Vicert

Vicert developed an IT infrastructure solution that ran on the cloud. It reduced the risk of human error and latency. Our client could subsequently track data and code changes, allowing them to comply with the new regulatory updates easily.

CASE STUDY

AWS Data Warehouse (HIPAA)

• Health Tech Skills: Health Cloud Solution
• Back-end: AWS, Docker, Java, Python
• Project Duration: 1 Month

Challenge
Our client’s business workflow depended on their ability to safely collect, store, and process large amounts of data. Due to scalability and IT maintenance challenges, Vicert developed a cloud based data management solution.

Our client’s business model rested on transforming conversations between patients and providers into proprietary data sets. They would later analyze these sets, determine key trends, and sell access to analysis results.

We identified the electronic data capture tool as the critical problem: bad user interfaces allowed for error-prone data entry.

This system required hundreds of hours per month for corrections. Vicert developed a data management solution to simplify data entry and support the client’s downstream needs.

We opted to develop a solution that runs as an AWS data warehouse with a single source of truth for the observational data they gathered. We’ve also automated the processes of data entry, pre-processing, and analysis.

Solution
Our data management strategy rested on providing a single source of truth for all data. It also logged changes to data and code used for data analysis. We’ve designed it to comply with all the necessary regulations (HIPAA, 21 CFR Part 11) and improve the client’s business processes.

Our amazon data warehouse deployed programmatic controls of configurable user permissions to ensure restricted access to specific data. Additionally, our IT architecture enabled the easy addition of new data registries/cohorts.

We included the process of historical data migration from the set of data files into the warehouse in the solution. We did the same with the logic that allows the switch-over from current data sources.

Benefits
Our data management software reduced the risk of human error and updated latency. All changes made to the data and code are now easy to track, allowing our client to go back and update compliance with any new regulatory updates.

We’ve optimized the client’s previous workflow processes: analysts no longer copied data from different EDC tools and historical files to a local machine.

We’ve achieved several benefits:

• We prevented possible exposures to data integrity risks.
• Our AWS data warehouse prevented potential compliance challenges.
• We removed the existence of divergent data sets and data silos inaccessible to all teams.

We’ve automated the client’s processing of historical data so it can be easily leveraged in further research. Our continuous delivery integrated into the solution provided the infrastructure to change the solution’s environment, reducing cost, time, and risk.

Our cloud based data management supports:

• Adding mobile apps
• Artificial intelligence
• Speech recognition
• EMR integrations

Vicert successfully integrated a third-party drug database into the client’s consumer portal.

CASE STUDY

Drug Database for FDB

• Health Tech Skills: Patient Engagement and Portals
• Technology and Tech Stack: Java, Oracle
• Project Duration: 4 Months

Challenge
Our client decided to improve on the existing pharmacy section of their online portal. Vicert needed to implement a solution that would make it easy to conduct a database search and how different drugs interact with each other.

The client wanted a custom-built web solution where Vicert would replace their existing formulary data with the First Data Bank database (FDB database). We needed to match the client’s old software and its information with the new features we added – creating links between the database and available insurance plans to show accurate coverage information to the members.

Solution
Vicert designed and developed the solution with a clearly defined architecture and additional functionalities, which included:

• Consumer and member views of formulary and copay info.
• Shell scripts for automating the FDB database import/update process.
• Administrative portal for database administration.

Benefits

• The client gained an effective database solution that is highly customizable to fit their specific needs.
• All portal members could find specific drug information and copay values.
• Our drug database had administrative functionality built in a way that clinical pharmacists could easily maintain the formulary data.

Our client needed us to develop an IT solution that would allow them to manage their appeals efficiently. In a short time, Vicert implemented a configurable solution that improved the client’s overall workflow and supported different entities: Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, and others.

CASE STUDY

Complaint Management System

• Health Tech Skills: Patient Engagement and Portals
• Technology and Tech Stack: Java, jQuery, Drools
• Project Duration: 9 Months

Challenge
Our client wanted us to develop an app that would help payer entities process virtual appeals in a legally-compliant way. Vicert needed to implement a complaint management software that would provide a high customization level pending the client’s specific business needs.

