Implementing a New Provider and Employer Portal for a Healthcare Insurance Provider

Streamlining Access to Care: A Case Study for Transforming Health Outcomes for Medicaid Eligible Children and Adults through Improved Quality of Care and Eligibility Access

Business Problem/Scope of Work

The Medicaid agency is facing a significant challenge in improving the overall health status and access to quality services for its eligible individuals. Children make up a large portion of those covered by Medicaid, and addressing their care is of utmost importance. However, many of these children suffer from chronic conditions such as asthma and high blood pressure, and there are also alarmingly high rates of pre-term births and infant mortality.
 
Commercial clients, such as employers, also have a need for improved access to member eligibility information. This is a crucial aspect of ensuring that the individuals covered by Medicaid are able to receive the care they need. The agency is working to address these issues and improve the overall healthcare outcomes for its eligible individuals.

Business Solution

The Medicaid agency is consolidating multiple programs into a single network called the Coordinated Health Network (CHN) to improve healthcare outcomes through appropriate care coordination targeting high-risk and high-cost individuals. Additionally, new provider and employer portals are being implemented to streamline access to care and information for both providers and commercial clients.

The provider portal will allow for easy access to patient information, and the employer portal will give commercial clients access to member eligibility information such as reviewing eligibility and ordering ID cards. The solution aims to improve healthcare outcomes for all Medicaid eligible individuals.

Technical Solution

To implement the solution of consolidating multiple programs into a single network and creating new provider and employer portals, the agency decided to use a combination of Java and JavaScript technologies. The application was developed using Java/J2EE, and the team made use of features such as Collections and Exception handling to ensure the stability and reliability of the system.
 
On the front-end, the team used technologies like React JS and Next JS to construct dynamic web pages. These technologies allow for the creation of interactive and responsive user interfaces, making it easier for providers and commercial clients to access and use the portals.
 
To handle the application logic, the team chose to use Spring frameworks, specifically Spring Boot. This framework is known for its ease of use and ability to create microservices-based applications, which is essential for the agency's solution. By using Spring Boot, the team was able to quickly and easily develop the application layer of the system, ensuring that it is robust and scalable.
 
Overall, the technical solution for this case study is a combination of Java, JavaScript, and Spring frameworks, which work together to provide a stable, reliable and scalable platform for the agency to improve healthcare outcomes for all Medicaid eligible individuals.
 
The customer outcomes for this case study include:
 
Improved healthcare outcomes for Medicaid eligible individuals: By consolidating multiple programs into a single network and targeting high-risk and high-cost individuals, the agency is able to better coordinate care and focus on the specific needs of these individuals, resulting in improved healthcare outcomes.
 
Streamlined access to care: The new provider and employer portals make it easier for providers and commercial clients to access and manage patient and member eligibility information, respectively. This streamlines the process of accessing care and improves overall healthcare outcomes.
 
Increased efficiency for providers: The provider portal allows for easy access to patient information and enables providers to better coordinate care for their patients, which results in more efficient healthcare delivery.
 
Improved member management for commercial clients: The employer portal gives commercial clients such as employers access to their member eligibility information, which makes it easier for them to manage the healthcare needs of their employees.
 
Scalability and reliability: The technical solution of the case study is built using Java, JavaScript, and Spring frameworks, which ensures that the system is robust, scalable and reliable. This ensures that the agency can continue to improve healthcare outcomes for Medicaid eligible individuals for the long term.
 

Latest Case Studies

Our Case Studies

Pronix is committed to protecting and respecting your privacy. Please confirm that you agree with our privacy policy by checking the box below.

* I agree with the privacy policy and consent to receive communications from Pronix.