With recent growth, Molina Healthcare wanted to use its existing technology assets and apply them to key business processes in order to drive down administrative costs and simplify customer interactions. Molina chose a cost-effective licensing program, the Microsoft® Enrollment for Application Platform (EAP) for Enterprise Agreements. Molina is controlling costs while preparing to meet new HIPAA 5010 standards, increasing collaboration, and continuing to provide access to affordable healthcare.
Molina Healthcare operates in 10 states, providing health insurance to participants in the government-sponsored plans Medicare and Medicaid. In three years, the health plan’s membership grew more than 40 percent; Molina now serves 1.4 million members and counts more than 100,000 healthcare providers in its provider network. An economy that is increasing Medicare and Medicaid enrollment and legislative efforts to mandate universal healthcare coverage make it likely that the plan’s membership will continue to grow.
A number of internal reporting and analytics processes that were done manually in the past became bottlenecks for the enterprise. “We needed to manage growth and communication through cost-effective means,” says Amir Desai, Chief Information Officer (CIO) at Molina Healthcare. “Our growth requires that we increase the use of technology to bring more efficiency and collaboration to the organization.”
In addition, the U.S. government announced new guidelines and compliance rules pertaining to the transaction and security standards of HIPAA (Health Insurance Portability and Accountability Act) version 5010. Because HIPAA 5010 compliance is required by January 1, 2011, Molina needed to plan for how it would meet the new regulatory standards, while taking advantage of innovative technology tools to improve people-driven processes.
With 3,000 employees, 1,000 servers, and 3,000 computers on its network, Molina needed a flexible and scalable licensing model that would allow the health plan to continue to implement new products and systems while being able to control and predict costs. Further, Molina needed to simplify the licensing of new technology components that support the expansion of its technical infrastructure.
When Desai learned of the Microsoft® Enrollment for Application Platform (EAP) for Enterprise Agreements—a new, multiple-year, volume licensing program that allows a company to deploy as many licenses of selected software as necessary for a set yearly fee—he saw the benefits.
||As a steward of the government’s money, we must be cost-effective, reduce administration costs, and implement technology that supports growth and regulations. The EAP allows us to operate in that spirit.
Chief Information Officer, Molina Healthcare
Molina’s EAP covers licenses for a number of Microsoft technologies, including Microsoft BizTalk® Server, Microsoft Office SharePoint® Server 2007, and Microsoft Office SharePoint Server 2007 for Internet sites.
“BizTalk Server is part of our EAP because it is absolutely core to our capability as an organization,” says Desai. The health plan uses BizTalk Server 2006 to process key healthcare transactions such as claims and authorizations. Desai also intends to use BizTalk Server to streamline complex, high-volume eligibility processes. Preparing to migrate to BizTalk Server 2009, Molina plans to take advantage of components in that release that are designed to help healthcare companies meet HIPAA 5010 regulations.
Molina also uses Office SharePoint Server 2007 for its intranet site, enabling users to share, publish, and search for information quickly and effectively. “SharePoint Server 2007 is a really big deal for us,” says Desai. “Our business users are now empowered to collaborate and automate on their own.”
The health plan incorporated some of the analytic capability of Microsoft Office PerformancePoint® Server 2007 (which has since become part of Office SharePoint Server 2007) into its SharePoint Server solution. “Our key metrics reporting is now automated,” says Desai. “We have all the data that a CIO would want to see, such as maintenance reporting and project updates.”
In addition, Molina moved its public Web site to SharePoint Server 2007 for Internet sites and will be hosting the Internet environment itself.
Through the EAP, Molina can assess its technology needs and employ solutions as necessary. “As a steward of the government’s money,” says Desai, “we must be cost-effective, reduce administration costs, and implement technology that supports growth and regulations. The EAP allows us to operate in that spirit.”
Supported Growth While Maintaining Fixed Licensing Costs
“We are growing rapidly, adding new technology, and increasing our need for licenses. Having the EAP allows us to not worry about our growth,” says Desai. “We make software decisions on a quarter-by-quarter basis under the EAP without worrying about the incremental costs. And we use technology in a more robust, meaningful way.”
Molina uses the technology it acquired through the EAP to automate its key metrics reporting, validate transaction quality, and enable stakeholders to update the plan’s intranet and public sites. In particular, says Desai, “Within the BizTalk Server framework, the speed with which claims transactions are processed will increase significantly. And by automating more of the claims processes, we can reduce our costs.”
Prepared for HIPAA 5010 Compliance
“BizTalk Server 2009 was designed to support specific needs of the HIPAA 5010 transactions,” says Desai. He estimates that without BizTalk Server 2009, Molina would have spent nearly U.S.$1million on building a system to meet HIPAA 5010 compliance. “With the latest version of BizTalk Server, we can accommodate the shift from HIPAA 4010 to HIPAA 5010 at a small fraction of that expense,” he says.
“By implementing SharePoint Server 2007, we’ve seen big gains in internal productivity,” says Desai. “We’ve empowered users to set up sites, manage their own microsites, and publish reports. That has been key to increasing employees’ ability to access what they need and to help reduce IT costs.” When Molinahealthcare.com migrates to SharePoint Server 2007 for Internet sites, business users can update the public-facing Web site with minimal IT involvement.