Summary
The largest niche player of travel health insurance in canada wanted to grow their business in claims processing.They chose repricing(matching a medical claim to a fee schedule) as the target area of growth. Inteq built a scalable .Net custom application which provided a flexible architecture to quickly implement changes in the fee schedule or easily change the match criteria.
Key Drivers
Solution
Results
Summary
The company develops and deploys sophisticated, high performance software applications,primarily for the healthcare industry. Their two flagship products LabWorks and WebCMR are designed for laboratories and public health departments to maintain lab orders and track outbreaks.
Key Drivers
Solution
Inteq developed and implemented an off-shore testing service including:
Results
The existing ERP system for a major toxicology laboratory was custom developed in the early nineties using an older client server platform. It was not meeting the company's current business requirements. The company could easily triple their business volume, but were limited by antiquated technology. Attempts to customize a popular ERP package had cost over 2 million dollars but had totally failed to meet user requirements. Eventually this package was abandoned and Inteq was asked to provide a solution. Since the requirements were not well established, Inteq used its wholly owned subsidiary in the US (ACM Healthcare Technologies) to conduct a feasibility study. The goal of this study was to analyze and assess the existing ERP system, assess the preparedness to respond to future changes in business such as supporting new market requirements for clinical testing and support of the needs of other laboratories.
The specific areas studied in the assessment included the feasibility of a platform that is technologically current, easily maintainable and has the ability to easily grow and interface with a host of other customer information systems eliminating double entry, provide efficiencies in managing throughput, and better quality. Other objectives of the technology study was to enable management to have a real-time dashboard of performance, integrating financial, operational and customer information. The study recommended to include a data-warehouse that is seamlessly integrated with day-to-day operations to support data mining and trending. Based on the results of the assessment, ACM Healthcare Technologies proposed a three phased approach. The laboratory awarded Inteq the contract to implement the system.
Phase 1 | Phase 2 | Phase 3 |
---|---|---|
Keep functionality the same and migrate to | .NET Develop the detailed new work flow, business intelligence facility and integration with in-house financial systems | Implement the business process changes defined in Phase 2 |
To help implement the phases, Inteq adopted its established on-shore/off-shore model. The on-shore work included developing the requirements and aligning it with the laboratory process. On-shore work was performed by ACM HT, a wholly owned subsidiary of Inteq based in the U.S. ACM HT has strong understanding of the healthcare market and a solid expertise in HIPAA and other compliance regulations (21 CFR Part 11). ACM Healthcare Technologies' business and technical analysts helped develop the RFP, the contract and quality acceptance criteria for the deliverables. They provided a fixed fee estimate and schedule. The critical aspect of the proposal was well articulated deliverables with quality acceptance criteria.
While the laboratory's CIO had complete management oversight, ACM Healthcare Technologies maintained and tracked the deliveries from a cost, schedule, risk and quality perspective. The customer had the assurance of on-site management, cost efficient off-shore development and exchange moderators who oversees the service providers performance. The key success factors were: well defined requirements, well defined work-breakdown structure, project status tracking, independent quality assurance, and acceptance criteria tied to each deliverable.
Inteq helped the laboratory save over 50% in total project costs using a blended off-shore/on-shore model. The laboratory has decided to use this blended global delivery model for other projects and has engaged Inteq as their primary partner in designing, developing and maintaining their IT systems.
About the Client:
The client is one of Canada's leading providers of specialized travel insurance and health plans for individuals, groups and businesses. The Company, through its subsidiary, also provides assistance, case management, cost containment and claims services. The Company is exploring new avenues for growth has identified claims repricing domain as a future growth driver.
Business Need:
The client thus wanted to build an enterprise wide data warehouse that would help integrate data across claims, product, sales etc. from all transaction systems into a consolidated data mart.
Inteq solution and approach:
Since time was as critical as cost savings, Inteq used its Global Delivery Model and its team of ten personnel completed the project in 9 months. An enterprise wide data warehouse was conceptualised for tactical and strategic business decisions and to help improve client's competitive positioning. The enterprise wide data warehouse would simplify information access and standardise it across source systems. A consolidated data mart provides enterprise view of the organisations business for advanced analytics and reporting.
Inteq took ownership of the project and undertook the following tasks for creation of an enterprise wide data warehouse, which is required for tactical and strategic business decisions:
I. Designing the Data Warehouse and dimensional model
II. Creation of the data preparation area and data warehouse database
Leveraging on the experience across healthcare organizations, the team quickly came up with a scalable and flexible architecture keeping in view the enormous data growth expected in the industry.