We needed to make it secure and capable of mitigating risks for entities such as Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, etc. The additional level of customization was needed to serve multiple clients to answer their particular needs.

Our client built their first product in their portfolio as economically as possible – there was a lot of “spaghetti code” under the hood. Vicert needed to develop complaints management software as the foundation for the client’s future projects – we designed a platform where all their future projects could sit and interact with other products in their portfolio.

Solution
Our greatest challenge was that the client didn’t fully articulate their needs. We received the requirements as an MS Access mockup containing only about 20% of the actual project scope.

That is why we had to sit with the client’s Chief Compliance Officer to develop our complaint management system by defining the remaining requirements and helping the client prioritize product features.

On the technical side, we had to deconstruct the client’s current software to understand its inner workings and architecture. Based on what we found and the client’s input, we developed an IT architecture that would provide the most flexibility for the client’s future product integration.

We made recommendations related to the structure and design of the shared data store. Our customer complaints software improved the client’s security model, rules engine, and UI.

We opted to utilize the following technology: Java with Spring and Hibernate frameworks for the backend, jQuery, RequireJS, and Handlebars for the client frontend. We also used a powerful rules engine based on Drools for automated case-processing and decision-making.

We named the solution Virtual Appeals Manager (VAM), and it included a fully configurable workflow with support for detailed customization of all its aspects. Our VAM complaint management software also had extensive reporting based on Jasper Server and an automated system for importing large data sets from third-party systems.

Benefits

• We managed to deliver the project in a short amount of time. Using Agile Scrum project management methodology, we saw the project through its entire lifecycle and exceeded the client’s expectations for dollars spent.
• We created an MVP in six months, allowing the client to start collecting their ROI.
• After nine months, our client a product they could deploy to customers.
• Our complaint management system was highly configurable, supporting multiple workflows of various organizations such as Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, and others.

Vicert developed a web-based workflow app for efficient and automated medical chart analysis. The fraud detection team used our solution to detect duplicate and fraudulent medical information. Health payers could also use it to review claims and charts received for payment.

CASE STUDY

Medical Chart Software

• Health Tech Skills: Patient Engagement and Portals
• Technology and Tech Stack: Java, jQuery, Oracle
• Project Duration: 9 Months

Challenge
Vicert had to develop a Health Care Reform (HCR) compliant solution. Its purpose was to review large quantities of claims and act as software for medical chart review.

Our client was facing issues related to the technical side. Their system at the time wasn’t adequately developed – the original estimate was that they would need to process about 10 000 records on a given day. Revised estimates later showed that the expected number of records was about 1 000 000 daily.

We recommended that the client revise their system and rely more on web services. The biggest threat our software for medical records faced was the CMS-mandated requirements and the client’s constantly changing interpretation of said requirements.

Vicert needed to develop an app that would be highly customizable and configurable to accommodate future changes in the requirements.

The client identified three main problems:

• Centers for Medicare and Medicaid Services (CMS) Mandate:

This mandate required the review of claims by the payers requesting reimbursement for balanced payments through the Health Care Reform legislation.

• Health Care Reform (HCR) Requirements:

Our app for medical chart review needed to comply with the HCR requirements – we needed to change the client’s current system as it failed to meet all the requirements.

• Manual Claims Processing:

Our client manually processed their claims, drastically reducing their processing capabilities. It was necessary to develop an automated solution to filter most suspected fraudulent claims and leave the rest for manual human review.

Solution
Vicert developed a medical chart repository within our medical charts software. It stored electronic versions of charts and identified those that needed risk adjustment.

We built logic by following CMS requirements to identify potentially fraudulent cases, and then we integrated the cases with external solutions for chart and claims data. In doing so, the client’s staff could review specific cases manually and locate fraudulent claims more efficiently.

