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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. 

Cloud-Based Web Application for Clinical Trial Design and Optimization 

Challenge 

Our client, a multinational statistical software development and contract research organization, is one of the largest providers of statistical software and advanced analytics for clinical trial design and execution. They sought to develop a cloud-based web application to optimize clinical trial design and management, aiming to reduce risks, improve operational efficiency, protect patient safety, and enable informed, data-driven decisions during initial trial design and on an ongoing basis. 

The objectives were to launch a multi-tenant SaaS application, offer real-time trial design alterations, enhance engine capability to handle more complex algorithms, provide a premium user experience, enable real-time application monitoring, and facilitate easy customer onboarding. Additionally, the application was intended to help development teams reach data-driven consensus rapidly and collaboratively through interactive visuals. 

Solution 

Emids’ dedicated teams embarked on the journey in February 2020, starting with knowledge transfer sessions and stakeholder visits. We built a robust foundation with the formation of core and scrum teams, and an initial four-week immersion in the client’s location. 

We focused on incorporating agile framework and practices into the client system, with regular sprints to accelerate the alpha release. Infrastructure recalibration, architecture optimization, and automation were some of the key steps towards the successful alpha release. 

The solution’s architecture was designed to be highly scalable, with a microservices-based approach and built-in application performance monitoring. We leveraged tools like Jest, Xunit, and JSLint for unit testing and integrated code quality reports. The CI/CD pipeline was automated, and we used CoreAccel and Pendo integration to enhance the platform’s functionality. 

Outcomes 

By deploying multiple scrum teams with domain and technology expertise, we fast-tracked development and launched the application 1.0 within two quarters of engagement. The result was a green field, cloud-based SaaS platform with end-to-end ownership, from architectural design and product ownership to production deployment. 

The new platform, equipped with superior compute power, can simulate 150k models simultaneously, providing real-time notifications. The platform has increased the probability of success for clinical trials and saved weeks to months of time by achieving consensus faster. It has delivered a potential business impact of 10-20% cost savings for drug trials and a 10-20% reduction in drug trial durations. 

The engagement also led to the development of a highly secure SDLC, compliant with OWASP top 10 web application security. By following a test-first approach and using code quality tools, we reduced defects and prevented manual errors. This successful engagement has underscored Emids’ dedication, nimbleness, and impact, making a real difference in the field of clinical trial design and execution. 

Unifying Data and Streamlining Service Delivery for a Health Benefits Administrator 

Challenge

Our client, a full-service Third-Party Administrator (TPA), serving a significant number of lives across multiple employer groups, faced a series of operational and technological challenges. Their growth strategy, involving the acquisition of multiple TPAs, led to a decentralized and siloed IT landscape, resulting in increased operational costs and complex data management. Their outdated legacy web portal for population health management was inefficient, leading to missed performance benchmarks in clinical case management and quality outcomes.

Moreover, the disparate systems and data structures across TPAs resulted in scalability issues, lengthy data load times, and relied heavily on manual processes. This resulted in non-uniform models and structures, thereby affecting data quality and trust.

Solution

To solve these challenges, we partnered with the client to undertake a series of transformative initiatives aimed at improving operational efficiency and service delivery.

Unified Data Platform (UDP)

Recognizing the difficulties posed by data management across multiple TPAs, we embarked on a project to create a unified data platform. The goal was to consolidate, rationalize and standardize data assets, effectively creating a single, comprehensive source of truth for business intelligence and analytics. The process involved careful planning, design and development, ensuring that the new platform could seamlessly integrate data from the various systems and formats previously in use.

Population Preventive Care (PPC)

To improve the efficiency and effectiveness of the client’s disease management processes, we developed a new product offering named PPC. This initiative was based on the existing Disease Management (DM) care gaps addressal process but aimed to provide a more robust and comprehensive solution. A critical part of this project was the development of a new multi-tenant clinical portal. Built using Design Led Engineering, this portal integrated all necessary member data in a single, user-friendly interface, greatly enhancing the efficiency of case managers and nurses.

Online Portal 2.0

Alongside these specific projects, we also recognized the need for a comprehensive, unified platform for various client services. We worked closely with the client to understand their specific needs and goals, leading to the development of a new portal integrated with the UDP. This platform, dubbed “Online Portal 2.0”, was designed to be highly intuitive and user-friendly, providing a seamless experience for both the client and their customers.

Payment Gateway Integration

Recognizing the importance of a seamless payment process, we integrated the client’s online platform with a payment processing solution. This project required careful coordination with various stakeholders and thorough testing to ensure secure, reliable operation. The result was a significantly improved user experience, empowering patients and members to make payments easily and securely.

Throughout these initiatives, we provided staffing services and implemented Agile project management methodologies. This approach ensured efficient project planning, tracking and reporting, and it allowed us to adapt and respond to any challenges or changes that arose during the projects.

Outcomes

The partnership led to significant positive outcomes. The creation of the Unified Data Platform resulted in a single, trustworthy source of data for all TPAs. This improved scalability and significantly reduced data load times, thereby overcoming one of the major challenges the client was facing. The new PPC product offering and the development of a clinical portal increased the productivity of case managers and nurses. By providing comprehensive member data in a single location, it became easier to identify care gaps, conduct screenings and provide preventative care.

