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Humana leverages the web: web-based applications facilitate systems integration. (Systems Integration).

Now that most of the hype surrounding the dot-com revolution has been laid to rest, companies are rediscovering the true value of the Web. For Louisville, KY-based Humana, that has meant achieving systems integration by using Web-based applications. But this national health plan organization--with more than 5 million members--also has expanded its online offerings to employees, physicians, vendors and members.

"When I joined Humana in 1999, we had a limited Web presence," recalls Brian LeClaire, vice president of information technologies. "It was generally a marketing site."

LeClaire credits Humana's Chief Information Officer, Bruce Goodman, with deciding that a more strategic Web presence was necessary. At first, the search was on for a "tool kit" that would allow Humana to build out its existing website. But after weighing several options and looking at products from various vendors, LeClaire, says his company chose HealthWeb by The TriZetto Group Inc. "It was a jump-start implementation," LeClaire explains. "It came with a lot of capability already in place. We just needed to configure the pieces."

Defining Parameters

Many of the challenges faced by Humana during the initial implementation of HealthWeb are typical of companies that are expanding their offerings over the Internet.

One question Humana senior management asked was, "Now that we've laid the pipeline, how are we going to leverage it across Humana?" To answer that question, the company formed an in-house "e-adoption group" which, with feedback from Humana's provider, agent/broker and member base, has been prioritizing initiatives based on the system's current and future capabilities.

Installing in-house Web servers meant Humana no longer had to use an outside hosting service and ensured the safety of mission-critical data. But there was another big challenge, notes LeClaire.

Since HealthWeb was able to provide a single point of entry into the organization, Humana needed a way to seamlessly integrate all of its internal systems. What complicated this problem was the fact that Humana's internal claims processing systems were being run on three separate legacy platforms.

However, TriZetto, based in Newport Beach, CA, did not see this as a major problem. According to Gall Knopf, chief operating officer of TriZetto's HealthWeb business unit, the use of predefined templates, as well as configuration utilities that allow the templates to be easily changed, gives HealthWeb's e-business platform the flexibility healthcare organizations need to give it the look and feel of a personalized website. It can also be connected to an organization's existing database. "When our teams went in, Humana decided to create database which they call their Operational Data Store," she says.

LeClaire explains that this database was, in fact, placed inside an area (or layer) called the "Corporate Information Factory," and is one of three separate areas of functional operations. The others are an area for core application systems and an area for e-business applications.

Humana also separated its e-business layer from its core-business layer using a messaging layer for common transactions. The system currently uses MQ Series middleware in its messaging layer, along with an intelligent router for cross-platform transactions. In essence, it works like a funnel, LeClaire explains. When a transaction (like an ID card request) is made, it is automatically routed to the appropriate back-end legacy system.

But LeClaire notes that his organization is moving toward XML (a generally-accepted standard residing in a network's middleware layer that can tie together different types of computing platforms) to gain more flexibility in the way data is represented and displayed.

In the meantime, though, Humana is upgrading to ANSI X. 12 to satisfy the requirements of the Health Insurance Portability and Accountability Act (HIPAA). "By October 2002, we will be HIPAA compliant," LeClaire predicts. Knopf notes that end users--health plan members, physicians and other constituents--need only a Web browser to use HealthWeb, once a relational data base has been created. "The software reads directly from that database," she says, adding that HealthWeb also can interact directly with a health plan's back-end system using XML without creating a separate staging database.

While XML will give Humana total systems integration, Knopf says, "It doesn't matter what kind of systems you have. Humana has three homegrown systems and we interact with them using IBM's MQ Series." Humana and TriZetto began working together in October 1999 and the site went live in March 2000. "In five months, we went from a marketing website to a service-oriented website," says LeClaire.

Adding Value

Calling HealthWeb a "channel," LeClaire says, "We developed four separate portals and we also have an intranet site." Portals now exist for members, providers/physicians, agent/brokers, and employers. He says members are especially pleased to have a way now to conduct business online.

Because most members are concerned with security on the Internet, LeClaire explains that "signing up to use the Web" means just that. "We put them through an authentication process. They pick an ID and password. Then, through the regular mail, we send them a letter with an access code, and that unlocks the access to their information."

It has been almost two years since Humana started offering online services to its members. Now, members can get detailed eligibility and benefits (including pharmacy) information, check their claims status, and order ID cards.

With the incorporation of "ePlan," a product offered by TriZetto as part of its HealthWeb suite, members can choose from a menu of only those areas they wish to access.

Customer service representatives also use ePlan to access the same information that members can see on their own PCs. However, customer service reps are getting that information from behind Humana's firewalls, LeClaire says.

Not only is it more convenient for members to get information online, but it's also more cost effective. "Health plans are averaging three calls per member per year into their call centers. And the average cost for these calls is $3 to $10 per call. Humana estimates that it gets 20 million calls per year, costing about $4 to $5 per call," says Knopf.

Serving Providers

Members aren't the only ones now benefiting from Humana's revamped website. Providing online access to physicians became a necessity and Humana entered into an agreement with Blue Cross/ Blue Shield of Florida to create a physicians' portal called "Availity," says LeClaire. But security was a major issue. "For physicians, we had to build a more flexible and secure model."

Knopf agrees, saying HealthWeb's easy-to-use utilities provided the means to limit access only to those physicians who need to see data on a particular patient. "You can set up rules for roles based on their log-in and authorization," she says.

LeClaire explains that because physicians often belong to more than one practice group, only those physicians directly responsible for a patient's care can see the claims for that patient. If a physician leaves a particular practice group and the group administrator deletes his name from the list, he can no longer gain access to claims information on any patient in his former group. Anticipating the challenges of future connectivity, LeClaire says, "The Internet isn't the end of the connectivity pursuit for Humana. We're looking at broadening to other platforms, other routes."

Handheld devices, which have become very popular among physicians, would be relatively easy to incorporate into Humana's Web-based system. "The front end of the handheld is a browser-based application," says LeClaire. He admits he has already begun a pilot program incorporating handheld devices, but he says a lot depends on the industry's acceptance of a standard. "We're waiting to see how the standards, Bluetooth for example, work themselves out. When it does, we'll build the right access layer."

Although Humana is relying on HealthWeb to serve as its backbone, it also has a direct link to WebMD which, LeClaire says, "is another spoke into the hub." But WebMD does not link to TriZetto's HealthWeb, he notes. There also is no link between HealthWeb and Humana's intranet. In fact, LeClaire points out, "You have to be inside Humana's network and inside the double firewalls for access into the intranet."

Building that kind of security into its own network is an example of how serious Humana is about protecting data that can be accessed through its website. "We hold privacy needs at the highest level," LeClaire says. "We have hired outside consultants to try to infiltrate our system. Our infrastructure has stood up to the test."

Richard R. Rogoski is a free-lance writer and a contributing editor to HMT. Contact him at rogoski@aol.com.
COPYRIGHT 2002 Nelson Publishing
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Copyright 2002 Gale, Cengage Learning. All rights reserved.

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Author:Rogoski, Richard R.
Publication:Health Management Technology
Geographic Code:1USA
Date:Jan 1, 2002
Words:1408
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