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Health plan integration hub

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Learn about health plan integration hub solution from IBM that provides a modular, flexible approach to support migration to ICD-10. It is built on a com-prehensive platform for code and policy …

Learn about health plan integration hub solution from IBM that provides a modular, flexible approach to support migration to ICD-10. It is built on a com-prehensive platform for code and policy translation and is designed to be a single trusted source of healthcare information. For more information on IBM Systems, visit http://ibm.co/RKEeMO.


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  • 1. IBM Systems and Technology Solution Brief Healthcare Health plan integration hub Highlights ●● ● ● Adopt a flexible, modular approach to ICD-10 conversion ●● ● ● Gain visibility into potential impacts and apply analytics capabilities ●● ● ● Benefit from secure, reliable technology provided by IBM System z ●● ● ● Build a platform for future code and policy transitions Converting to ICD-10 means that the number of medical codes used for diagnosis and treatment information will grow from 14,000 to over 140,000. As healthcare evolves as an information-based industry, health plans will increasingly need the information generated from this conversion to support priorities such as administrative and medical cost reduction, chronic disease cost containment, new product and services development, fraud prevention and benefit plan customization. The health plan integration hub solution from IBM provides a modular, flexible approach to support migration to ICD-10. It is built on a com- prehensive platform for code and policy translation and is designed to be a single trusted source of healthcare information. Solution capabilities, available in pre-integrated, configurable modules of IBM software, sup- ported by IBM services and IBM® System z®, facilitate integration and access to enterprise information. Organizations can select the capabilities that best meet their needs to accelerate testing, ensure cost neutrality or achieve other desirable business outcomes.
  • 2. 2 Solution Brief HealthcareIBM Systems and Technology Adopt a flexible, modular approach to ICD-10 conversion Leveraging the integrated software capabilities of IBM and the enterprise power of System z—as well as comprehensive ICD-10 services offerings—provides health plans with all the tools needed to adopt a scalable approach for managing regulatory change. We offer three distinct sets of capabilities: ●● ● Workflow management, code and policy governance: Enables orchestrated workflows for rules authoring and management to build complex mapping solutions such as interactions with medical policy and benefit rules, sharing of mappings and rules between departments, collaboration between users dur- ing the mapping resolution process, and robust governance for management approvals. ●● ● Business analytics, dashboards and reports: Enables out-of- the-box dashboards and reports, and a framework to easily add or configure new dashboards or reports to support informed decision-making. ●● ● Business rules authoring and governance: Enables benefit plan rules authoring capabilities, allowing benefit plan spe- cialists and analysts to redesign rules based on ICD-10 codes, and then turn these rules into business requirements for benefit plans. Implementing the health plan integration hub begins with business needs identification and leads to configuration of the modules you select, as well as testing, validation and deploy- ment. Our solution can make code and policy conversion both smart and cost-efficient. It will allow you to orchestrate and manage each step of this complex transition process, including monitoring and managing workflow and resource deployment for mapping and policy integration. Business intelligence capa- bilities include managing the transition effort, determining cost and revenue neutrality, and offering support for processing and exception handling. Our solution is designed to meet your specific needs, allowing you to manage the migration at your own pace. The underlying toolset can be configured to align with your remediation approach and your workflow, and integrate with your preferred mapping tool. As a result, you gain implementation flexibility regardless of which ICD-10 adoption strategy you choose— whether an ICD-10 crosswalk, a complete transformation of processes and systems, or something in between. Our solution can also grow and change with your needs. Built on a service oriented architecture, it can extend to include additional applications and databases and encompass a growing library of workflows, business rules, dashboards and reports. Gain visibility to potential impacts and apply analytics capabilities Our solution can increase business flexibility and improve control through clear visibility into the potential impacts of ICD-10 migration. It incorporates the IBM Transformation Accelerator and Manager for ICD-10, providing integrated capabilities at each ICD-10 touchpoint, from front-end transac- tional systems to testing environments and data warehouses. Our solution enables continual enhancements during design, testing and deployment. It can also apply the IBM Rational® product suite to find codes, rewrite and test applications to support ICD-10 changes, and track and trace changes to ensure they work. Embedded audit capabilities aid execution and docu- ment changes. We can also conduct testing as an independent third party. In joint planning with you, we take into account not only pending ICD-10 milestones but also how the information generated can be used to increase business value. As your migration progresses, you can take advantage of business analyt- ics capabilities to support activities such as testing and cost neutrality verification as needs change over time. Richer data
  • 3. 3 Solution Brief HealthcareIBM Systems and Technology for advanced analytics, transaction management and trend analyses can help ensure that benefits and payments conform to the intent of the original medical and benefit policies. And the data can strengthen positioning for future policy and code translations, while providing the foundation for expanded information management capabilities going forward. Benefit from secure, reliable technology provided by IBM System z The health plan integration hub solution is well-suited for organizations that use System z to support business functions such as premium billing and payment processing, claims intake and adjudication, and claims processing. Taking advantage of proximity to data in transactional systems as you convert to ICD-10 provides the ability to more easily integrate and access data for use in testing environments or data warehouses. When data resides on a single platform, performance, throughput and efficiency objectives can be more easily maintained and potential security exposures can be reduced. If you choose to apply business intelligence and analytics capa- bilities in support of your conversion, software products such as IBM Cognos® and IBM SPSS® are optimized to perform well on System z. Application performance will be consistently high, due to the System z compute-intensive analytics processing capabilities. Our solution can protect and extend your investment in System z. Adjudication on IBM z/OS® and policy transfor- mation on Linux on System z can be managed as a single integrated workload. Performance and availability goals can be assigned to combined operational and new business require- ments so you can benefit from the secure, reliable technology environment and management efficiencies that System z provides, reducing total cost of ownership. Administrative, medical management and compliance information can be integrated, accessed and analyzed on the same platform, allowing continued benefits from the high performance technology environment provided by System z. Build a platform for future code and policy transitions Your ICD-10 migration is an ideal time to invest to create transformative value. The health plan integration hub provides more than a holistic approach to ICD-10 conversion. Its powerful and robust capabilities provide an extensible platform for business process management, analytics and collaboration. Workflow and policy governance capabilities can position you for future policy and code translations, as your needs evolve. IBM offers the deep healthcare business process expertise, extensive experience in ICD-10 implementations and an extensible technology platform to support this transition with reduced risk. For more information To learn more about the health plan integration hub, please contact your IBM representative or IBM Business Partner, or visit: ibm.com/healthcare Additionally, IBM Global Financing can help you acquire the IT solutions that your business needs in the most cost-effective and strategic way possible. We’ll partner with credit-qualified clients to customize an IT financing solution to suit your busi- ness goals, enable effective cash management, and improve your total cost of ownership. IBM Global Financing is your smartest choice to fund critical IT investments and propel your business forward. For more information, visit: ibm.com/financing
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