Amerigroup Corporation is a Fortune 500 company and the ninth-largest publicly traded healthcare company in the United States, with more than 1.9 million members. Founded in 1994, it focuses on coordinating local Medicare and Medicaid programs and services one out of every 45 Medicaid recipients nationwide. With more than four thousand employees across the U.S., Amerigroup processes 24 million claims annually.
To accommodate Amerigroup members who are disabled, bed-ridden or otherwise cannot get to one of its offices, associates make more than 2 million outcalls annually in order to assess members’ health needs and ensure they’re getting the right care. While Amerigroup processes over 80 percent of insurance claims electronically, the associates on outcalls record meetings on paper, return to the office and key in the data. As with most data-entry work, this system is prone to errors that raise costs and delay processing. Bringing this aspect of the business online was a key challenge to providing better, more timely care for members.
Staying secure while boosting member service
Amerigroup’s IT group looked at various approaches that would provide a secure way for associates to manage members electronically in real time from any location. As a result, Amerigroup designed and developed a mobile application for the Apple® iPad® that can interactively assess and record the health care needs of members in their homes or other places of care.
Although this approach facilitated mobility, ultimately the iPad offered little more than a way to create islands of information if they couldn’t connect back to Amerigroup’s datacenter, where its systems of record resided. But transmitting member information over cost-effective public networks raised a number of security questions for Amerigroup. For example, the sensitive data had to meet stringent HIPAA patient privacy requirements entailing encryption over the wire, but there were also questions around safely traversing Amerigroup’s corporate firewall in order to access its internal applications exposed as API-based Web services. The IT group considered a VPN-based approach but didn’t think it streamlined enough – they wanted something that would “just work”.
Robust protection on a tight deadline
Amerigroup put out an RFP for an API management project designed to securely connect its internal applications to mobile tablets. Amerigroup selected CA API Management because of its impressive security credentials, ease of use, and flexibility to meet the tight deadlines of the project. In fact, CA API Management was up and running in less than a week, providing the API security and data routing Amerigroup required, effectively firewalling its JBOSS-based Enterprise Service Bus (ESB) while guarding it against intrusion with strict API authentication, authorization and comprehensive threat protection.
Amerigroup’s new mobile API management solution serves approximately 80,000 Medicaid recipients throughout Texas. Initially, fifty case workers were equipped with Apple iPads in order to provide real-time interaction with members at their residences or places of treatment, but that number is growing.
Information is recorded directly within the application, and the data synchronized back to Amerigroup’s datacenter once the associate has access to a Wi-Fi or 3G access point. When the application connects to Amerigroup, the incoming XML messages are screened for threats by the CA API Management device located in the DMZ. The incoming user is authenticated and authorized against the local LDAP before being routed via Amerigroup’s ESB to update the appropriate system of record. Troubleshooting is streamlined by easy access to CA API Management log files that show requests and responses as they happen, simplifying diagnosis, and helping to ensure high availability.
Benefits for associates and members
The iPad application allows Amerigroup to improve its health care coverage and member services, while increasing the effectiveness and efficiency of its Medicaid program. At the same time, Amerigroup is helping Texas to manage the health care needs of its citizens, while keeping it more affordable for taxpayers.
The API-based solution that connects the app to Amerigroup’s internal systems is key to advancing the efficiency and capability of Amerigroup’s associates, allowing them to reduce time spent on administrative tasks and increase time spent with members. And with real time information gathered from members, Amerigroup’s time to decision making has been greatly reduced.
Going forward, Amerigroup is looking at extending the solution to business partners, which include radiologists, test and lab services, and hospitals that would then be able to submit claims directly to Amerigroup, further streamlining and simplifying the claims process.