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Strategic Integration & Engineering for a Large RCM Solution Provider 

Healthcare organizations operating in revenue cycle management (RCM) face the challenge of optimizing financial outcomes while ensuring a seamless patient experience. For one large RCM solution provider, this mission was hindered by inefficiencies that impacted operational effectiveness and client satisfaction. Recognizing the urgency for transformative change, Emids partnered with the provider to deliver innovative solutions that addressed their most pressing challenges and unlocked measurable results. 

Challenge 

The provider faced mounting challenges that hampered its ability to meet business goals and client expectations. Manual processes consumed excessive time and resources, leading to high operational overheads and inefficiencies. The existing research and development (R&D) processes were rigid, causing significant delays in the delivery of features and impacting the provider’s ability to stay competitive. Onboarding for data licensing services was another pain point, with timelines stretching up to eight weeks and creating dissatisfaction among clients. Furthermore, prolonged transaction times during patient access workflows introduced bottlenecks, detracting from the overall user experience and client trust. 

Solution 

Emids approached these challenges with a strategic and holistic solution. At the core of the engagement was the introduction of the Right-Speed R&D Model—a flexible framework designed to optimize costs without compromising speed-to-market. This model reduced R&D spend by 40%, enabling the provider to deliver value faster and more efficiently. 

In addition, Emids automated key operational workflows, reducing dependency on manual processes and achieving significant efficiency gains. The onboarding process for data licensing services was revamped and streamlined, cutting the timeline from eight weeks to less than two weeks. To tackle transaction bottlenecks, Emids implemented optimized systems that reduced patient access transaction times from 30 minutes to just a few seconds. These targeted interventions were instrumental in driving operational excellence and elevating client satisfaction. 

Outcome 

The strategic collaboration between Emids and the RCM solution provider resulted in impactful and measurable outcomes: 

This partnership underscores Emids’ ability to deliver customized, impactful solutions that drive tangible results in the RCM domain. By addressing critical inefficiencies and fostering innovation, Emids empowered the provider to achieve its business goals while enhancing client satisfaction and operational excellence. Know more about how we are solving problems for HealthTech with strategic solutions. 

How a Large National Payer Reaped the Benefits of Strategic DevOps

How a Large National Payer Reaped the Benefits of Strategic DevOps

Modern software and IT organizations are defined these days by Agile and DevOps. The goals are to increase efficiency, accelerate time-to-market for new applications and services and be more responsive to customer needs. In 2017, Forrester Research reported that 50 percent of enterprises are implementing DevOps in some fashion. However, progress is slower than it could be, because these methodologies require fundamental transformations in how team members work. As such, new tools, new skill sets, new processes and new mindsets are required.

For QA teams, specific hurdles include changing workflows to move testing earlier in the cycle, mastering technical tools needed for automation and working at a faster pace that requires more frequent collaboration. Oftentimes, organizations don’t have months to figure out how to transition, so they jump in with mixed results.

Our customer, a large national payer, decided to be proactive and establish best practices upfront. Like many large companies, they are in the midst of a massive digital transformation project. In 2017, the company launched an initiative to improve member engagement, coordination of care and quality of care across 20 million members. Digital tools such as interactive mobile apps and analytics are core to their strategy. The data coming from those programs will help them understand and manage populations for better outcomes. Given the fast pace of change in consumer technology, they needed to embrace Agile and DevOps models.

Project leaders knew that effective collaboration between all stakeholders including business analysts, QA and developers would be necessary. They wanted to implement two-week sprint cycles, incorporate big data technology and test across multiple platforms and devices. This was a lot to accomplish within those tight time frames.

As we began partnering with them on their DevOps transformation, we recommended a strategy that incorporated in-sprint automation and a shift-left orientation. This involved moving testing activities earlier in the sprint, aided by automation, so that QA could keep pace with the volume of test cases and catch problems immediately instead of during the next sprint. These practices align well with continuous development and continuous testing, hallmarks of DevOps. Plus, since automated testing tools typically require coding skills that most manual testers don’t have, we recommended a platform incorporating scriptless automation. That means testers can use business language to write cases, allowing them to ramp up quickly. We also integrated the automated testing platform with Rally to get automated results and defect reporting.

We were thrilled to learn that our customer realized some great benefits from this approach. The highlights included a 15 percent time savings in test planning, 60 percent time savings in regression testing, faster time-to-market and $500,000 annual cost savings by using a framework that eliminated the need to have deeper coding for every Quality Engineer. With a majority of the teams adopting in-sprint automation, they are well on its way to establishing a mature DevOps practice.

DevOps can be an exciting shift for everyone on the development team, including QA. People are able to implement new ideas faster and experiment with the latest technologies. Developers and testers can learn from each other to improve products on the fly, and end-users are happier. Ensuring that your team has the proper training, tools and senior-level support to make this shift will keep your best people on board and help the organization reap the benefits of DevOps and Agile faster.

