ActiveHealth Management
Health management company improves patient health, lowers healthcare costs
Based in New York City and employing more than 550 people, ActiveHealth Management recognized a need to help people be more proactive about healthcare. The company built a solution for health plans that would consolidate members' health-related information and, more importantly, offer recommendations about practical steps that members and their physicians could take to head off potential problems. Working with Microsoft Gold Certified Partner Netsoft USA, ActiveHealth developed ActiveHealth PHR, a personal health record built using Microsoft .NET Framework 2.0 and powered by the ActiveHealth CareEngine System. The solution draws information from a Microsoft SQL Server 2005 database and interoperates with other non-Microsoft–based technology. With the new solution, health plans can deliver clinical decision support while engendering member loyalty and reducing insurance costs.
Blue Cross Blue Shield of Tennessee
Leading Health Insurer Realizes Benefits of Automation and Collaborative Care
BlueCross BlueShield of Tennessee chose CareAdvance Enterprise from TriZetto to provide medical management for its members on a single platform. Using rule-based automation, the Microsoft technology–based solution provides catastrophic care coordination, chronic disease management, and wellness and family care with better quality and reduced cost. Further, the application's multichannel, bi-directional communication capabilities are an integral part of the organization's ongoing consumer-focused initiatives. The result is improved customer care and the flexibility to deploy similar solutions across the enterprise.
BlueCross BlueShield of Kansas City
Health Insurer Switches to Exchange Server to Streamline Operations, Help Mobile Workers
Blue Cross and Blue Shield of Kansas City is the largest provider of health benefits in its 32-county region. In 2004, the company was suffering from frequent outages of its GroupWise 5.5 enterprise messaging system. This product also did not support the company's growth, its expanding mobile and remote workforce, or its strategy to improve employee collaboration. Working with Horizons Consulting, a Microsoft Gold Certified Partner, Blue Cross and Blue Shield of Kansas City switched to Microsoft Exchange Server 2003 and standardized on Microsoft Windows Server System™ integrated server software The new solution contributes to a simplified, more integrated IT environment, provides reliable communications, and is easier and less expensive to manage. It also supports more effective employee collaboration, especially for mobile workers.
Calypso Healthcare Solutions (a subsidiary of Premera)
Healthcare Claims Detection and Recovery Providers Boosts Efficiency, Competitiveness
Calypso Healthcare Solutions needed a more efficient way of handling the millions of potentially overpaid claims presented to it by its customers in the health insurance industry. The firm worked with Microsoft Partner OTB Solutions Group to replace a hybrid legacy detection-and-recovery solution with one based fully on Microsoft technologies, including the 2007 Microsoft Office system and Microsoft SQL Server 2005. Now Calypso can help ensure that auditors receive claims in a way that prioritizes those most likely to be overpayments and that provides powerful trend analysis. Consequently, auditors are working more efficiently, customers are recovering overpayments more rapidly, and the trending information will help them reduce the frequency of future overpayments. Further, the solution is easily expandable to help Calypso accommodate growth and maintain its competitive position.
Choicelinx (a subsidiary of CIGNA Healthcare)
Software Company Enables Cross-Authentication for Benefit Enrollment Process
Choicelinx is a subsidiary of CIGNA HealthCare and provider of health benefits technology solutions. Both companies are committed to advancing consumer-driven products that will redefine the benefits industry. Choicelinx's Benefits Configurator decision-support tool and online enrollment application allow consumers to tailor their health benefits packages and enroll in them over the Internet. Choicelinx teamed with Microsoft to create a solution that would extend personalization capabilities to partner enrollment applications while maintaining a seamless consumer experience. Using Microsoft Windows Communication Foundation, developers created the Choicelinx Authenticator—a Web service that supports cross-authentication and eliminates the need for separate sign ins to multiple systems. The solution also supports a quick adoption and can be tailored to meet the needs of each partner.
Clalit Health Services
Experts Help healthcare Company Optimize Architecture to Unite 1,300 Clinics
"We've been able to switch to a more proactive way of working…. We're no longer engaged in 'putting out fires.' Instead we work in a way that's much more positive, efficient, and economical."
Health Management Corporation (HMC)
WellPoint HMC improves patient care with 6-terabyte SQL Server 2005 data warehouse
Health Management Corporation (HMC) is based on a great idea: If you help keep people healthy, healthcare costs will go down. HMC, a wholly owned subsidiary of WellPoint Inc., an independent licensee of the Blue Cross and Blue Shield Association and the largest health insurer in the United States, works with insurers to keep healthy those who suffer from chronic medical conditions such as asthma, circulatory problems, or diabetes. HMC develops predictive models from a data warehouse expected to reach 6 terabytes by the end of 2006. The program has been so successful that HMC needed to upgrade its data warehouse to support rapid growth, and to gain enterprise-grade extract, transform, and load (ETL) capabilities. The company upgraded to Microsoft SQL Server 2005 Enterprise Edition on an Itanium 2 platform, and is using SQL Server 2005 Integration Services for ETL.
Highmark Inc.
Health insurer uses business process analysis tools to improve service, save U.S. $75,000
Highmark Inc. used internal and external resources in multiple locations to run its short-term disability program, causing inefficiencies and customer dissatisfaction. Management sought to understand the impact of proposed process changes on resources, costs, and service quality. Highmark used information from the Human Capital Group and ProcessView, a business process analysis tool from the Orlando Software Group, to make data-driven decisions.
