Unified Excellence

Overcoming Healthcare Management Challenges with Master Data Management Integration for a Leading ACO in Massachusetts

About the Client

The client, a leading Accountable Care Organization (ACO) in Massachusetts, USA, encountered multifaceted challenges in healthcare management, including compliance with new regulations, provider system replacement, HIE integration complexities, and data synchronization issues. The goal was to establish a unified and accurate source of truth, marking a transformative success in healthcare management integration.

Services

Artha Value Add

  • Holistic Platform Build

    Created an enterprise integration platform comprehensively addressing HIX, HIE, and MDM needs.

  • Operational Efficiency

    Improved workflow actions by addressing data collection processing challenges.

  • Data Repository Accuracy

    Ensured accurate and synchronized data repositories for providers and members.

  • Compliance Assurance

    Provided a solution that met the immediate integration needs and adhered to compliance mandates.

Challenges

  • Comprehensive Integration Requirement: Comply with new regulations demanding integration with HIX for member-related processes.
  • Provider System Replacement: Replace the existing provider contract and credentialing application for enhanced efficiency.
  • HIE Integration Complexity: Address challenges in integrating HIE for managing clinical data across the organization.
  • Data Synchronization Issues: Tackle data synchronization issues for member and provider data.

Results

  • Automation of Member Data Integration: Successfully automated member data integration for enrolment and eligibility verification.
  • HIX Compliance: Attained compliance with HHS/State Health mandates by integrating with the Health Insurance Exchange.
  • Provider System Integration: Integrated the new Provider (Cactus) system with Member Management, Network Directory, Care, and Medical Management System.
  • Clinical Data Integration: Successfully integrated clinical data from HIE to the care and medical management systems.
  • Single Source of Truth: Generated a unified and accurate source for provider and member data repositories.
  • Enterprise Services Implementation: Implemented enterprise services based on industry models, enhancing overall operational efficiency.

Solution

Strategic Framework

Reviewed HIX/HIE infrastructure, development, delivery, and security requirements to support the Enterprise Integration Platform.

Data Management Strategy

Defined a comprehensive data management strategy to meet current and future organizational needs.

Architecture and Design

Analyzed source systems, captured detailed requirements, and designed an SOA solution with an enterprise data model.

Provider System Interface Development

Developed interfaces for the new Provider (Cactus) system integration across internal and external partners. We have implemented the Enterprise Master Patient Index (EMPI) for the PROVIDER Registry.

Strategic Framework

Reviewed HIX/HIE infrastructure, development, delivery, and security requirements to support the Enterprise Integration Platform.

Data Management Strategy

Defined a comprehensive data management strategy to meet current and future organizational needs.

Architecture and Design

Analyzed source systems, captured detailed requirements, and designed an SOA solution with an enterprise data model.

Provider System Interface Development

Developed interfaces for the new Provider (Cactus) system integration across internal and external partners. We have implemented the Enterprise Master Patient Index (EMPI) for the PROVIDER Registry.

Insights

artha
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