Total Health Care Enhances Membership Data Quality and Visibility with Precisely Solution
Customer Company Size
Mid-size Company
Region
- America
Country
- United States
Product
- Precisely Solution
Tech Stack
- Cloud-based Solution
Implementation Scale
- Enterprise-wide Deployment
Impact Metrics
- Customer Satisfaction
- Cost Savings
- Productivity Improvements
Technology Category
- Platform as a Service (PaaS) - Data Management Platforms
- Analytics & Modeling - Real Time Analytics
Applicable Industries
- Healthcare & Hospitals
Applicable Functions
- Business Operation
Services
- Cloud Planning, Design & Implementation Services
- Data Science Services
About The Customer
Total Health Care is a Michigan-based managed care organization that offers a variety of health plans, including group health, ACA exchange, and Medicaid plans, to approximately 100,000 members. The organization operates in the health insurance industry and is focused on providing comprehensive healthcare coverage to its members. Total Health Care's operations are characterized by a complex structure involving multiple internal systems, external vendors, and CMS, which has historically impacted its data management efforts. The company is committed to improving its membership processes and data quality to enhance the member experience and ensure compliance with industry standards. With a focus on member satisfaction and operational efficiency, Total Health Care is dedicated to leveraging technology solutions to address its data challenges and improve overall business performance.
The Challenge
Total Health Care faced significant challenges due to the disjointed structure of its membership processes, which involved multiple internal systems, external vendors, and CMS. This fragmentation limited the company's visibility into membership data, preventing leadership from gaining a complete and accurate understanding of key membership analytics. The lack of insights and quality control posed financial risks, led to inaccurate quality of care reporting, and missed opportunities to improve the member experience. The company's CIO, Noah Monro, recognized the need for a single platform to provide complete visibility across disparate systems, improve membership analytics, and make better business decisions. Duplicate membership files, resulting from members frequently switching between exchange and Medicaid plans, further complicated the situation by providing an inaccurate view of care gaps and quality measures, ultimately lowering HEDIS scores and health plan reimbursement.
The Solution
Total Health Care implemented the Precisely solution to address its data management challenges and improve membership data quality. The solution provided enterprise-wide visibility and automated membership data reconciliation, identifying duplicates, discrepancies, and other data issues across disparate systems. It featured real-time dashboards for viewing membership analytics, tracking enrollment files, and reporting on exceptions. The reconciliation workflow allowed users to easily view process statuses, obtain reports, and resolve potential issues. As a cloud-based solution, it offered financial advantages and enabled rapid implementation. The Precisely solution provided end-to-end reconciliation of membership system extracts and daily 834 enrollment transactions at over 30 key data points. It reconciled the Medicaid population with the monthly Medicaid audit file at more than 18 unique data points, creating exception lists and appropriately dispositioning them. Members were assigned unique identifiers enterprise-wide to reconcile between different business lines and systems. The solution included a queued workflow where suspect matches were investigated to consolidate duplicates and properly identify unique members.
Operational Impact
Quantitative Benefit
Case Study missing?
Start adding your own!
Register with your work email and create a new case study profile for your business.
Related Case Studies.
Case Study
Hospital Inventory Management
The hospital supply chain team is responsible for ensuring that the right medical supplies are readily available to clinicians when and where needed, and to do so in the most efficient manner possible. However, many of the systems and processes in use at the cancer center for supply chain management were not best suited to support these goals. Barcoding technology, a commonly used method for inventory management of medical supplies, is labor intensive, time consuming, does not provide real-time visibility into inventory levels and can be prone to error. Consequently, the lack of accurate and real-time visibility into inventory levels across multiple supply rooms in multiple hospital facilities creates additional inefficiency in the system causing over-ordering, hoarding, and wasted supplies. Other sources of waste and cost were also identified as candidates for improvement. Existing systems and processes did not provide adequate security for high-cost inventory within the hospital, which was another driver of cost. A lack of visibility into expiration dates for supplies resulted in supplies being wasted due to past expiry dates. Storage of supplies was also a key consideration given the location of the cancer center’s facilities in a dense urban setting, where space is always at a premium. In order to address the challenges outlined above, the hospital sought a solution that would provide real-time inventory information with high levels of accuracy, reduce the level of manual effort required and enable data driven decision making to ensure that the right supplies were readily available to clinicians in the right location at the right time.
Case Study
Gas Pipeline Monitoring System for Hospitals
This system integrator focuses on providing centralized gas pipeline monitoring systems for hospitals. The service they provide makes it possible for hospitals to reduce both maintenance and labor costs. Since hospitals may not have an existing network suitable for this type of system, GPRS communication provides an easy and ready-to-use solution for remote, distributed monitoring systems System Requirements - GPRS communication - Seamless connection with SCADA software - Simple, front-end control capability - Expandable I/O channels - Combine AI, DI, and DO channels
Case Study
Driving Digital Transformations for Vitro Diagnostic Medical Devices
Diagnostic devices play a vital role in helping to improve healthcare delivery. In fact, an estimated 60 percent of the world’s medical decisions are made with support from in vitrodiagnostics (IVD) solutions, such as those provided by Roche Diagnostics, an industry leader. As the demand for medical diagnostic services grows rapidly in hospitals and clinics across China, so does the market for IVD solutions. In addition, the typically high cost of these diagnostic devices means that comprehensive post-sales services are needed. Wanteed to improve three portions of thr IVD:1. Remotely monitor and manage IVD devices as fixed assets.2. Optimizing device availability with predictive maintenance.3. Recommending the best IVD solution for a customer’s needs.
Case Study
HaemoCloud Global Blood Management System
1) Deliver a connected digital product system to protect and increase the differentiated value of Haemonetics blood and plasma solutions. 2) Improve patient outcomes by increasing the efficiency of blood supply flows. 3) Navigate and satisfy a complex web of global regulatory compliance requirements. 4) Reduce costly and labor-intensive maintenance procedures.
Case Study
Cloud-based healthcare solution for Royal Philips
Royal Philips wanted to launch its cloud-based healthcare solution HealthSuite Digital Platform in China to deliver services to help cope with challenges related to urbanization and population growth. Philips wanted to achieve this goal by combining mobile, cloud computing and big data technologies. To bring this platform and product to market, Philips required cloud computing and local technical service capabilities in China, in addition to a flexible IT infrastructure that could handle user requests.
