The Payer of the Future: Modernizing Health Insurance with API-led connectivity May 2016
Jan 09, 2017
The Payer of the Future: Modernizing Health Insurance with API-led
connectivityMay 2016
Matt SernaIndustry Marketing, MuleSoft
• Health insurance is in a state of continued disruption
- Transition from fee-for-service to value-based care
- Technology transforming care delivery
- Increasing importance of member and provider engagement
State of health insurance in 2016
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Engagement and connectivity
• For providers:- Improved care for patients- Increased retention in
network
Why engagement matters more than ever
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The challenge: Personalized engagement requires real-time integration of multiple systems of record in order to provide a full 360 view of the member or provider.
• For patients- Proactive, preventive care- Member retention- Cost savings
Praveen MuruganSolutions Architect, Healthfirst
Quinn SolomonPrincipal, Deloitte
Speakers
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Quinn SolomonPrincipal, Deloitte
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Praveen MuruganSolutions Architect, Healthfirst
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Who are we?
Healthfirst® is a not-for-profit health insurance company sponsored by some of the most prestigious hospitals and healthcare systems in New York.
We serve close to 1.2 million members in New York City and in Long Island through government-sponsored programs including Child Health Plus, Medicaid, Medicare Advantage, and Managed Long Term Care (Senior Health Partners), as well as through private health plans including Healthfirst Leaf and Qualified Health Plans, offered on NY State of Health, The Official Health Plan Marketplace
We are the only Medicaid Plan in NYC and Long Island rated 5 stars two years in a row.
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Who are we?Mission
To ensure that our members have superior healthcare and satisfaction. We will fulfill this promise through our partnerships with providers and, together, will transform the system so that it is accountable for the cost and quality of healthcare for our populations.
Vision To treat our members with the same care and attention we would want for our own families.
Values Members first. We exist to serve our members. Their satisfaction and well-being is the best barometer of our
success. Quality execution and continuous improvement. We chase perfection in order to catch excellence and we know we
cannot rest on past success. Excellence, willingness to change, and continuous improvement are our only paths to the future.
Employee success. Our employees are our greatest asset. We strive to create an environment where every employee has the tools, feedback and opportunity to excel and grow professionally. The success of our employees guarantees the success of Healthfirst.
Cooperation. Our success depends on our ability to overcome challenges better and faster than our competitors. To do this, our employees at all levels must work together as a team regardless of their functional departments.
Integrity and transparency. We work at the highest level of openness, honesty and integrity. We honor our commitments and keep our promises. Transparency fosters trust.
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Business Transformation for Vision 2020GOAL: To be the pre-eminent health plan in our market by 2020
Business Transformation Initiatives: Multi year projects aimed to deliver superior customer engagement, improve population health and drive cultural change to enable Healthfirst to become industry leader
Identify and Clean Existing Processes
Build robust MDM solution
API Led Connectivity
Improve Member and Provider Services
Build new Sales, Broker and Employer Service Units
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Member & Provider Services – Previous Architecture
Project: Improve Member and Provider Services
End User Pain Points
Reps move between multiple applications to service members and providers which leads to increased resolution time
Inability to manage cross-functional processes creates inconsistency and duplication of work
Thick client requires updates to be pushed to representative machinesTechnical Debt
Point to point connectivity No single source of truth for members
and providers Batch oriented update transactions
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Member & Provider Services – Current Architecture
Project: Improve Member and Provider Services
Improvements
Reps get 360o view of members and providers
API based integrations to all backend systems
API based integrations to BPM system to create and receive status of inter-department processes
Real time updates instead of batch updates
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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API Led Connectivity using MuleSoft
API Gateway
Leveraged OOB Security, QoS and Compliance policies
Built custom logging policies Created and published
documentation on API Portal
API
RAML first approach to building APIs
Standardized logging, exception handling and alerting across all APIs
Leveraged MuleSoft enterprise security components
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Performance
Performance Requirement: All responses had to be <= 3 seconds
How was it achieved?
Salesforce page designed to load member and provider 360 details in several cards
Parallel callouts to APIs from Salesforce to load cards
Smaller and faster queries vs larger and slower queries
Parallel callouts to DB from MuleSoft(Scatter-Gather)
Enabled connection pooling on MuleSoft
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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Summary
Cloudhub helped us be project ready in a very short time
OOB features on API Gateway minimized development effort
RAML first approach for better REST APIs. Enabled mock services for parallel development.
Standardizing on logging, exception handling and alerting frameworks ensured consistency across projects
Leveraged Anypoint Exchange private library to upload sample projects/template to help developers
Increased adoptability and reusability of APIs across enterprise by documenting on API portal
The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.
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What’s next?
Setup Anypoint MQ
Operational housekeeping Build Process to Archive Logs Build health checks for APIs and boundary systems
Will be hosting close to 100 integrations by Q2 2017
Q&A