In the healthcare industry, it’s critical to keep costs down while preserving and improving the quality of care for patients. Our client, a national medical management company, plays a vital role in doing so through medical cost management services, a variety of innovative programs, the development and introduction of new services, the reduction of overall treatment costs, and by improving diagnostic accuracy.
A critical component of this company’s business is the exchange of healthcare data files, ranging from large radiology images to claims preauthorization. It has an enormous and diverse trading partner community consisting of hospitals, 55 of the nation’s largest insurance companies, and offsite facilities.
As a rapidly-growing player in its industry, the company was exchanging thousands of files daily with over 80,000 different medical facilities. Because of the sensitive nature of the data they send and receive, avoiding data breaches and system outages was paramount.
Because of the sensitive nature of the data they send and receive, avoiding data breaches and system outages was paramount.
In addition to their heightened security needs, the company was growing at a very rapid pace, from around $250 million to over $900 million in less than three years.
Their outdated B2B Integration system was putting sensitive data at risk and hindering further growth because it could not meet security, regulatory and transfer load requirements.
As a result, they faced inefficient, error-prone processes and file exchanges that impacted their business and those of their partners.
Furthermore, the process of ensuring numerous files and claims reached their destination—and communicating the status to partners as needed— was challenging.
In addition to their partner communication inefficiencies, the time required by internal IT staff to research and track down transactions was becoming a drain on the company’s bottom line.
To help remediate this, they needed a secure solution that would provide their customer service and business users visibility and quick and direct access to data—yet restricted to the point where they could not reprocess data.
The Solution – B2B Integrator and B2B Framework
Because of the numerous requirements for their B2B Integration environment, the company looked for an experienced B2B Integration partner to help them through the process.
Eliassen Group, an IBM Platinum Business Partner, was able to provide the company guidance in determining the best B2B Integration plan for their needs. After reviewing their current environment, Eliassen Group created a customized B2B Integration strategy, identified areas of improvement, and indicated potential pitfalls.
With Eliassen Group's expertise and direction, the company made the decision to implement IBM Sterling B2B Integrator. IBM Sterling B2B Integrator boasts the robust security features and scalability that the company required.
The company leveraged the Eliassen Group team to design, implement and customize the B2B Integrator solution. In addition, it selected Eliassen Group's B2B Framework with Document Visibility Interface (DVI) to reduce implementation time and costs, minimize the need for custom business process development, simplify business partner onboarding, and empower business users with visibility and access to data.
Expanding B2B Capabilities
The upgrade to IBM Sterling B2B Integrator provided the company numerous capabilities and benefits, including:
- HIPAA and healthcare industry-compliant security features
- A true high-availability, any-to-any translation and communication environment to communicate with their 80,000+ business partners
- Role-based security and protection of sensitive patient, insurance and healthcare data
- Business process management to relieve the administrative burden on their IT department
It was imperative to implement IBM Sterling B2B Integrator with minimal business disruption, and the Eliassen Group B2B Framework helped the company go live with B2B Integrator and begin conducting commerce sooner—without the need for extensive customization.
Furthermore, the company had numerous command line utilities, .Net rules, and stored procedures in place. The B2B Framework allowed the company to improve the management of these processes with its pre- built protocols, components, and templates. Additionally, they were able to reduce the time to onboard their numerous trading partners—from hours or days down to minutes.
X-Ray Visibility into Data
IBM Sterling B2B Integrator and B2B Framework with Document Visibility Interface (DVI) helped the company improve the efficiency and security of the file and data exchange process. The combined allows the company to communicate safely with a wide range of business partners – from small medical facilities to large insurance providers – and they can now quickly receive large radiological images and other data from medical facilities.
The B2B Framework provides robust document visibility and tracking features, including:
- Detailed information about a document’s status, protocols, sessions and business processes accessible across the company’s national locations and satellite branches.
- Access that enables the insurance company’s non-technical users to perform essential activities, such as viewing document status and reprocessing documents
- Pre-defined, configurable processes for their diverse communication, translation and routing needs
- Unique file naming conventions and sequence number generation
- Dynamic routing of inbound transactions to multiple downstream applications as required
The Results Are In
With the enhanced security, the company can preauthorize medical facilities to complete work prior to insurance claims, leading to over 16,000 preauthorizations per day.
Through the complete, 360-degree document visibility that the Eliassen Group B2B Framework provides, the company can identify and address problems proactively, which in turn improves customer service levels and business partner relationships.
With the addition of the Document Visibility Interface (DVI) to Eliassen Group's B2B Framework, the company can empower its business users and select business partners with self-service access to specific data and documents (based on the specified user, group and role).
These users can now perform essential document tracking without requiring IT staff involvement. The time that IT staff spends performing administrative tasks like researching document statuses has sharply declined, freeing the department up for more important initiatives.
Eliassen Group’s B2B Integration services and solution implementation helped the company migrate to a streamlined, current-generation system with little business disruption.
The medical management company’s B2B Integration operations now boost, rather than hinder, their innovative strategic plan for the future.