Our client is a leading insurance provider in the US, offering integrated managed healthcare services and excellent care with very reasonable premiums to millions of American people across eight states and the District of Columbia. They cater to a substantial community, serving 12.6M+ healthcare plan members, supported by 217K dedicated employees, 24K physicians and 64K nurses. Their expansive network spans 39 medical centers and 724 medical facilities.
Their business model is to offer various services with discounted premiums and low out-of-pocket cost/deductibles/co-pays — even free healthcare plans for those who qualify. They wanted their users to consistently award them a 5-star rating across their healthcare programs, including health care services (primary, inpatient, extended, home health), emergency, laboratory, radiology and pharmacy.
Our client wanted to offer proactive preventive care and wellness support to their users with a seamless flow of healthcare data to the right user, online support, accessibility to doctor and patient healthcare records, appointments and real time access to their application portal, thereby making it easier to get needed services and file claims in timely manner.
HCLTech built a data warehouse capable of capturing a wide spectrum of information, including membership data, pharmacy claims, healthcare provider details, encounters, referrals, third party liabilities, appointments, pharmacy operations and financial reporting, which played a crucial role in enabling our client to transform and integrate data from diverse sources. This initiative empowered our client to consolidate and structure transactional data, enabling streamlined analysis and reporting processes and helping our client become truly progressive.
The Challenge
Navigating data quality challenges: Silos, inaccuracy and regulatory compliance
Our client encountered difficulties meeting the heightened demand for the accurate data processing and analytics that are essential for business decision-making and compliance/regulatory reporting. Frequent lapses due to manual intervention, data misrepresentation, error in data handling, data quality rules and redundant information storage posed challenges in handling sensitive and transactional data, leading to non-compliance with data management standards, regulations and external governmental regulatory compliance requirements. Unreliable and inconsistent data within legacy systems hindered decision-making processes and increased the chances of financial damage to the business, regulatory fines and above all, irreversible reputational damage that would erode trust in data-driven insights. Our client wanted to develop improved business capabilities for mitigating such issues through complete automation of the reporting process based on business rules and KPIs and certainly by improving data quality.
The Objective
Architecting a comprehensive data warehouse: Integrating healthcare operations for informed insights
The client sought to establish a comprehensive data warehouse system encompassing membership details, pharmacy claims, healthcare provider information, encounters, referrals, third party liabilities, appointments, pharmacy operations and financial reporting to meet the regulatory compliance requirements and to provide a central repository of information that can be quickly analyzed and queried to generate relevant insights. The data pipelines needed to be significantly planned, created and implemented for daily, weekly, monthly, quarterly and annual reporting. These automated pipelines would be scheduled and run on demand to facilitate proactive and informed decisions, resulting in improved and risk-free quality of healthcare data.
The Solution
Improved data quality and providing data on demand with Informatica
HCLTech leveraged Informatica’s robust capabilities that offered a comprehensive data integration platform, streamlining end-to-end integration processes. The platform excelled with impeccable data quality services, instrumental in enhancing data migration and integration pipelines. Its mass ingestion services facilitated seamless replication of legacy data into a modernized enterprise data warehouse. Additionally, the flexible data integration services empowered ETL engineers and data stewards to efficiently prepare, transform and load data into data marts and data warehouse systems. Overall, the solution has provided a positive approach for saving an enormous amount of time, and these features also reduce the potential for errors when meeting different requirements. HCLTech also used Business Objects (BO) to provide scheduled and on-demand reports to the users.
The Impact
Enhancing business efficiency with a positive impact to provide quality care and delivery of reports
As a comprehensive data integration platform, Informatica empowered the creation of automated workflows for scheduling, managing dependencies and executing pipelines. These automation workflows encompassed scalability, performance and standardization, ensuring efficient data processing and management.
- Accurate and timely reporting
- Saving lots of manual intervention, cost and effort by implementing data quality rules through automating the processes and defining the data
- Increased productivity with minimal data issues
- Enabled improved business operating decisions, preserved reputation and avoided any penalties/fines
