Harvard Pilgrim Health Care (HPHC), headquartered in Canton, Massachusetts, offers flexible health plans through provider networks, preventive health programs and self-service tools, guiding members toward better health. HPHC needed to improve service delivery to its members, reduce administrative costs and meet increasing demands for digitization.
HPHC partnered with NTT DATA to modernize applications and automate critical processes to better identify risk with predictive models. Together, they rebuilt the plan’s core claims processing system into a new services framework that includes components for membership, customer management, provider management and claims-pricing applications. Another initiative will help HPHC expand it view of members to a full 360-degrees.
For 50 years, Harvard Pilgrim Health Care (HPHC), a leading not-for-profit health services company, has provided health benefit plans, programs and services to more than three million members across New England and beyond. “Our mission is to improve healthcare for our members and the communities we serve,” says HPHC CIO Deborah Norton.
Bob Trombly, HPHC’s Deputy CIO, says, “What keeps us awake at night is the constant pressure to reduce administrative costs and provide better service. There has been a lot of consolidation nationally, so we were trying to remain competitive as a regional health plan.” Additionally, HPHC needed to address the ongoing trend of digitization. “Our membership is looking for seamless service and a faster, more reliable experience,” he says. “They want to see their claims online, to buy or change their products online, and to examine their networks to make sure everything is optimized for them. We have to be able to compete in this area.”
- Stabilizes pended claim volumes
- Isolates risks and financial liabilities
- Delivers a modern, scalable application platform
- Processes 92% of claims in an average time of 1.61 days from receipt
Enabling automation, supporting DevOps and cutting costs
Harvard Pilgrim Health Care turned to technology partner NTT DATA to help reduce costs, improve service and meet the demand for digitization. Since 1999, NTT DATA has worked with HPHC to help the plan meet its application modernization, business process outsourcing (BPO) and infrastructure needs. “NTT DATA is a key strategic partner in our digital transformation,” says Norton.
The application modernization team worked with the HPHC CIO and CTO offices to automate application code deployment processes and support the organization’s DevOps development model. The teams replaced a core claims-processing system, rebuilding the overall system into individual components. The new services framework includes membership, customer management, provider management and claims-pricing applications. “We took an aging legacy system and rebuilt and redeployed it with a modern architecture that is scalable to meet Harvard Pilgrim’s future business needs,” says Andy Fransen, Senior Director, Customer Delivery Executive at NTT DATA.
The teams also automated critical inventory management processes to reduce potential insurance claim backlogs. NTT DATA programmers use robotic process automation (RPA) and bots to automate pending claims in HPHC’s business process organization. “We can't possibly sort through these complex issues ourselves. We need a trusted global innovator — NTT DATA — to help guide us as we approach these very important issues,” says Norton. “NTT DATA really understands our business.”
Optimizing claims inventory management
The teams reduced inventory levels using process automation, business process redesign, and optimized inventory tracking and processing. This approach gives HPHC the operational stability it needs to evaluate and calculate risk. The company also stabilizes pended claim volumes so it can better isolate risks and financial liabilities.
For example, the industry’s standard claims payment with a 30-day turnaround is 95% clean. HPHC processes 92% of insurance claims in an average time of 1.61 days from receipt. From 2016 to 2018, HPHC reduced interest penalties by 60% year over year. Further improvements were expected for 2019.
Saving millions of dollars through application modernization
Modernizing applications helps HPHC reduce costs. NTT DATA created a scalable software solution to meet the plan’s future needs. “We’re getting more agility, a more modern platform and a better ability to use new technologies for data access and data acquisition — and a skill set that’s readily available at a lower cost,” says HPHC CTO David Querusio.
Additionally, NTT DATA’s aplication, BPO and infrastructure teams helped HPHC cut its total core budget by $13.5 million. Querusio says, “NTT DATA helps us reduce our costs and put the savings into other business areas, so we can be responsive in the marketplace.”
Moving forward, HPHC will continue to grow its relationship with NTT DATA. “One of the most important initiatives that NTT DATA will help us with is expanding the traditional view of our members to a 360-degree view,” says Norton. “That comes with a lot of challenges, because every access point has a security or privacy point. We are thrilled and privileged to have NTT DATA help us think through those problems.”
About Harvard Pilgrim Healthcare
Founded by doctors nearly 50 years ago, Harvard Pilgrim and its family of companies provide health benefit plans, programs and services to more than three million customers in New England and beyond.