Amerigroup Corporation

EnablingMobileMedicaidviaAPIManagement

Amerigroup by the Numbers

1.9 million members $5.2B in revenues (2009) 4,000 employees 49 offices/facilities US-wide

AmerigroupCorporationisaFortune500companyandtheninthlargestpublicly tradedhealthcarecompanyintheUnitedStateswithmorethan1.9millionmembers in11statesnationwide.Foundedin1994,Amerigroupfocusesoncoordinatinglocal MedicareandMedicaidprogramsfortheUSgovernment.Infact,oneoutofevery45 MedicaidrecipientsisservicedbyAmerigroupnationwide.Withmorethanfour thousandemployeesacrosstheU.S.,Amerigroupprocesses24millionclaimsannually foroperations,prescriptiondrugbenefits,ambulatorycare,andmore.

2.2M out-calls to members, assessing their health needs

AstheU.S.federalgovernmentslocalhealthcarerepresentative,Amerigroupaccepts alleligiblepeople(regardlessofage,sex,raceordisability)anddoesnotdeny coverageduetopreexistingmedicalconditions.ToaccommodateAmerigroup 24M claims processed yearly memberswhoaredisabled,bedriddenorotherwisecannotgettooneof Amerigroupsoffices,associatesmakemorethan2millionoutcallsannuallyinorder toassessmembershealthneedsandensuretheyregettingtherightcare.WhileAmerigroupprocessesmorethan 80percentofinsuranceclaimselectronically,theassociatesonoutcallsrecordmeetingsonpaper,returntothe officeandkeyinthedata.Aswithmostdataentrywork,thissystemispronetoerrorsthatraisecostsanddelay processing.Bringingthisaspectofthebusinessonlinewasakeychallengetoprovidingbetter,moretimelycare formembers.

The Business Challenge

AmerigroupsITgroupheadquarteredinVirginiaBeach,Virginialookedatvariousapproachesthatwouldprovidea securewayforassociatestomanagememberselectronicallyinrealtimefromanylocation.Asaresult, AmerigroupdesignedanddevelopedamobileapplicationfortheAppleiPadthatcaninteractivelyassessand recordthehealthcareneedsofmembersintheirhomesorotherplacesofcare. Althoughthisapproachfacilitatedmobility,ultimatelytheiPadofferedlittlemorethanawaytocreateislandsof informationiftheycouldntconnectbacktoAmerigroupsdatacenterwhereitssystemsofrecordresided.But transmittingmemberinformationovercosteffectivepublicnetworksraisedanumberofsecurityquestionsfor Amerigroup.Forexample,thesensitivedatahadtomeetstringentHIPAApatientprivacyrequirementsentailing encryptionoverthewire,buttherewerealsoquestionsaroundsafelytraversingAmerigroupscorporatefirewall inordertoaccessitsinternalapplicationsexposedasAPIbasedWebservices.TheITgroupconsideredaVPN basedapproachbutdidntthinkitstreamlinedenoughtheywantedsomethingthatwouldjustwork.

Enter Layer 7
Inlate2010,AmerigroupputoutanRFPforanAPImanagementprojectdesignedtosecurelyconnectitsinternal applicationstomobiletablets,andobtainedanumberofresponsesfromvendorsthatpromisedtocoordinatethe wholeprojectforthemifonlytheydtakeabackseatandjusttrustthem.AmerigroupselectedLayer7 TechnologiesnotonlybecauseofLayer7sabilitytoworkcollaborativelywithAmerigroupsITteam,butalso becauseofLayer7simpressivesecuritycredentials,easeofuse,andflexibilitytomeetthetightdeadlinesofthe project.Infact,theLayer7Gatewaywasupandrunninginlessthanaweek,providingtheAPIsecurityanddata routingAmerigrouprequired,effectivelyfirewallingitsJBOSSbasedEnterpriseServiceBus(ESB)whileguardingit againstintrusionwithstrictAPIauthentication,authorizationandcomprehensivethreatprotection.

AmerigroupCaseStudy

The Solution
InproductioninTexassinceFebruary2011,AmerigroupsmobileAPImanagementsolutionservesapproximately 80,000Medicaidrecipientsthroughoutthestate.Initially,fiftycaseworkerswereequippedwiththeAppleiPadin ordertoproviderealtimeinteractionwithmembersattheirresidencesorplacesoftreatment,butthatnumberis growing. InformationisrecordedinteractivelydirectlywithintheiPadapplication,andthedatasynchronizedbackto AmerigroupsdatacenteroncetheassociatehasaccesstoaWiFior3Gaccesspoint.WhentheiPadapplication connectsovertheInternettoAmerigroup,theincomingXMLmessagesarescreenedforthreatsbytheLayer7 devicelocatedintheDMZ.TheincominguserisauthenticatedandauthorizedagainstthelocalLDAPbeforebeing routedviaAmerigroupsESBtoupdatetheappropriatesystemofrecord.Troubleshootingisstreamlinedbyeasy accesstoLayer7logfilesthatshowrequestsandresponsesastheyhappen,simplifyingdiagnosis,andhelpingto ensurehighavailability.

The Results
TheiPadapplicationallowsAmerigrouptoimproveitshealthcarecoverageandmemberservices,whileincreasing theeffectivenessandefficiencyofitsMedicaidprogram.Atthesametime,AmerigroupishelpingTexastomanage thehealthcareneedsofitscitizens,whilekeepingitmoreaffordablefortaxpayers. TheAPIbasedsolutionthatconnectstheiPadapptoAmerigroupsinternalsystemsiskeytoadvancingthe efficiencyandcapabilityofAmerigroupsassociates,allowingthemtoreducetimespentonadministrativetasks andincreasetimespentwithmembers.Andwithrealtimeinformationgatheredfrommembers,Amerigroups timetodecisionmakinghasbeengreatlyreduced. Goingforward,Amerigroupislookingatextendingthesolutiontobusinesspartners,whichincluderadiologists, testandlabservices,andhospitalsthatwouldthenbeabletosubmitclaimsdirectlytoAmerigroup,further streamliningandsimplifyingtheclaimsprocess.

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