Neighborhood Health Plan

Success Story

New England-based HMO leverages Novell exteNd to overhaul internal portal, streamline HIPAA compliance via Web services model.

Overview

Neighborhood Health Plan (NHP) is a not-for-profit HMO providing health care to over 120,000 members, including individuals and families enrolled in MassHealth (Medicaid).

Challenge

Until recently, healthcare providers sent patient information to NHP via a mix of paper mail, email and fax. NHP staffers then keyed this data into various back-end systems. Not surprisingly, this process was time-consuming, expensive and prone to error. Information on patient referrals was unavailable to providers for days, sometimes weeks, as data was manually moved from paper into several disconnected information systems.

NHP sought a technology solution to replace the inefficient mix of manual and automated data collection, storage and retrieval. The near-term goals of the new system were to:

• Reduce the cost of manual data entry
• Improve data accuracy by eliminating human errors
• Increase information timeliness and availability
• Strengthen relationships with healthcare providers by offering user-friendly interfaces for creating, accessing and updating patient information

NHP's first attempt at an integrated system was developed in partnership with an outsourced vendor, which created a Web-enabled referral and eligibility application. While this solution was more efficient and accurate than the mixture of paper- and fax-based data collection of the past, its per-provider cost model limited its use to NHP's largest providers. Further, the system did not offer real-time information to users, undermining the advantage to participating providers.

"Our initial solution was comprised primarily of a custom-built application. It was limited in terms of both business model and architecture," said Marilyn Daly, R.N., director of eCommerce and clinical applications for NHP. "What we really needed was an IT infrastructure that could support our quality, community, cultural and financial objectives."

NHP sought an IT infrastructure that could support near-term priorities and provide a platform for future initiatives. The solution needed to be highly reliable and scalable to support the growth of NHP's membership and extended partner communities. Ideally, the solution would enable NHP to lead their partner organizations in the transformations necessary for HIPAA compliance.

NHP needed the new system to immediately:

• Eliminate per-user licensing costs
• Preserve the feel of prior systems while simplifying workflow
• Enable users to interact via highly personalized, secure Web interfaces
• Eliminate manual data entry to back-end systems, to reduce errors and make referrals and eligibility information available in real time, and
• Allow authorized users to search the database by member, by referral or by provider, from any point in the system.

In addition, the new system needed to support NHP's legal and strategic objectives of:

• Facilitating HIPAA-compliant information exchanges among their partners in the healthcare community
• Enabling phased implementation of HIPAA compliance features, allowing NHP to accommodate different compliance timetables among its community participants
• Supporting continuous improvements to the quality and flexibility of member services
• Providing an architecture foundation that could quickly and cost-effectively adapt to unknown future requirements

"We are not in the technology business; we are a health care organization," Daly said. "What we really needed was to create an information architecture that is flexible and powerful enough to handle all of our near-term needs and support our vision of compliant, high quality membership services."

Novell solution

"Our members love NHPnet. We don't get anything but positive feedback. They're able to check eligibility, process notifications and receive authorization numbers in less than two minutes. In some cases, we've eliminated reams of batch reports and hand-written forms from basic health care management processes. It's a qualitative shift; our members can't even quantify the time that they've saved."

Marilyn Daly, R.N.
Director of eCommerce and clinical applications
Neighborhood Health Plan

After evaluating several alternative solutions, NHP chose Novell exteNd as its new technology foundation. Key to NHP's selection was Novell exteNd's ability to support a comprehensive, Web-based architecture. Novell exteNd delivered all of the capabilities NHP required, from back-end integration to flexible, Web-based information delivery. Using Novell exteNd, NHP quickly created a Web portal that fit the look, feel and functional demands of NHP's diverse user communities.

In partnership with Novell, NHP developed NHPnet, a secure, Web-based solution combining complete back-end integration with personalized, user-friendly Web interfaces. NHPnet's flexible Web Services architecture allows healthcare providers to input, access and update patient healthcare information in real time. In the words of one key NHP customer: "I've been at Boston Medical Center for almost 15 years and have never seen anything this good happen."

Novell exteNd Composer was chosen for its rapid integration capabilities - an AS/400 integration proof-of-concept was accomplished for NHP's claims system in only three hours. NHP soon learned that exteNd Composer's advantages extended beyond the needs of NHPnet. While creating Web Services interfaces to all back-end systems, NHP put exteNd Composer to work as its core technology foundation for HIPAA compliance.

Novell exteNd Director was selected for its powerful personalization, content and rules management capabilities. exteNd Director enabled NHP to quickly create sophisticated user portals that can be managed centrally while allowing users significant freedom to personalize their views. "Novell's visual designers produced beautiful, customized Web pages from our rudimentary diagrams in less than three weeks," Daly said.

Using Novell exteNd Composer, NHP has created Web Services interfaces for each of its back-end systems, including NHP's ONYX Member Care application, relational databases and EDI information sources. NHP uses exteNd Director to deliver member portals that tailor content for different communities and personalize interfaces to each user's preferences.

NHPnet itself is deployed on the Novell exteNd Application Server, which offers the highly scalable, highly reliable processing infrastructure demanded by NHP's quality standards. Using Novell exteNd's visual designers, NHP was able to meet or exceed all of its aggressive time-to-market objectives for NHPnet.

Results

In the first three months after NHPnet went live, the number of registered users creating eligibility checks and referrals with NHP quintupled. Over 70% of NHP's 120,000 members are now being managed through NHPnet; the remainder - most of whose healthcare providers did not have Internet access - are migrating quickly onto the Web by the efficiencies of working with NHPnet.

Sixty percent of NHP's referral volume now comes through NHPnet. For a typical healthcare provider, the cost of doing eligibility verifications through NHP has dropped from approximately $8,000 per year in the paper-based system to $200 per year using NHPnet - just for this single step. The ease and efficiencies of working with the new system far exceed NHP's expectations for enhancing member satisfaction and loyalty.

Novell exteNd has reduced NHP's initial estimate for achieving HIPAA compliance by almost 60 percent. Using exteNd Director, NHP is creating user-friendly, Web-based interfaces that insulate users from the complexity of HIPAA-formatted information. Internally, exteNd Composer permits NHP to exchange HIPAA-compliant data will all health care participants, including patients, providers, payers and third party services. NHP has now assumed a leadership role in HIPAA compliance initiatives.

NHPnet's Web Services foundation has positioned NHP to quickly respond to new requirements and opportunities in the evolving health care industry. NHP's internal systems are now accessible using standard Web Services methods, creating unlimited possibilities for integration with key industry players and interaction with NHP's growing member community. Importantly, NHP is now using technology to achieve its ongoing quality, community, cultural and financial objectives.

"Novell exteNd delivered the goods. We needed an information architecture that allowed us to rapidly meet near-term initiatives and lay the groundwork for our future," Daly said. "Novell exteNd gives us the best of both worlds. Technology, which once limited our growth, is now largely responsible for our success."