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Success Story

Data Integration for an American Healthcare Payer

Driving Better HEDIS Ratings and Incentives

Client Background

The client is a leading New York State health insurer, serving 1.5 million+ members and a network of 67,000+ providers across all 62 counties.

Client Need

The client faced the challenges of ensuring 24/7 monitoring and timely resolution of ETL jobs during offshore hours, key challenges included:
Need to manage diverse vendor requests for data extract
Inefficient data processing of existing ETL jobs
Inadequate support feature upgrades and changes for key client applications and projects
Inability to handle ad-hoc business requests for customized data, job setup, and job automation
Lack of maintenance of accurate key metrics in management dashboards and reports

Solution

We took a comprehensive approach to address these challenges:
Data Security: Implemented a customized audit mechanism for all incoming and outgoing files between the client and vendors, compliance with data governance policies
Operational Efficiency: Optimized ETL jobs for better performance and shorter execution times accelerating data processing.
Application Upgrades & Business Continuity: Supported multiple FACETS upgrades, ensuring seamless transitions and minimizing disruption to business operations
Streamlined Data Integration: Automated numerous jobs end-to-end and scheduled them for easy data integration across multiple environments and applications
Data-Driven Insights: Analyzed member data from different provider groups and created extracts to help analyze quality metrics, facilitating accreditation from state authorities.

Realized Benefits

The solution yielded significant benefits:
Reduced overall RCA effort and time through continuous monitoring and prompt resolution
Migrated client applications and IT infrastructure according to current mandates, aiding in process standardization
Assisted plans in achieving improved HEDIS ratings, thus facilitating better incentives
Provided centralized documentation for all jobs, including DB components and architecture, for easy access
Enabled comprehensive insights into operational efficiencies through metrics displayed on an operational dashboard

Tools & Technologies

Greenplum Database
Microsoft .NET
SQL Server
IBM InfoSphere DataStage
Information Builders WebFOCUS
SAP Sybase IQ
Denodo
Talend

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