Highlights

• Fast 6 week implementation
• 50% decrease in new customer on-ramp time
• Accelerated cash flow
• 50% decrease in data update time
• 40% increase in data issues caught before load
• Expanded product capabilities

Benefits

Scalable revenue realization in half the time – Pervasive automated validation, reusable integration components, and ability to handle a vast variety of file formats has cut new customer on-ramp time from 5-7 months (20+ weeks) down to 9-12 weeks, and made the final data far more trustworthy. As Chris Andrews says, “We only get paid when we’re providing analytics. Getting customers’ data in the system faster allows APH to provide the analytics faster which leads to faster revenues.”

Improved decision-making results from availability of key data anytime, anyplace – By discovering actionable data through data profiling, predictive modeling and advanced analytics, APH can more accurately evaluate historical trends as well as project future health costs and risks, thus better meeting customer needs. This enables APH to provide proactive suggestions to their clients to mitigate some of the claims payments and make the health situation of patients better.

50% decrease in data load time, with improved data quality – Automated quality assurance and error checking has decreased time to load existing customer updates by 50% - from 8 hours on average to only 4 hours.

Resource Savings – One year after initial implementation of the One year after initial implementation of the Pervasive process, staff size has remained the same while client load has almost doubled.

Fast, flexible adaptation to change over time – Pervasive has armed APH with the information they need to become a high-performing organization by building a workflow designed for change. Data sources are automatically picked-up, identified and mapped into a comprehensive and homogeneous data model – the Operational Data Store (ODS). This extensible process allows APH to add new sources quickly and easily by simply creating a data map in the intuitive Pervasive Map Designer interface. The Pervasive integration suite eliminates the need to hand-code data integration connectivity to new sources and enables APH to scale up as needed. With this independence from outside contractors, the cost of change is significantly reduced, and APH gains greater control over their own corporate destiny.

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Flexible Integration Solution Needed for Disparate Data

Hidden in data collected from insurance claims are patterns and health care trends that can help insurance providers cut costs, improve patient health, and improve spending efficiency. Advanced Plan for Health (APH) analyzes medical and pharmacy claims data, employee eligibility, lab values and other data to look for opportunities for improvement and refinement.

As its business and product offerings grew, now providing health care cost variability control initiatives for over 270,000 patients, APH sought a flexible and powerful integration solution. They needed to address the wide variety of disparate file formats and systems involved in day-to-day operations, and eliminate dependence on expensive and slow outsource service providers and brittle custom code.

APH implemented Pervasive Data Profiler™ and Pervasive Data Integrator™ to create agile, easily maintained in-house processes for customer on-ramping, cut customer update data load times by 50%, increase speed to revenue, and establish a vital data warehouse to power health information analysis.

Challenge: Bring Processes In-House and Improve Inputs for Decision-Making

APH was using an outsourced provider to handle the company’s ETL functions. The company received over 40 different file formats from various vendors, including XML, XLS, EDI, MDB, various text formats, and image files. All of these different formats needed to be transformed, validated and standardized to one common output.

Chris Andrews, Managing Director of Information, summarized the problem, “The outsourced provider was taking about 5 months or so to get a client on-boarded. The model for APH is a PEPM basis, so we charge per employee, per month. And, we can’t start charging until companies and their employees are live in the system.” 

Andrews adds, “Also, their level of QA wasn’t what it should be. So, after taking 5 or 6 months to get a client up, if they didn’t do a certain level of validation on the data and there was a problem, then it would take another month, or another 2.”

That also frequently left APH taking responsibility for data quality problems they had no power to prevent or correct. Andrews contrasts that with the current situation with Pervasive. “That’s been one nice thing that Pervasive has allowed us to do; data validation in-house. It’s just made our overall QA much more robust.” They also recognized a need for more effective reporting and analysis.
In addition, APH required a flexible integrated data warehouse to:

• House customer data from the over 40 vendors
• Allow monthly validation of newly received files
• Power more informed, effective decision-making organization-wide
• Prepare for future application development

Choosing the Software

Chris Andrews talks about how Pervasive was selected. “We put together an RFP, pulled together Forrester and Gartner reviews on different data integration platforms. We had about 25 main level criteria. One would be ease of mapping data, financial stability of the company, industry experience, the labor pool, and some other soft criteria. We did a full software selection process with criteria, weights, and pulled in the top two contenders. Pervasive was there.

