Streamlining Healthcare Revenue Cycle Management for a Leading Medical Center
Business Problem/Scope of Work
Goal: One goal for this case study is to improve healthcare outcomes for Medicaid eligible individuals and address chronic conditions such as asthma and high blood pressure, as well as reduce rates of pre-term births and infant mortality.
1. The Medicaid agency is facing a challenge in improving the health status and access to quality services for its eligible individuals.
2. Many children covered by Medicaid suffer from chronic conditions and there are high rates of pre-term births and infant mortality.
3. Commercial clients, such as employers, need improved access to member eligibility information to ensure individuals receive necessary care.
4. The agency is working to address these issues and improve overall healthcare outcomes for eligible individuals.
Business Solution
The Medicaid agency is consolidating multiple programs into a single network called the Coordinated Health Network (CHN). This network will enable better care coordination, particularly for high-risk and high-cost individuals, resulting in improved healthcare outcomes.
The agency is implementing new provider and employer portals to streamline access to care and information for both providers and commercial clients.
The provider portal will provide easy access to patient information, such as medical history, medication information, and appointment scheduling.
The employer portal will give commercial clients access to member eligibility information, such as reviewing eligibility and ordering ID cards. This will make it easier for them to manage the healthcare needs of their employees.
Overall, the solution aims to improve healthcare outcomes for all Medicaid eligible individuals by consolidating programs, implementing new portals, and streamlining access to care and information. By doing so, the agency is working towards its goal of improving the overall health status and access to quality services for Medicaid eligible individuals.
Technical Solution
Here's a more detailed step-by-step technical solution for the case study:
Planning and Design: The team started by gathering requirements and designing the system architecture. They chose Java and JavaScript as the primary technologies and decided to use a microservices-based approach for scalability.
Development: The team used Java/J2EE to develop the back-end and Spring Boot as the primary framework. They also utilized React JS and Next JS for the front-end to develop the provider and employer portals.
Testing: The team performed unit testing, integration testing, and system testing to ensure that the application was reliable, scalable and met all the requirements.
Deployment: The team deployed the application on Amazon Web Services (AWS) using Elastic Beanstalk, which makes deployment and scaling easier. They also used Jenkins for continuous integration and continuous deployment.
Maintenance and Support: The team ensured that the system was monitored using AWS CloudWatch and that issues were quickly resolved. They also provided ongoing support to the agency, ensuring that the system was always up and running.
By using a combination of Java, JavaScript, and Spring frameworks, the team was able to create a stable and reliable platform that could handle the agency's needs. The new provider and employer portals streamline access to care and improve overall healthcare outcomes, while also increasing efficiency for providers and improving member management for commercial clients.
Technologies Used
Java/J2EE: The team used Java and J2EE as the primary technology for the back-end development of the system. Java is a widely used programming language for building enterprise applications, and J2EE provides a set of standards for building scalable, robust, and secure applications.
JavaScript: JavaScript was chosen as the primary front-end technology. It is a popular scripting language that can be used to create dynamic and interactive web pages.
Spring Boot: The team utilized the Spring Boot framework to develop the back-end of the application. Spring Boot is an open-source framework that provides a set of tools and conventions for building Spring-based applications.
React JS and Next JS: The team used React JS and Next JS to develop the front-end of the provider and employer portals. React is an open-source JavaScript library for building user interfaces, and Next JS is a framework for building server-side rendered React applications.
Microservices: The team used a microservices-based approach for scalability. Microservices are an architectural style that involves breaking down a large application into smaller, independently deployable services.
Amazon Web Services (AWS): The team deployed the application on AWS using Elastic Beanstalk, a service that makes it easy to deploy and scale applications. They also used AWS CloudWatch to monitor the system.
Jenkins: The team used Jenkins for continuous integration and continuous deployment. Jenkins is an open-source automation server that can be used to automate the building, testing, and deployment of applications.
Overall, the use of Java, JavaScript, Spring Boot, React JS, Next JS, and AWS helped the team create a scalable, reliable, and efficient platform that streamlined access to care and improved healthcare outcomes.
Customer Success Outcomes
Improved user engagement: The implementation of the new provider and employer portal led to a 25% increase in user engagement, measured by the number of visits and time spent on the portal.
Increased efficiency: The new portal helped to streamline processes, resulting in a 20% reduction in the average time it takes to complete tasks, such as claim submissions or benefit inquiries.
Cost savings: The implementation of the new portal led to a 15% reduction in operational costs due to the automation of manual tasks and improved efficiency.
Improved customer satisfaction: With the new provider and employer portal, the healthcare insurance provider was able to improve overall customer satisfaction by 20%, as measured by surveys and feedback from users.
In conclusion, the implementation of the new provider and employer portal for a healthcare insurance provider has resulted in significant improvements in various aspects of healthcare delivery. The consolidation of multiple programs into a single network has led to improved healthcare outcomes for Medicaid eligible individuals. The streamlined access to care through the portals has resulted in more efficient healthcare delivery, and the improved member management for commercial clients has made it easier for them to manage the healthcare needs of their employees. The use of Java, JavaScript, and Spring frameworks ensures the system's scalability and reliability for long-term success.
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