Insurance Provider Claims Win with Stronger Data Analytics

Our Customer

This health insurance payer (HIP) works with more than 29,000 healthcare providers across its state, serving 11,000 employer groups and more than 3.5 million members. 

The Challenge

HIP’s priority is to expand client options and access to key services. Increasingly cost-prohibitive analytics and business intelligence tools, however, put this goal in jeopardy.

HIP’s existing analytics and BI platform contract was coming up for renewal at a substantial cost, and this would effectively lock them into an obsolete data processing framework. The company decided it was time for a change—upgrade current data feeds and consolidate sprawl across their existing enterprise data warehouse (EDW) solution.

This left HIP with a looming deadline to either:

• Extend their existing contract without solving the issues of data complexity or cost 
• Or find a new partner capable of helping them make the switch

That’s when HIP and Prolifics connected – and Prolifics was up for the challenge.

How We Met HIP’s Challenge

With Prolifics on board, the first step was to build a better roadmap from current solutions to modern BI and analytics alternatives. Thanks to a wealth of industry experience, it was possible for Prolifics to create a roadmap that went beyond the basics of managing upstream and downstream data feeds to include end-to-end data migration.

Next, Prolifics put together a team dedicated to upgrading the integration aspect of the migration, introducing a metrics-based approach that provided HIP visibility into the process.

Data layers were then modernized and consolidated to simplify key data feeds for the new data platform and warehousing solution.

Results

By focusing on migrating data to a single data warehouse and integrating key data feeds into new platforms, Prolifics helped the health organization save time and money. For example:

• The initial cost of migration was estimated at $2 million, but Prolifics was able to reduce this total cost to $700,000 
• Prolifics teams were also able to identify specific resources and assets HIP wouldn’t require moving forward, allowing them to further reduce costs by leaving behind 20-40% of existing data processes

In addition, the Prolifics integration effort made it possible for HIP to leverage healthcare data on demand, enabling them to support dynamic plan pricing, member segmentation, claims analysis, and mandatory regulatory reporting.

To learn more about what Prolifics can do for you, connect with an expert today.

About Prolifics

Prolifics is a global digital transformation leader with expertise in Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity across multiple industries. We provide consulting, engineering and managed services for all our practice areas at any point our clients need them. Vision to Value. Faster. It’s not just the Prolifics’ tagline, it’s what drives us. Reach out to learn more – solutions@prolifics.com.