). This resulted in decreasing the amount of calls into their contact center for members who exceeded their out-of-pocket deductibles.
CASE STUDY #6 - Member ID Cards & Fulfillment
Business Objective: Each year during its enrollment periods, IBC processes thousands of new members in addition to managing many membership benefits change requests by their member base and product managers. This has required IBC to rethink the current strategy for their fulfillment processes in order to provide a high-level of quality service to their members while controlling their internal costs to maintain their competitive standing in the marketplace.
IBC engaged a2c to perform a “Business Process Re-engineering” (BPR) effort for their current ID Card fulfillment processes, which would incorporate the newly established BCBSA mandates for card information. These BCBSA guidelines would standardize the formatting of information on the membership ID cards and allow BCBSA organizations to significantly reduce the complexity and processing time for generating ID cards during the fulfillment process. Creating a standard format for all Blue Plans to incorporate brand requirements would reduce confusion for providers who are part of the BCBSA national network.
Solution: As part of the ID Cards BCBSA Mandate Standardization engagement, the following key objectives and goals were accomplished:
- IBC was able to standardized the ID Card required data elements and reduce the number of complex business rules by 75%
- Developed a standardized structure for business rule development to be later incorporated into a Business Rules Engine for even great efficiencies
- Transition of all PA business (PAPPO, KHPE, AHPA) to the new platform
- Implemented Benefit Exception Management features and SOP which will allow IBC to monitor overall status of the customer’s ID Cards during the fulfillment process to assist with manual email notifications, advanced warning of exceptions and ensure external integration points
- Instituted a formalized QA framework that will provide appropriate change management for the ID Cards program and ensure that the Service Level Agreements established with external vendors are maintained
- Recommend and implement a new Production Support Model that will provide operations with the ability to handle and manage problem resolution, develop and integrate necessary enhancements and upgrades, and the required reports to assess program performance measuring SLAs and KPIs
Benefits Realized: IBC was able to reduce the time it took for members to receive their ID Cards in half, in addition to ensuring the accuracy of card information, improving the satisfaction of its membership base
CASE STUDY #7 - Wellness Credit Program Management
Business Objective: Our client was a large healthcare insurance organization providing health benefits solutions for Pennsylvania and Delaware. Each year during its enrollment periods, the client issues Wellness Credits to its Employer Group Members to be used throughout the year to achieve various health improvement goals for its constituent base.
The client needed a way to define individual strategies for their wellness programs and then track the usage of wellness credits against these planned activities.
Solution: a2c developed an application that allowed their Sales & Marketing group to perform the following functions:
- Define an individual Employer Group Wellness Strategy with supporting activities to achieve estimated health improvement targets and goals
- Manage Wellness Credit authorizations and debits from the associated Employer Group accounts and expenses from the SG&A budgets
- Issue automated Check Requests from HealthAmerica’s Accounts Payable system
Benefits Realized: As part of the Wellness Credit Program engagement, the following key objectives and goals were accomplished:
- The client’s group management organization was able to automate the process of issuing, managing and tracking the usage of Wellness Credits by its Employer Groups
- Sales & Marketing Operations personnel were able to define and reuse Wellness strategies & activities to help reduce the overall healthcare costs of their Employer Groups
CASE STUDY #8 - Member Benefits Information Exchange
Business Objective: As a member of the Blue Cross Blue Shield Association (BCBSA), IBC is required to respond to requests for member data from other BCBSA member companies through the Blue Exchange hub. The BCBSA continually releases iterations of new requirements for these transactions. Enhanced Eligibility Iteration 4 (EEI4) required all BCBSA member companies to provide member benefit information for eligibility transactions. IBC elected to re-architect the system to leverage a Service Oriented Architecture, allowing common access to member benefit information which would then be available for any consumer within the organization.
Solution: As part of the Member Benefits SOA Enablement engagement, the following key objectives and goals were accomplished:
- Integrated multiple benefits COTS systems and mainframe systems to provide a consolidated view of the data
- Developed a standard Canonical Model for benefits information.
- IBC was able to exchange Member Benefits information seamlessly across the Blue Exchange network with its peer organizations
- Multiple IBC initiatives and mandates were able to utilize the Member Benefits Web Services providing quicker implementation time and data quality
- IBC engaged a2c to architect the Member Benefits Web Services to provide a standard way in retrieving a member’s coverage and utilization against individual benefits. These web services would serve to provide the integration to IBC’s numerous benefit’s data-stores, removing that requirement from consumers and a standard Canonical Model for reporting coverage and utilization for a member’s deductible, co-pay, co-insurance, out of pocket maximums, benefit limitations, and penalties.
Benefits Realized: IBC was able to meet the BCBSA requirements for Blue Exchange, while simultaneously providing a common infrastructure for retrieving member benefit information, resulting in reduced implementation costs, improved data quality and quicker implementation times for multiple projects and initiatives.
