A health insurer with a national reputation needed to transform the tedious process of analyzing the effects of the health care reform law from a back room process for actuaries into a front line tool to drive conversations with worried customers to retain their business.
The Patient Protection and Affordable Care Act (PPACA) changes the way individuals and employers view the delivery of health insurance when it becomes effective in 2014. Estimates have indicated that 10 – 30% of employers plan to immediately drop group health insurance coverage after the reform laws are implemented. The health insurer had a complex set of spreadsheets that modeled the potential economic effects of health care reform on their customers. However, the process to transform the data into useful information was accomplished by hand, proving to be a costly and timely endeavor. The challenge tasked was to transform their process into a custom software tool that could be installed on sales staff laptops. This tool needed to contain actuarial-grade mathematics and modeling, and present the resultant data in clear format to help clients understand the specific effects of health care reform on their organizations.
SDLC Partners proposed and won a competitive bid for the project, largely due to an early round of analysis that allowed its team to get in front of the client’s needs, not simply responding to their request for proposals, but extending and rethinking it.
After careful analysis, it was determined that the true purpose of the tool was to empower the sales professional with real client data, advanced actuarial analysis of future financial impact and compelling client educational materials. This information would be used to create a series of side by side comparison illustrating different options and choices – evaluated in both quantitative and qualitative measures. The ultimate goal was to retain clients in the commercial line of business, rather than losing them to the public and private exchanges.
The proposal of this technology stack exceeded the customer’s initial need to benefit the larger direction of the client organization preparing the system for eventual deployment to Apple and Android tablets in future iterations without architectural reorganization.
As the actuarial engine worked at the contract holder and member level, the management of Protected Health Information was a concern. The system was required to function in untrusted network environments where a secure connection to the client’s data warehouse would not be possible. A detailed analysis of the underlying mathematics allowed the technical team to push PHI- related calculations outside of the real time client, so that only data free of PHI needed to be stored on the laptop. With this carefully scrubbed data, real time calculations at the contract holder level were possible using only the locally stored information.
SDLC used a truly iterative development process, with testing resources participating early on, driving a process of continuous refinement. Business Analysts, technical leads and client subject matter experts consulted “without borders” to maintain the highest quality requirements, creating an intelligent development process. SDLC’s use of a risk-based iterative approach allows the client to clarify crucial business requirements and mitigate technical risk as early in the project as possible.
The final system used the best practices of the Service Oriented Architecture model to aggregate, transform and abstract the client’s big data, delivering it on demand to a mobile-ready client.
The project has been a success on multiple levels. The actuarial department that originally specified the mathematics was thrilled to be able to see the results of the efforts depicted in real time. The sales staff now utilizes a recognized application that enables them to have meaningful conversations about their clients’ future, and be seen as a trusted resource for health care reform advice. The iterative development process led to a zero-defect code freeze and subsequent deployment. SDLC has since received continued business, both vertically in the form of additional version releases of the software, and horizontally as popularity of the tool itself has made inroads to other insurers around the country.