At AWPRx, we work with 95 percent of U.S. pharmacies to help
workers’ compensation beneficiaries fill prescriptions and manage claims
online. We manage these prescriptions on behalf of our clients: insurance
companies, self-insured employers and third-party administrators.
Our software validates every medication before it is filled
and provides notification of filled prescriptions and those requiring prior
authorizations. By incorporating this information into our software as a
service-based application—ForceRx—we can immediately reject prescriptions for
noncovered medications or medical devices.
These processes are extremely data-intensive because of the
number of parties involved and the varying rules for different states’ workers’
compensation benefits. For example, an injured worker takes his or her
prescription to the pharmacy, which logs on to AWPRx to verify the co-payment
amount and determine whether the medication is authorized or requires prior
approval.
The problem is that workers’ compensation is a reactive
process in which 45 percent of injured workers seek medical treatment before
notifying their employer of the injury. Most of the time, workers are in their
doctor’s office before they realize that an injury is work-related and probably
falls under their company’s workers’ comp policy.
Because they’ve already sought treatment, a system is needed
that can effectively manage all these processes. That’s where AWPRx comes in.
AWPRx’s clients provide us with information on new injuries
that qualify for medication benefits, and that information is pulled into
Salesforce.com, where it is available to 60,000 network pharmacies. These are
data-driven processes that require immediate communications among insurance
providers, pharmacies and affected workers, so our overall success is tied
directly to accurate and quick data movement.
Until 2010, we were using a number of less-than-reliable
tools for these processes, including Cast Iron for integration and an old
Oracle J2EE data center. The Cast Iron appliance required constant custom
coding to keep up. In addition, our entire infrastructure was not ready to
scale. When we realized that, we decided to move everything to the cloud.
In 2010, we deployed a new cloud storage infrastructure
solution and replaced Cast Iron with Jitterbit, flexible, powerful cloud
application integration software. As a result, we are now completely in the
cloud, and prescription approvals are being performed in real time.
By moving to the cloud, we have cut our allocated
integration budget by more than 80 percent and seen a large return: up to
$400,000 in savings by the end of 2010, based on the savings realized by
partnering with Jitterbit and Salesforce.com. We have saved on internal
training, support and development costs by moving applications off our Oracle
J2EE data center and onto the servers of our cloud partners.
The Force.com cloud allows our employees to access
applications and on-demand systems seamlessly, delivering improved data
management to all authorized personnel. Jitterbit enables us to automate many
more processes than the previous environment did. Jitterbit’s graphical
“no-coding” approach to integration accelerates and simplifies the
configuration and management of moving data to the Force.com platform. We’re
able to scale faster, even though our IT team has not grown.
The integration helps us quickly identify which injured
workers are eligible for certain medications and which are not, while
simultaneously keeping our clients updated on pharmacy activity. Having the
ability to integrate data from the businesses to the pharmacy network is critical
for us.
Working in the health care industry adds layers of control
requirements and regulations, such as the Health Insurance Portability and
Accountability Act (HIPAA). The Salesforce.com platform allows us to track and
log any instance where protected health information is accessed, updated or
removed.
All interactions via the client portal are managed via a
secure two-factor authentication process, and every transaction is protected by
password and token authentication. Password complexity and reset thresholds
meet HIPAA
requirements. All of our data partners are SAS70 TYPE II organizations,
securing our stored data so we can offer our data-driven services in a secure
cloud computing environment.
We now have many more upcoming development projects since
we’ve moved to the Salesforce platform, which has allowed us to do things we
couldn’t do with our former system because it would have been too expensive.
For instance, we have partnered with ForceBrain.com, a Salesforce architect, to
design, develop and deploy several new functions, including our prescriber
portal.
Looking toward the future, we want to involve the injured
workers even more directly, and our cloud-based model will help us do that. We
must meet our clients’ requirements, but, at the same time, we want to empower
injured workers to help themselves through self-service.
We’d like to get the workers more involved by pushing
information to them without compromising the security of the data. It’s safe to
say that technology is helping us deliver a service that makes the health care
system more effective and secure, as well as being easier to use.
Jay Roy is CEO of AWPRx, a pharmacy-benefits management
company based in Altamonte Springs, Fla.
IT Management 
