Case Study

Application Rationalization

Benefits delivered by Stackyon

  • PBM was able to go to market 5x faster than traditional app development processes
  • A 4x reduction in the application development costs
  • Achievement of a 305% ROI within just 4 months of deployment of the new platform
  • Average benefits of $1.4 million realized within the first year after deployment
  • Real time data availability and insights for ‘informed decisions’
  • Easy integration of 7 large and disparate legacy applications
  • Large US based health insurance company uses Stackyon to consolidate and streamline multiple applications and programs for fraud, waste and abuse of prescription drugs.

    Fraud, waste and abuse are problems that plague almost every sector of health care in the United States. Estimates put the annual cost-to-taxpayers in billions of dollars, ranging from as much as 3% to 10% of all health care expenditures.
    To address this constant increase in fraud, waste & abuse; as well as meet regulatory compliance requirements, our customer was using an extensive array of applications for tracking, analyzing and reporting the usage of prescription drugs. But despite continuous management of these applications, the company faced several challenges such as:

    Inability to get a 360o view of the patient across all clinical programs

    Reporting was delayed by weeks due to the need for manual work

    A loss of $1.5 million after a consolidation project failed to deliver after several months of development efforts

    About the company

    The company is one of the largest providers of health insurance and pharmacy benefits in America, with annual revenues of over $50 billion. As a company of this scale, the company needs to deliver not only good customer experience but also meet stringent regulatory and compliance requirements. This is not an easy goal and the company has to continuously innovate for providing members with a simplified experience to a complicated and confusing benefits system.

    Need for a new platform

    With close to a million patients being managed, the (multiple) legacy systems were proving to be highly inadequate – they were not integrated, required substantial manual work that often led to errors. This caused SLAs to be missed and service delays for patients.
    The company evaluated several solutions for the development of a Centralized Clinical COE application that addressed all the lacunae of the legacy system and brought in advantages of Cloud & AI technologies. The options evaluated were traditional dev processes as well as existing low-code dev platforms.

    The Stackyon advantage

    Stackyon was selected as the preferred platform as it provided several key benefits over the other solutions. These included:

  • Easy setup of automation & workflows – Both business and dev teams were able to visualize the process flows in the Development Studio canvas, and this improved collaboration between them and also helped reduce the dev time substantially. Stackyon provides extensive automation features for processes as well as backend data processing. This capability was important for reducing manual tasks and improves throughput.

  • Extensive integrations via plugins– Stackyon provides a wide choice of out-of-the-box integration plugins that helped reduce the development time for integration with other systems. It also provided features to easily add custom code wherever necessary, and the code can be in any language.

  • Shorter dev time – The teams were able to configure the flow and business logic through the visual interface which reduced the development time from 24 months (originally estimated through traditional development) to just 4.5 months.

  • Lower cost – By using the new low-code approach, the Clinical COE application was implemented in a 4x less cost than the traditional development approaches.
  • Features of new application

  • Automation of patient risk identification, with details about factors contributing to risk
  • Automation of workflow routing between CSRs, Pharmacists, providers and Claims examiners
  • Automation of generation of patient reports.
  • Ability to quickly change the risk identification rules based on changing prescription trends
  • 360 view of patient records and clinical interventions
  • Seamless integration with core adjudication system and other enterprise systems