Data Integration Enables Cloud Success

At AWPRx, we work with 95 percent of U.S. pharmacies to helpworkers? compensation beneficiaries fill prescriptions and manage claimsonline. We manage these prescriptions on behalf of our clients: insurancecompanies, self-insured employers and third-party administrators.

Our software validates every medication before it is filledand provides notification of filled prescriptions and those requiring priorauthorizations. By incorporating this information into our software as aservice-based application?ForceRx?we can immediately reject prescriptions fornoncovered medications or medical devices.

These processes are extremely data-intensive because of thenumber of parties involved and the varying rules for different states? workers?compensation benefits. For example, an injured worker takes his or herprescription to the pharmacy, which logs on to AWPRx to verify the co-paymentamount and determine whether the medication is authorized or requires priorapproval.

The problem is that workers? compensation is a reactiveprocess in which 45 percent of injured workers seek medical treatment beforenotifying their employer of the injury. Most of the time, workers are in theirdoctor?s office before they realize that an injury is work-related and probablyfalls under their company?s workers? comp policy.

Because they?ve already sought treatment, a system is neededthat can effectively manage all these processes. That?s where AWPRx comes in.

AWPRx?s clients provide us with information on new injuriesthat qualify for medication benefits, and that information is pulled intoSalesforce.com, where it is available to 60,000 network pharmacies. These aredata-driven processes that require immediate communications among insuranceproviders, pharmacies and affected workers, so our overall success is tieddirectly to accurate and quick data movement.

Until 2010, we were using a number of less-than-reliabletools for these processes, including Cast Iron for integration and an oldOracle J2EE data center. The Cast Iron appliance required constant customcoding to keep up. In addition, our entire infrastructure was not ready toscale. When we realized that, we decided to move everything to the cloud.

In 2010, we deployed a new cloud storage infrastructuresolution and replaced Cast Iron with Jitterbit, flexible, powerful cloudapplication integration software. As a result, we are now completely in thecloud, and prescription approvals are being performed in real time.

By moving to the cloud, we have cut our allocatedintegration 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 bypartnering with Jitterbit and Salesforce.com. We have saved on internaltraining, support and development costs by moving applications off our OracleJ2EE data center and onto the servers of our cloud partners.

The Force.com cloud allows our employees to accessapplications and on-demand systems seamlessly, delivering improved datamanagement to all authorized personnel. Jitterbit enables us to automate manymore processes than the previous environment did. Jitterbit?s graphical?no-coding? approach to integration accelerates and simplifies theconfiguration and management of moving data to the Force.com platform. We?reable to scale faster, even though our IT team has not grown.

The integration helps us quickly identify which injuredworkers are eligible for certain medications and which are not, whilesimultaneously keeping our clients updated on pharmacy activity. Having theability to integrate data from the businesses to the pharmacy network is criticalfor us.

Working in the health care industry adds layers of controlrequirements and regulations, such as the Health Insurance Portability andAccountability Act (HIPAA). The Salesforce.com platform allows us to track andlog any instance where protected health information is accessed, updated orremoved.

All interactions via the client portal are managed via asecure two-factor authentication process, and every transaction is protected bypassword and token authentication. Password complexity and reset thresholdsmeet 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 securecloud computing environment.

We now have many more upcoming development projects sincewe?ve moved to the Salesforce platform, which has allowed us to do things wecouldn?t do with our former system because it would have been too expensive.For instance, we have partnered with ForceBrain.com, a Salesforce architect, todesign, develop and deploy several new functions, including our prescriberportal.

Looking toward the future, we want to involve the injuredworkers even more directly, and our cloud-based model will help us do that. Wemust meet our clients? requirements, but, at the same time, we want to empowerinjured workers to help themselves through self-service.

We?d like to get the workers more involved by pushinginformation to them without compromising the security of the data. It?s safe tosay that technology is helping us deliver a service that makes the health caresystem more effective and secure, as well as being easier to use.

 

Jay Roy is CEO of AWPRx, a pharmacy-benefits managementcompany based in Altamonte Springs, Fla.

 

Picture of Jay Roy

Jay Roy

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