Data Integration Enables Cloud Success

By Jay Roy Print this article Print

A big pharmacy service company gets good results and lower costs.

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.  

This article was originally published on 2012-01-19
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