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Data Integration drives better HEDIS ratings and improved incentives for a leading healthcare payer

 

Client Background

The client is one of the largest health insurance payer in New York State with 1.5 million+ members, a network of 67,000+ providers and presence in all 62 counties of New York

Challenges

  • Monitor the ETL jobs which run round the clock and work towards their resolution during offshore hours
  • Handle multiple vendor requests for sharing data extracts as per the requirements
  • Analyze, optimize and migrate the existing ETL jobs as per the requirements
  • Support feature upgrades and changes for key client applications and projects
  • Handle ad-hoc business requests for customized data, job set-up or job automations
  • Maintain accurate key metrics in management dashboards and reports

Solutions

  • Implemented a customized audit mechanism for all incoming and outgoing files from client to vendors
  • Optimized ETL jobs for better performance and short execution times enhancing the efficiency of overall support functions
  • Supported multiple FACETS upgrades
  • Automated numerous jobs end-to-end and scheduled them for easy data integration across multiple environments and applications
  • Analyzed member data from different provider groups and created extracts that help analyzing the quality metrics and achieving accreditation from state authorities

Tools & Technologies

Greenplum Database, Microsoft .NET, SQL Server, IBM InfoSphere DataStage, Information Builders WebFOCUS, SAP Sybase IQ, Denodo, Talend

Key benefits

  • Decreased overall RCA effort and time through constant monitoring and quick resolution
  • Migrated client applications and IT infrastructure as per the current mandates helping them to standardize the processes
  • Helped plans to achieve better HEDIS ratings thereby facilitating better incentives
  • Provided central documentation of all jobs, involved DB components and architecture for easy access
  • Enabled comprehensive insights into operational efficiencies of the processes through metrics available on an operational dashboard
Key Benefits of Data Integration for an American Healthcare Payer

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