Advancing Population Health Management and Automating Coding Through NLP

Global Leader of Healthcare Coding Software Brings Enterprise Technologies to Fruition

Overview

The client is a global leader in coding, classification, grouping and performance management software and consulting services for 7,500 hospitals in more than 20 countries worldwide. The company provides intelligent software, data analytics and strategic expertise to help providers as well as government and commercial payers simplify health information and payment, analyze risk and manage population health as they shift from volume- to value-based care. Their innovative algorithms, software and services have saved customers millions of dollars and improved clinical performance and quality of care for thousands of healthcare organizations across the globe.

Business Opportunity

The client was working on several enterprise projects, but needed help to push them forward. One project involved building an internal natural language processing (NLP) tool to improve the automated capture of critical clinical data needed to optimize coding for billing and diagnosis purposes. Another project evolved from an idea the client had to use terabytes of data across their customer base to create a population health management platform that analyzed information on patient populations and financial performance, with the goal of providing insights to help providers improve care and reduce costs.

With their current staff busy maintaining and enhancing their existing product portfolio, the company lacked the development bandwidth to turn these ideas into realities. They needed a global partner with deep healthcare IT knowledge and Agile training that could provide rapid development resources and experience with deploying technologies in cloud-based environments. Product development for the population health platform was highly complex. Not only did the product need to be housed within the client’s next-generation platform, but the number of internal and external health information systems involved in exchanging the data posed significant integration and interoperability challenges.

Solution

The client turned to emids for help modernizing their platform and developing frameworks for these new technologies. We formed scrum teams across three cities—Nashville, Salt Lake City and Silver Spring, Maryland—to augment their internal teams, ramping up production within eight weeks.

Initially, we provided development support for the population health platform, with two self-contained teams working on user experience-based elements of the new product. But we soon began proactively helping the client’s internal teams with back-end integration so they could keep pace with completion of the front-end elements.

The client was using a third-party vendor to provide data analytics and algorithms for the product. They needed to exchange data with the vendor securely through the cloud, but lacked expertise on how to make this happen. We were able to quickly grasp and resolve these integration issues, eventually taking the lead on these more complicated elements. We worked directly with the vendor to determine how the integration and encryption should occur, experimenting with different solutions before settling on one and establishing a proof of concept.

We created a cloud environment through an 1,800-plus server farm on Amazon Web Services and established the secure transfer of the data, enabling the information to flow in an efficient, meaningful way, encrypt at the appropriate time and return analytics quickly.

Technologies Used

Results

While our work with both of these engagements are ongoing, we have helped the client meet their initial deadlines for bringing these projects to fruition and transforming them from concepts into viable technologies ready for the first phase of internal testing. Our team of healthcare experience technologists, which included 50 people at peak, jumped into both projects quickly and have added value uniformly and quickly.

We understood what needed to be built to execute the projects and assembled teams with deep healthcare knowledge to help drive their development. With the population health project, we worked closely with the client to flesh out the engineering for the product and set its direction. We helped anticipate and resolve issues before they became problems, even taking the initiative to collaborate with the third-party analytics provider that came on board to keep the engagement proceeding smoothly. The client still raves about how the initial prototype of the product matched their vision and met their needs right out of the gate.

We have continued to deliver new functionality for these projects, overseeing production releases every two weeks. The NLP tool we are developing for the client has enabled them to quickly explore the impact of different scenarios for coding by changing the rules for the automatic capture of clinical data. This process used to take days, but we have helped the client shorten the turnaround to few hours.

Developing Award-Winning EHR Technology for Care Transitions

Leading Long-Term Care Provider Develops Award-Winning Software Applications to Advance Their Mission

Overview

The client is a leading long-term care provider operating more than than 200 skilled nursing homes, assisted living facilities, Alzheimer’s centers and retirement communities across the U.S. Their facilities offer multiple levels of patient care, from skilled nursing to independent living, and also provide Alzheimer’s and dementia care, post-acute care, inpatient and outpatient therapy and on-site physicians. Campuses are centered around residents and provide a homelike environment that differs from more traditional long-term care settings

Business Opportunity

The provider was using a software bundle from a third-party vendor to manage clinical processes and all other activities related to resident care. The software was not intuitive and did not fit well with their mission or the overall processes the provider used to care for residents. The technology was also not scalable enough to support the volume of patients at each facility and the number of activities that needed to be processed on their behalf. Dependency on the vendor hampered the provider’s ability to easily and quickly customize, scale and update the software, and gaps in compliance with mandates led to increased costs. The company did not want the software to dictate how they cared for residents and wanted more control over their technology infrastructure, so they decided to develop their own suite of software applications piece by piece.