III. Extracting data from operational systems into data preparation area
IV. Cleansing and transforming data in the data preparation area
V. Loading data into the data warehouse database
VI. Preparing presentation information for users
VII. Distributing data to data marts
Team devised an execution strategy which included data profiling at source, mapping of each source to target based on business requirements, comparing across sources to ensure consistency, data conflict resolution, end user involvement from beginning and interim releases by phasing the warehouse project.
Business Benefits:
The Client:
Sperry Van Ness (SVN) is one of the largest commercial real estate investment brokerage firms in the US. SVN has about 900 agents, organized as Corporate or Franchised, and then by Region, Office and Sub-office. The SVN operation system (property tracking and publishing system) includes: Agent & User Management, Agent Websites, Property Entry & Update, Financial Analysis, External data & Wizards, Document Vault, Commission Management, Workflow Management, Publisher, Report Generation, Listing Alert and Intranet among a host of other features.
The Engagement:
SVN decided to use the blended global delivery model for maintaining and re-engineering their property tracking and publishing system and has engaged Inteq (through USourceIT) as their primary partner in designing, developing and maintaining their IT systems. The project is executed on a blended delivery model, with a project manager being onsite 25% of the time and the balance team offshore. The offshore team comprises of Software engineers and testers.
Maintained System Features:
A partial list of system features that are maintained by Inteq:
Core Listing Management System
Additional Listing Related Features
Advisor Related Features
Technology:
OS | Windows Server Family, Windows XP/Vista clients |
IDE | MS Visual Studio 2005 |
Scripting | ASP.NET/IIS, C#, Javascript |
Reporting Tool | Crystal Reports for Visual Studio |
Middle Ware | COM+, XML, XSL, Windows Workflow Foundation |
Database | MS SQL Server 2005 |
Client's Problem:
Client acquired EZ-CAP product in 2005 which is a leading product in the Health Insurance market. EZCAP is a fully integrated system that supports and manages day-to-day business operations of healthcare organizations such as HMOs, MSOs, PHOs, IPAs, specialty service organizations, medical groups, hospitals and government sponsored health plans. It has over 16 integrated modules including Benefit Enrollment and Eligibility administration, Claims processing and Adjudication, Authorizations, Capitation, Case Management, Internet Connectivity, EDI capability and HIPAA ready.
The Product has been installed in 130 clients in US and other countries. However, there was no release or version upgrade to the existing clients from 2001 and the same version is being marketed to new clients. In order to be competitive and meet the customer expectations the new management felt that product enhancement, modifying the existing features and migration to new technologies is of prime importance.
The main application is written utilizing Gupta SQLWindows. Finding resources in Gupta is one issue and the other issue is whether the Gupta has all the capabilities that are required for the enhancements. Hence the management would ultimately like to move away from Gupta and transition the product fully into Visual Studios.net.
The management also would like to explore new markets such as PPOs, POS, TPAs etc., for EZCAP penetration. In order to go into these markets the EZCAP product need to improvise on its capabilities and features suiting to the different business lines.
Additional Resources with the required skill set in existing and newer technologies to fine tune the product, develop and deploy new features, support with QA is required.
Solution Offered:
Inteq offered to setup an offshore team dedicated to EZCAP for Development, Maintenance and QA support. A team of 70 members were put in place for handling the assignment. The assignment is divided into two distinct projects maintenance and migration.
Maintenance Project:
Maintain System:
Maintain Bug / Change Matrix:
Enhance the System for Customer Requirement:
Re-engineer the background system:
Documentation:
Improve the Process:
Migration Project:
Migration of existing product into newer technology dotnet and adding features which are current in the industry was the main objective of the project. The following are the highlights of the dotnet project.
Benefits:
Technology:
OS | Windows Server 2000, Windows Server 2003, NT and XP |
IDE | MS Visual Studio 6.0, Visual C++ |
Front end | Gupta version 3.1 ptf 3, ASP.NET/IIS, VB.Net |
Mapping Tool | Sybase EC-Map, FREDI |
Reporting Tool | Crystal Reports 8.0, 11 |
Middle Ware | COM+, XML, XSL |
Database | MS SQL Server Version 7, 2000 and 2005 |