“One of the finalists was Informatica. Their solution just really did not fit what we were doing. Especially after a lot of product demos and everything else, Pervasive definitely was the one that demonstrated that they knew what we were going through, and how we needed to get rid of the problems in our area.

“It was a pretty easy choice going with Pervasive, especially when you consider just the overall costs to bring Pervasive in compared to some of the other integration suites that are out there. It’s almost laughable some of the quotes that we saw from other people. I don’t know how you could actually do an ROI on that.

Building A Solution: Efficient Implementation and High Employee Buy-In

After only 2 days of training, Chris Andrews and his team were up and running on Pervasive Software. Andrews raves about how easy the software is to use: “I think that’s invaluable that you guys have an application that you don’t have to go out and find this specialist person, this needle in a haystack within the labor pool.”

APH leveraged Pervasive Professional Services consultants to incorporate best practices in the implementation of Pervasive Data Integrator™ and Pervasive Data Profiler™, and speed the implementation process by working in parallel with APH personnel.

Pervasive consultants architected the high-level processes for the initial migration, including profiling and analytics to make sure that only clean, valid data went into APH’s data warehouse. The initial data migration contained three years of data for the newly created data warehouse.

Next, Pervasive set up scheduled integration processes to automatically pull in new data on existing customers as it became available on a near real-time basis. There are several hundred different types of third-party administrators, ranging from the big ones, Blue Cross, Blue Shield, and Aetna, down to a multitude of small regional third-party administrators, and each one uses their own data file format. Pervasive Data Integrator pulls data from all of those different file types, transforms it to a standard format, and validates the metadata from previous integrations against key data in the existing data warehouse. This data is processed through the Ingenix Symmetry system, and also added to the data warehouse for more analysis.

Taking Data Profiling to the Next Level

Pervasive Data Profiler applies multiple business rule tests to the data, and provides detailed reports showing audit results. Data Profiler does basic validation, making sure that required fields are never blank, dates are in the proper format, etc. but APH and Pervasive take that to the next level. Andrews explains, “We’re even doing eligibility checks within our project. The process design that we had done by the Pervasive consultants would go out into our data warehouse and check to see if these people are actually eligible for the benefits we’re about to process.”

The entire project which included mapping, converting and automating over 40 file formats was completed in only six weeks. The result was an easy system for nontechnical staff to use, without the high levels of expense, time, and upheaval normally associated with major integration projects of this kind.
Andrews talks about the Pervasive Professional Services consultants, “We had that aggressive time line and everybody was super professional, and they were flexible on all of our demands. Everything was turned around fast.”

Conclusion

Even as their business has doubled in size, the strategic deployment of Pervasive integration technology has helped APH achieve and sustain a competitive advantage by effectively capturing, storing, and scrubbing incoming data. The new data warehouse has become the hub of data integration in the enterprise providing better master data management, richer data segmentation, and improved data and risk selection.

In addition, thanks to the ease of use of the Pervasive interface, and the thorough understanding business-oriented APH personnel gained of the Pervasive software suite, APH has been able to organically add on functionality to expand their business offerings. They now check workmen’s compensation claims for double-dipping and fraud by checking new claims against previous claims in the data warehouse.

Chris Andrews sums up the results of the shift to internal client on-ramping with Pervasive: “Our client satisfaction improved tremendously. I mean, just consider that a year and a half ago, it took us six months to get up. Now we’re able to cut that in half, get them up on the system faster. But also they’re seeing that the data set we’re giving them is really clean. So, the APH system now, through Pervasive, has become a system of source for our clients. They really trust our data.”