Problem: Data Management for Existing Claims Systems
Health plans of all sizes must modernize to stay competitive and prepare for growth. This includes the need to convert legacy claims systems to modern systems that support expansion and innovative product offerings.
To make this happen, a health plan provider needs to see their whole world of data at any given moment. They can’t get today’s data tomorrow without risking compliance and regulatory issues.
But, data comes into a health plan in many ways. Often, it’s imported from an independent service provider, such as a pharmacy or specialty clinic, but it can also come from other types of plans, such as a vision care plan.
In many cases, this data is insufficient because claim’s vendors only ingest and organize it, often restricting access. This data can be complex, convoluted, and poorly organized. This means that it lacks completeness and doesn’t pull up at the necessary speed once it’s been transferred to the new system.
Additionally, many health plans are beholden to their claims systems for all of their data. If they transition to a new claims system, they lose access to that data, which significantly affects their ability to make strategic business decisions.
When the client approached us, they were struggling to redesign new product offerings because they couldn’t look at holistic data across their enterprise.
As the first step to modernization, our client selected HealthRules from HealthEdge as their leading-edge claims processing system. Then came the hard work of migrating all legacy data from their old platform to the new HealthRules system.
Solution: DataCHROME: A Real-Time Data Hub
We immediately realized that the client needed a real-time data hub that delivered a vastly simplified model while also incorporating all necessary external data elements into a single solution. Essentially, the client needed to get all their enterprise data in one place in an architecture and structure that was easily understood and consumable by their staff.
To create this solution, we developed DataCHROME. DataCHROME includes a number of different technologies, including replication engines and real-time Extract-Load-Transform (ELT) solutions. We configured the HealthRules system to fit the specific needs and methods of our client and designed an enterprise data warehouse (EDW) and a Business Intelligence (BI) layer to support consolidated and customized reporting.
The EDW served to consolidate complex and disparate databases, including the HealthRules claims system, pharmacy claims systems, provider data systems, and EMR/EHR data. In the end, we streamlined over 1,000 data tables down to 200, which greatly improved reporting efficiency.
With this new model, our client now has the ability to unleash the power of the data to create a self-service business intelligence lair. By taking multiple data sources and consolidating them into one single hub, the data has become actionable for key decision-making.
Outcome: Transformational Change
This solution created transformational change at the organization. For the first time, the company had consolidated data that could support its new business initiatives.
SourcEdge’s Role: Ideation, Architecture, and Implementation
SourcEdge played a significant role in the ideation and architecture of the solution. We also led the development team in the implementation of the HealthEdge product.
At SourcEdge, we specialize in modern technology solutions for health plans. We offer a variety of services, including consulting, staffing, and full project implementation.