Horizon Healthcare Services
Leading Health Insurer Speeds Transactions and Affordably Meets New Business Demands
Horizon Healthcare Services, Inc. (Horizon), the independent licensee of the Blue Cross and Blue Shield Association in New Jersey, automated its claims and referral transactions in 2001 using off-the-shelf integration software. This linked the transactions to its mainframe systems. The integration solution required considerable manual intervention, was hard to adapt to new types of transactions, and often failed to meet required transaction-processing speeds. To address those challenges, Horizon switched to Microsoft BizTalk Server to link claims and referral transactions to its mainframe. The transition increased transaction-processing speed by more than 30 percent, simplified integration with mainframe systems, added flexibility for future development, and helped reduce costs by a projected 40–50 percent. It also expedited customer support response from minutes or hours to seconds.
Humana Europe
Commissioning Services Provider Uses Software-plus-Services for Global Markets
Based in London, England, Humana Europe is a subsidiary of Humana Inc., an American health benefits company. When Humana Europe was named an approved supplier to 152 regional Primary Care Trusts (PCTs) within the United Kingdom’s National Health Service, it looked for the best technologies to develop applications for the PCTs, and an optimal method for delivering them. Humana Europe chose the Microsoft Application Platform, including the Visual Studio 2008 development system to cut development time and differentiate its products with superior business intelligence and data visualization capabilities. It chose a software-plus-services model that’s scalable, cost-effective, and easy for the PCTs to consume. All they require is a browser, Microsoft Office programs, and Microsoft Silverlight—a free download—to access and interact with the healthcare services online—a competitive edge for Humana.
Independence Blue Cross
Health insurer saves $2 million yearly with enterprise content management platform
Independence Blue Cross spends over U.S.$4 million yearly to produce, print, and mail policy booklets to its members. The company now provides its members with fast, reliable, searchable, and secure online access to booklets—and anticipates saving $2 million a year—in part due to Microsoft Office SharePoint Server 2007, which also is used as the enterprise content management and collaboration solution for other initiatives at the company.
Independence Blue Cross
Insurer creates center of excellence to optimize collaboration, meet compliance needs
To boost return on investment as it upgraded to Microsoft Office SharePoint Server 2007, Independence Blue Cross created a five-person Center of Excellence that provides best practices, accelerates deployment, and manages site growth. The COE is helping the company to make full and effective use of enterprise search, to reduce costs and boost efficiency by moving off Lotus Notes, and to increase its security for collaboration sites.
Mercy Health Plans
Integrated Solution Enhances Productivity of Customer Care Representatives
Mercy Health Plans (MHP) places the highest value on member health and service quality. MHP needed to integrate its call center systems to better serve its customers. The Infosys Integration and Collaboration Solution, coupled with the Microsoft Customer Care Framework, provided the integration MHP needed, and the result has created a more streamlined customer care organization.
Paradigm
Catastrophic Medical Case Manager Aims to Improve the Quality of Patient Care Through a Data Management System.
Paradigm provides medical case management services for individuals receiving complex, intensive medical care as a result of a work-related catastrophic injury by serving as the medical and financial liaison as well as a critical contact between medical providers and carriers. Due to the complexity and severity of such cases, clinical care requires extensive, detailed reports on each injured worker. Although Paradigm developed a custom clinical data form a few years ago, the content volume required in these types of cases often expands to more than 24 custom views of client records, each consisting of several information fields. As a result, clinical staff tasked with updating and managing case information experience significant time delays and loss in productivity when required to download, display, and navigate the custom forms. Even more delays result when files must be formatted into contract documents as this process involves multiple format conversions that at best are very time-consuming, and at worst can cause their applications to stop responding. Lost time associated with handling inefficient software solutions and processes in turn affects the timeliness of case management Paradigm can provide to its clients.
Premera Blue Cross
Leading Healthcare Provider Avoids $9.6 Million in Costs with Case Management Tool
At Premera Blue Cross, an independent licensee of the Blue Cross Blue Shield Association, case managers handle the post-hospitalization needs of patients with complex medical conditions. Until recently, opening a new case could take 160 minutes and require using two different case management systems. Ongoing management was paper-intensive. Working with Microsoft and Microsoft Certified Partner Accenture, Premera built its Case Management Collaboration Tool using Microsoft Office Professional Edition 2003, Microsoft Office SharePoint® Portal Server 2003, and the Microsoft Office InfoPath 2003 information gathering program. The new tool shaved 40 minutes off the time to open new cases, reduced research time by 70 percent, increased case capacity by 20 percent, and improved employee satisfaction by 17 percent. Premera estimates that the annual medical cost savings from deploying the Microsoft solution will be at least U.S.$9.6 million.
The Regence Group
The Regence Group Unites Its Four-State Sales Force on a Common Microsoft Platform Using the Onyx Employee Portal
The Regence Group wanted to move from four disparate paper-driven systems to a single sales management information system that could accommodate differences based on local needs and legislative requirements. They implemented the Web-based Onyx Employee Portal built on Microsoft Windows 2000 and Microsoft SQL Server 2000 which provides a single platform for managing the sales process for group accounts.
Sentara Health Plans
Health Plan Improves Broker Effectiveness and Shortens Sales Cycle with Pivotal CRM
Sentara Health Plans, Inc., a health insurance provider with more than 319,000 members, offers coverage for businesses with 2 to 50 employees through its Small Group Business branch. To bring in new business and retain current customers, the branch relies on a network of 200 insurance brokers. Until recently, the organization's internal staff and external brokers had been using a labor-intensive, paper-heavy process for managing business and communicating with Sentara sales representatives. To streamline and automate its internal sales process and ability to share information with brokers, Sentara deployed a customer relationship management solution built on Microsoft® software as its front-end enrollment and member-service solution. Sentara has experienced impressive results, adding 5,000 new members, increasing quotes by 30 percent, and increasing its customer retention rate by 5 percent.
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