The user experience was also enhanced by integrating the payment gateway, which facilitated easier and more streamlined payment processes. The engagement showed steady growth, starting with a small team and expanding to a large team with a high retention rate. This growth was accompanied by multiple successful releases, including the rollout of the new online portal, improved messaging and other feature enhancements.

This engagement exemplifies a comprehensive digital transformation journey, highlighting the immense value that strategic partnerships can deliver in overcoming complex operational and technological challenges.

Taking a Design-Led Approach to a Provider Portal Experience

Availity, a benefits and claims management platform, facilitates over 4 billion clinical, administrative and financial transactions annually for their payer & provider network.

Facing market pressure from customers and competitors, Availity wanted to take a blue sky approach and reimagine their provider portal to reduce the overhead that resulted in calls to support. They turned to Emids for their design-led approach to product creation.

Emids and the Availity product team worked to ideate, research, and deliver on an experience prototype, initially solving for a narrow slice of the workflows that could be scaled to the entire platform. 

With an advisory committee, composed of existing end users spanning organization size and specialty, the Emids team implemented an agile, iterative design and research framework that allowed for the quick creation of design concepts that could be tested with end users before the next iteration.

The final experience design was delivered in the form of a clickable Invision prototype.

End users were delighted by the reimagined portal experience, remarking how quickly and frictionless formerly confusing processes were made, which will no doubt reduce the need for phone calls to health plans for support.

My Diabetes Coach – A Holistic Care Management Solution

The My Diabetes Coach solution is designed to improve and strengthen the teamwork between parent and child in diabetes management. Establishing and encouraging good practices and patient compliance at an early stage will provide significant benefits to the patients over the years by mitigating the complications that can result from non-compliance.

Most diabetes management solutions on the market today function as logbooks for keeping track of blood glucose levels and some connect to Bluetooth enabled glucometers to make the collection of this data quite simple. However, as anyone with diabetes knows, the measurement of blood glucose levels alone do not paint the entire picture of your condition or your progress towards meeting goals set by your clinician. Diet, exercise, sleep, stress, body weight, and medication compliance all play an important role in mitigating the impacts of the disease but these can be daunting to manage for anyone suffering from diabetes, let alone a youth or young adult recently diagnosed.

Along with contributions from the Children’s Hospital of Eastern Ontario, Healthwise, & the University of Ottawa, we’ve developed a diabetes care management solution that builds upon the features of many logbook applications as part of a larger, more holistic solution that gains context from multiple devices and patient data to help youth with type 2 diabetes better manage their care.

At its core, My Diabetes Coach is a cloud application that leverages a companion mobile app to collect data from a variety of connected devices like sleep trackers, weight scales, blood glucose monitors, and patient-centered data like daily food intake. The cloud application also pulls data from Healthwise, a rich library of content for both physicians and patients on managing various diseases, and converts it into a format that will lend itself well to providing guidance to the patient. The Alexa skill makes entering data quick and easy, while also allowing the patient to ask questions about their daily targets or for help with food choices to keep them on track.

My Diabetes Coach in Practice

Clinicians and parents play an important role in setting specific goals and objectives for a diabetic patient to achieve and to reinforce those goals and objectives, but they are often not enough. My Diabetes Coach complements and enhances the initiatives of the clinician and members of the patient’s circle of care. The voice interface is used to provide access to typically asked questions and is used to improve patient engagement by making patient information that much more efficient to capture or access.

Through elements of gamification, the voice skill can also encourage and reward patients who are monitoring and managing their care effectively while providing advice and guidance to those that are struggling. The conversational user experience developed for the skill is designed to establish a relationship with the patient and provide guidance and mentorship as a trusted coach would. By understanding the patient’s context and integrating an AI engine to deliver relevant and empathetic responses to voice queries, the solution provides customized care for each user according to their specific needs.

How Did We Build It?

My Diabetes Coach is built upon Emids proprietary application-development system called Hive. Hive takes a backend as a service (BaaS) approach and aggregates common pre-built microservices, or cells, that include authentication, authorization, data storage modeling, notifications, and background processing.

The solution is comprised of a custom developed mobile application that runs on both iOS and Android and provides direct connection to Bluetooth enabled devices (such as a weight scale, blood glucometer, Fitbit or other wearables), allowing the patient to record the necessary information from wherever they are located. The mobile application integrates with Alexa via AVS calls to enable access to the MyCoach skill when the patient is out of the house.

The Alexa Skill and mobile application are supported by a cloud-based backend application that communicates directly to the Alexa Skills Kit (ASK) and provides data storage for any patient information. Patient Health Information (PHI) is stored separately from other data in a manner that ensures HIPAA compliance.

The MyCoach Alexa skill is integrated into the cloud application so that it can leverage data collected from the mobile application and patient portal (and stored in a common database) to provide customized responses according to how well the patient is managing their care and according to the specific goals set by the clinician.

The My Diabetes Coach solution is designed to improve and strengthen the teamwork between parent and child in diabetes management. Establishing and encouraging good practices and patient compliance at an early stage will provide significant benefits to the patients over the years by mitigating the complications that can result from non-compliance.

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.

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.