HealthPlan Services enjoys
Real-time view & analytical reporting
of data movement & interaction between
multiple internal and external partner systems
key highlights
Became a USP attracting numerous new clients & there by achieving considerable business growth
Equipped more than 200 users of the operations team to manage over 100,000 transactions daily
Resulted in significant cost efficiency as it provided ‘self-serve’ capabilities to run and manage millions of transactions
The Context.
WellDyne is a leading Pharmacy Benefit Management Company that leverages technology and data analytics to offer personalised engagement and targeted services to payers, patients and providers.
The Patient Protection and Affordable Care Act dramatically altered the health insurance landscape in the US. It required ‘Payers’ to integrate with the newly established public and private exchanges. They had to, thus keep pace with the fast growing individual market while keeping their administrative costs low and predictable.
HPS was one of the first TPAs to provide cutting edge technology, connecting its ‘Payer’ clients with over 40 public exchanges and more than 150 private exchanges. This led to a multifold increase in HPS business volume, and it was handling about a 100,000 transactions a day in a short span of time. Given the tremendous spike in the volume of transactions, HPS needed to amplify its capability to spot, rectify & act upon errors arising at any point during the lifecycle of a transaction.
The Business Ask.
HealthPlan Services required a comprehensive platform that gives real-time visibility into the lifecycle of each transaction - as it moves through multiple internal & external systems. The solution must offer capabilities to spot, highlight & resolve transactional errors & issues. It must also enable HPS to make better strategic & operational decisions by way of analytical reporting.
The Business Ask.
HealthPlan Services required a comprehensive platform that gives real-time visibility into the lifecycle of each transaction – as it moves through multiple internal & external systems. The solution must offer capabilities to spot, highlight & resolve transactional errors & issues. It must also enable HPS to make better strategic & operational decisions by way of analytical reporting.
The Solution Strategy.
Build a custom portal platform that offers:
1
Real-time visibility into each file or non-file based transaction processing, at a macro & micro level
3
An extremely simple User Interface to track failures & fix errors at the ease of a click
5
An extremely robust authorisation model to control access to critical and sensitive data among internal and external users
2
Ease of operations and management of transactions, as they flow through multiple internal & external systems
4
Dynamic and pre-built analytics and reports for facilitating ‘informed & efficient’ business decisions
The Solution Strategy.
Build a custom portal platform that offers:
1
Real-time visibility into each file or non-file based transaction processing, at a macro & micro level
2
Ease of operations and management of transactions, as they flow through multiple internal & external systems
3
An extremely simple User Interface to track failures & fix errors at the ease of a click
4
Dynamic and pre-built analytics and reports for facilitating ‘informed & efficient’ business decisions
5
An extremely robust authorisation model to control access to critical and sensitive data among internal and external users
The Technology Components.
Portal Platform
Spring with Backbone JS
-
User Interface along with its presentation and business logic
-
Integration with data sources to read and write data
Search Engine
Apache Solr
-
Fast data retrieval
-
Ultra fast data operation, with rapidly growing data
The Craftsmanship.
Built by a team of 14 people
over a span of 5 months,
Comprised a mix of:
- Product & Business Experts
- Portal Technologists
- FrontEnd Developers
- Integration Experts
- Visual Designers
- Infrastructure Engineers
Collaborated with three external
service partners to drive this project
to successful fruition
The Impact.
- HPS showcased this platform as a key highlight in its go-to market approach.
- Served as a USP, attracting multiple new clients & thereby achieving considerable business growth.
- Significant cost efficiency in IT Operations Cost, as it provided ‘self-serve’ capabilities to run and manage millions of transactions.
- Improved access to care via shortened resolution time.
- Facilitated Customer SLAs for transaction processing.
- Equipped more than 200 users of the operations team to manage over 100,000 transactions daily.
More Work.
A cloud-based CRM platform, tailor made for a leading PBM, offering cost effective & intuitive service capabilities aimed to enhance customer experience.
EBMS builds a Self-serve Member Portal,
An exhaustive single point to
navigate through all healthcare needs.