CASE STUDY #9 - Healthcare Data Platform
Business Objective: Thomson Healthcare is the leading provider of decision support solutions that help organizations across the healthcare industry improve clinical and business performance. Their solutions inform healthcare decisions affecting more than 150 million U.S. lives. Thomson Healthcare selected a2c to assess the technical and operational health of their core information product systems that support the Provider side of their business, and to propose a strategy that would address their needs to simultaneously:
- Meet new and explosive industry scalability requirements
- Reduce the latency in processing and publishing provider-submitted data
- Lower overall system complexity to simplify operations
- Incorporate requirements for Healthcare Reform (HIPPA5010, ICD-10, HITECH)
- Reduce provisioning and on-boarding times for new subscription customers
Solution: a2c’s Information Services practice conducted a top-down and bottom up assessment of Thomson Healthcare’s data warehousing environment , which scrutinized their existing framework’s robustness, root causes for latencies and quality issues, ability to scale, ability to extend to meet future requirements, and operational support profile. Based on this assessment, a2c’s resultant strategy included:
- Implementation plan for reengineering their technical environment, including high-level designs of proposed changes
- Recommendations to improve overall quality while reducing QA effort and latencies
- Realigning their operational support work flow with the proposed, simplified technical framework – which will dramatically streamline and simplify Thomson’s key product delivery platform and operations
- A Technology Roadmap detailing steps to evolve the new technical and operational framework
Benefits Realized: Thomson Healthcare now has an viable alternative to their existing environment – one with great potential to be significantly simpler, faster, more scalable, more empowering to customers, and lower cost. a2c continues its relationship with Thomson Healthcare to explore realization of the strategy and recommendations – through technical proofs of concept and feasibility studies, new release designs and planning, and refining and realigning the organizational structure in support of a continuous innovation delivery objective.
CASE STUDY #10 - Pinpoint Quality® Suite Data Platform
Business Objective: Elsevier is a leading publisher of science and health information serving more than 30 million scientists, students and health and information professionals worldwide. They develop online information solutions that help healthcare professionals achieve better outcomes. Pinpoint Quality® application identifies and improves clinical performance in hospitals or a group of hospitals. It incorporates severity adjustment and artificial intelligence with evidence-based guidelines and benchmarks. Pinpoint Quality® offers a systematic approach to improving care outcomes, patient satisfaction and operational efficiency. It provides desktop access to clinical, quality and cost indicators for disease categories, provides coverage of 100% of the inpatient population and allows for immediate identification of cost savings opportunities and improvements in clinical quality, safety, and service.
Solution: a2c’s Information Services practice implemented a Multi-Dimensional Data Warehouse repository utilizing Oracle’s 11G platform with OLAP services and OBIEE integration. This solution enabled Reed Elsevier to achieve the following:
- Meet new and explosive industry scalability requirements including Global deployments
- Reduce the latency in processing and publishing provider-submitted data
- Reduce provisioning and on-boarding times for new subscription customers
- Realigning their operational support work flow with the proposed, simplified technical framework – which will dramatically streamline and simplify Reed’s key product delivery platform and operations
Benefits Realized: Reed Elsevier was able to increase revenues and take advantage of market opportunities by decreasing their customer onboarding times, and being able to react immediately to market conditions and adhering to federal healthcare mandates.
CASE STUDY #11 - SVMC - Electronic Medical Record
Business Objective: Saint Vincent Medical Centers of New York (SVMC) serves as a major healthcare resource for the greater New York Metropolitan area. SVMC is currently in the planning process for building a new “All Digital, All Green” hospital which will utilize state-of-the-art technology to serve and provide the highest quality care to its patients. As part of this transformation, SVMC needed to implement an Electronic Medical Record strategy, in order to be compliant with the upcoming regulatory legislation and take advantage of the federal economical stimulus bill for Healthcare Information Technology.
SVMC engaged a2c to formulate an appropriate EMR Roadmap , that would include the implementation of a digital repository, comprised of patient information, that would be digitally converted from their historical, paper-based medical chart and forms data.
Solution: As part of the EMR Digital Transformation engagement, the following key objectives and goals were accomplished:
- Completed conversion of all post-discharge paper medical forms and patient information which could be shared and managed by hospital personnel in a secure, digital repository
- Instituted a classification schema for all patient information and medical data which included bar code identification to virtually eliminate any human error
- Implemented a formalized QA framework that achieved less than 2% rework
- Developed electronic versions of all patient and medical forms used by hospital personnel to significantly reduce the amount of paper forms which were being printed and inventoried
Benefits Realized: SVMC was able to establish a strong foundation for their Electronic Health Record strategy that will not only enable them to provide the highest quality of care to its patients but they will be eligible to receive several million dollars in reimbursement from the federal economic stimulus plan under the American Recovery & Reinvestment Act of 2009.