The provider faced several challenges in this endeavor, including:

Solution

emids came on board to help the long-term care provider develop their first software application: an incident management system that provided staff with a consistent process for tracking and addressing incidents that arose among residents. We set up a product engineering team to help the company with end-to-end development, rollout, support and maintenance of the application. We also introduced efficiencies into the process by adopting Agile product development methodologies and assembling an enterprise production support team.

After the successful deployment of the first application, company leaders envisioned more modules they wanted to create—and the engagement grew to include the development of applications for clinical, therapy and rehab systems.

Restrictions on proprietary software from the previous vendor made it difficult to obtain documentation from existing applications and apply it to new modules under development. Therefore, the development process required constant communication and collaboration between emids and the provider to ensure newly designed applications would meet the needs and expectations of the business.

The company also turned to emids for help developing a resident information and tracking application, user and patient portals, and an electronic medical record (EMR) for its physician group that met Meaningful Use (MU) requirements. We analyzed and delivered requirements for the new EHR application within a month, giving the client more time to prepare the business case and helping board members make the most informed decision.

Technologies Used

Results

Not only has emids helped the provider successfully build their own suite of integrated software applications, but we have also continued to upgrade, enhance and maintain these technologies, while keeping them aligned to the evolving needs of the company and changing regulatory environment in healthcare. Our partnership has helped the client accomplish their core mission of providing resident-centered care and break down barriers to innovation.

emids’ technology work with the provider has even resulted in award-winning recognition for the company, including McKnight’s Excellence in Technology gold award for care transitions technology in 2015. The award praised interoperability features in the provider’s EMR system that import essential clinical and care information from disparate systems outside the network into patient health records to ensure no medication, diagnoses or other vital information is missed or misinterpreted.

Population Health Provider Boosts Quality and Customer Satisfaction for Member Health Solutions

Overview

The company is a major population health provider and independent subsidiary of a top U.S. health insurance provider. Its suite of products caters to large health plans, delivering analytics and decision support tools to help improve the health of their members.

The company’s wellness apps, care management, condition management and other mobile/web apps serve a population of 20 million consumers. The products analyze clinical data, such as lab results and pharmacy records, from submitted claims to provide suggestions and recommendations to improve member health.

For instance, data from these different sources can be analyzed to show risk for a patient developing a particular condition, such as diabetes. The mobile apps are monitoring 64 million patients and generating a savings of $1,856 per nurse-engaged member per year, along with a 6.1 percent reduction in admissions for disease management participants.

Business Opportunity

Despite having a well-rounded suite of population health products to serve a wide variety of constituents, the company was struggling with quality management and a higher than average quantity of user complaints. It lacked standard testing and quality assurance (QA) processes, resulting in challenges achieving time-to-market goals and high costs for development.

These issues were hampering the company’s ability to compete in the market and achieve optimal patient management and cost reduction goals for clients.

Solution

emids came on board to establish a practice for integrating business analysis (BA) and QA roles that included the creation of a comprehensive testing center of excellence for the client along with other processes implementation across the development cycle. By merging the BA and QA roles, the client benefited from more comprehensive test coverage, incorporating both user stories and acceptance criteria. The BA-to-QA model placed individuals with both sets of skills on each end of the process, telling developers how to build the feature at the outset and ensuring they did it right upon completion.

We provided an initial assessment, instituted best practices, integrated BA and QA recommended tools and conducted Agile training and test automation across the company’s entire portfolio of products. The engagement has ramped up to more than 220 emids team members today, located in both offshore and onshore offices to facilitate 24-hour workflow coverage.

What started as a BA and QA engagement has now matured into a much broader initiative based on overall quality and time-to-market improvement, with services expanding to include delivery and management for product development and infrastructure support.

Results

The BA/QA integration we provided enabled the company to uncover defects early in the development process and helped identify metrics that contribute to the overall quality of the product. The establishment of testing center of excellence and institutionalization of best practices led to improved performance metrics year on year across BA and QA functions.

Migrating to Cloud Platform for EHR Vendor

The Challenge

The client’s legacy EHR application, which was initially developed to enable physician productivity and provide superior clinical experiences, needed to be migrated to a cloud-based environment that would support the client’s key business objectives, including: scale for growth, ease of access and integrations aligned with the growing business needs of the end-consumer. Unfortunately, bandwidth constraints hindered the client’s initial migration initiative, leading to missed go-to-market commitments and non-compliance with MU mandates.

Our Approach

We developed an extremely aggressive migration schedule for the EHR application, with a staggered go-to-market strategy and multiple releases in one year. The emids Healthcare Practice team achieved this goal by acting as the interim product owner, defining modules and sequencing throughout the project. The team updated the legacy EHR and practice management system to the latest .NET stack, with a configurable message exchange platform, allowing for more flexibility in integrations.

In 18 months, the team delivered a fully cloud-based EHR and a new interface engine that connected the client’s EHR with external systems. The resulting project management plan was also fully aligned with the client’s businesses priorities, especially regarding faster go-to-market.

Value Addition for the Customer