Bridging the Gap

Vista Health Plan's claims processing engine handles premium billing, claims payments, enrollments and referrals. But its four front-end portals (for brokers, members, employer groups and healthcare providers) did not provide access to the system. Without any connection between the IBM (Armonk, N.Y.) iSeries data and screen-based applications and its back-end systems, the carrier's claims personnel often had to enter data twice -- once into its front-end business application and then again into its PowerMHS core processing engine from DST Health Solutions (Kansas City, Mo.) -- resulting in poor customer response times and inefficiencies, according to David Gallegos, the Hollywood, Fla.-based carrier's SVP and CIO.

Further, the siloed systems meant that Vista's ($1 billion in total assets) partners had to wait up to three weeks to respond to member requests as Vista researched information on its mainframe, printed requested materials and then mailed hard copies. "We wanted to create hassle-free services for our [partners and] customers ... [and] expose them to the power of our back-end system in real time," Gallegos says. "We knew that we needed to create a connection between the front-end and back-end systems."

Gallegos explains that the solution had to be compatible with Microsoft (Redmond, Wash.) .NET, which the carrier often uses to develop proprietary programs, as well as Vista's front-end systems. Further, Vista wanted to see a proof of concept. In March 2005, Gallegos began considering solutions from several vendors, including Seagull Software (Atlanta), Jacada (Atlanta), Attachmate (Bellevue, Wash.) and Sugar Land, Texas-based Neon Systems, which recently was acquired by Progress Software (Bedford, Mass.) and merged with Progress' DataDirect unit. Gallegos notes, however, that Jacada's solution is Java-based.

After Neon completed the proof of concept for its Shadow z/Services Distributed integration solution in August 2005, showing that the application would connect seamlessly with the insurer's front- and back-end systems, Vista signed a contract with the vendor later that month. Since the proof of concept involved running the application in a test environment, final installation on a Wintel server housed by Vista took less than 40 hours, and the carrier went live with the system for small group renewals this past October, reports Gallegos, who notes that the Neon application translates information requests from front-end applications, retrieves the necessary information from PowerMHS and presents the information back to the front-end user.

Before the implementation, it took two full-time employees nearly three weeks to key and audit small group renewals manually each month, resulting in renewal notice delays, Gallegos relates. As a result, insured workers often were automatically renewed at existing rates rather than with appropriate increases.

With the Neon application, which cost Vista $60,000, it now takes one employee just a single day to upload and audit all information, and accuracy issues have been eliminated. Gallegos estimates that this saves Vista a total of 1,344 man hours annually in addition to enabling superior customer service.

In the second quarter of 2006, Vista will implement the Shadow solution for its large group portal, Gallegos says. And Vista also hopes to tap the solution to offer plan members direct account access and self-service features, he adds.

Systems Integration

company:

Vista Health Plan (Hollywood, Fla.; $1 billion in assets).

lines of business:

Group and individual health insurance.

vendor/technology:

Neon Systems' (Sugar Land, Texas) Shadow z/Services Distributed integration solution.

challenge:

Create a seamless connection between front-end applications and back-office systems.