Updates made by the staff were stored and transmitted to CMS using the standard format. We built our medical chart software using a Java web-based app with Spring and Hibernate frameworks. The web-based solution was flexible, secure, and scalable. The solution had a configurable workflow, allowing for automated processing and indexing of medical data.

Vicert implemented integration with third-party vendors, Epi Source and Record Flow, using them to automate chart retrieval and processing.

Benefits

• Improved overall workflow: our client gained the ability to process larger quantities of data.
• Time-saving: our medical chart software filtered most of the claims, leaving the client’s staff with a small subset of claims for manual analysis.
• The solution’s flexibility allowed our client to utilize it better in the long run and increased the client’s ROI.

Vicert developed the Business Service Interface layer that improved the client’s IVR system, tripling their overall performance.

CASE STUDY

Interactive Voice Response System

• Health Tech Skills: Interoperability and Data Quality Management
• Technology and Tech Stack: WAS/ATG, Oracle, RightFax
• Project Duration: 2 Months

Challenge
Our client needed to modify and improve their current software to meet their new business goals. They needed Vicert to present all of their information in a more concise and limited manner (due to the limitations imposed by the IVR).

We opted to improve the client’s current interactive voice response software by implementing a new VXML application. It allowed members, producers, and providers to utilize various online services. Our application offered the client the same information that was available on their website but did so in a more limited format.

Solution
We decided to group our responsibilities for this project into two groups:

1. BSI-API Design
2. BSI-API Implementation

BSI-API served as the contract between the application and the backend. Our interactive voice response system had interfaces exposed via Plain Old Java Objects (POJO).

The main features that the BSI-API provided are:

• WPR Data Retrieval
• RightFax Integration
• Sigaba Integration
• MTM Data Collection

The APIs we installed implemented the business logic necessary for the system handles, like data access.

Benefits

• Our software improved the client’s overall operations: we added more ports to handle traffic, enhanced reliability, and improved performance.
• Our interactive voice response software also improved consistency for members, producers, and providers, through different channels (IVR and web).
• The enhancements we made also improved caller interactions in the following segments:
  • We added new functionalities.
  • Speech for a more natural interface.
  • We improved the structure of the client’s software.
  • Our interactive voice response system now also improved the quality of the recordings.

Our client asked us to develop a data gateway tool to filter corrupted or duplicate data from the client’s system. Our solution improved data quality and consumption for both members and prospects.

CASE STUDY

Database Management System

• Health Tech Skills: Integrations and Data Interoperability
• Technology and Tech Stack: Java, McKesson
• Project Duration: 9 Months

Challenge

Our client recognized poor Provider Data Quality as the root of their problems. They had significant challenges processing claims, and their provider directories were full of inaccurate information.

The client bought a new Provider Information Management System (PIMS) from McKesson – but faced implementation challenges. As opposed to having a data management system, our client opted to buy another solution from a third vendor to address PIMS problems. That solution didn’t work.

In other words, Vicert needed to develop a fully functional system to provide our client with healthy data sets and filter corrupted and duplicate data.

Solution

Vicert developed a mass update tool to consume and update data from multiple sources and then process it in a predetermined format.

Against a tight timeframe, we fully integrated a database management system with an on premise data gateway. Our tool enabled:

• Ingesting external data from 9 different sources.
• Applying configurable business rules.
• Comparing the data against the live PIMS data allowing either automatic or manual updates of that data in the PIMS system.

We made updates to PIMS in the following way:

1. For the automatic updates, the PDQ tool we developed first inserts data into the PIMS stating tables and then uses PIMS’ PDX Update feature to trigger data processing.
2. Our data management system also had a new web service to perform real-time updates to PIMS data when data is entered manually.

Vicert developed the entire system to allow the client better data collection, merged it with the client’s existing infrastructure, and added a layer for content browsing. Additionally, our tool had reporting capabilities, informing the client on data trends and timelines.

Benefits

• Improved member and prospect experience.
• Enhanced workflow automation.
• Our database management system also complied with the California Department of Managed Health Care’s expectation for more timely data validation.
• We also saved roughly 10 000 working hours for the client’s staff with the updated processes.