The Payer of the Future: Modernizing Health Insurance with API-led

connectivityMay 2016

Matt SernaIndustry Marketing, MuleSoft

• Health insurance is in a state of continued disruption

- Transition from fee-for-service to value-based care

- Technology transforming care delivery

- Increasing importance of member and provider engagement

State of health insurance in 2016

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Engagement and connectivity

• For providers:- Improved care for patients- Increased retention in

network

Why engagement matters more than ever

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The challenge: Personalized engagement requires real-time integration of multiple systems of record in order to provide a full 360 view of the member or provider.

• For patients- Proactive, preventive care- Member retention- Cost savings

Praveen MuruganSolutions Architect, Healthfirst

Quinn SolomonPrincipal, Deloitte

Speakers

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Quinn SolomonPrincipal, Deloitte

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Praveen MuruganSolutions Architect, Healthfirst

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Who are we?

Healthfirst® is a not-for-profit health insurance company sponsored by some of the most prestigious hospitals and healthcare systems in New York.

We serve close to 1.2 million members in New York City and in Long Island through government-sponsored programs including Child Health Plus, Medicaid, Medicare Advantage, and Managed Long Term Care (Senior Health Partners), as well as through private health plans including Healthfirst Leaf and Qualified Health Plans, offered on NY State of Health, The Official Health Plan Marketplace

We are the only Medicaid Plan in NYC and Long Island rated 5 stars two years in a row.

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Who are we?Mission

To ensure that our members have superior healthcare and satisfaction. We will fulfill this promise through our partnerships with providers and, together, will transform the system so that it is accountable for the cost and quality of healthcare for our populations.

Vision To treat our members with the same care and attention we would want for our own families.

Values Members first. We exist to serve our members. Their satisfaction and well-being is the best barometer of our

success. Quality execution and continuous improvement. We chase perfection in order to catch excellence and we know we

cannot rest on past success. Excellence, willingness to change, and continuous improvement are our only paths to the future.

Employee success. Our employees are our greatest asset. We strive to create an environment where every employee has the tools, feedback and opportunity to excel and grow professionally. The success of our employees guarantees the success of Healthfirst.

Cooperation. Our success depends on our ability to overcome challenges better and faster than our competitors. To do this, our employees at all levels must work together as a team regardless of their functional departments.

Integrity and transparency. We work at the highest level of openness, honesty and integrity. We honor our commitments and keep our promises. Transparency fosters trust.

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Business Transformation for Vision 2020GOAL: To be the pre-eminent health plan in our market by 2020

Business Transformation Initiatives: Multi year projects aimed to deliver superior customer engagement, improve population health and drive cultural change to enable Healthfirst to become industry leader

Identify and Clean Existing Processes

Build robust MDM solution

API Led Connectivity

Improve Member and Provider Services

Build new Sales, Broker and Employer Service Units

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Member & Provider Services – Previous Architecture

Project: Improve Member and Provider Services

End User Pain Points

Reps move between multiple applications to service members and providers which leads to increased resolution time

Inability to manage cross-functional processes creates inconsistency and duplication of work

Thick client requires updates to be pushed to representative machinesTechnical Debt

Point to point connectivity No single source of truth for members

and providers Batch oriented update transactions

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Member & Provider Services – Current Architecture

Project: Improve Member and Provider Services

Improvements

Reps get 360o view of members and providers

API based integrations to all backend systems

API based integrations to BPM system to create and receive status of inter-department processes

Real time updates instead of batch updates

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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API Led Connectivity using MuleSoft

API Gateway

Leveraged OOB Security, QoS and Compliance policies

Built custom logging policies Created and published

documentation on API Portal

API

RAML first approach to building APIs

Standardized logging, exception handling and alerting across all APIs

Leveraged MuleSoft enterprise security components

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Performance

Performance Requirement: All responses had to be <= 3 seconds

How was it achieved?

Salesforce page designed to load member and provider 360 details in several cards

Parallel callouts to APIs from Salesforce to load cards

Smaller and faster queries vs larger and slower queries

Parallel callouts to DB from MuleSoft(Scatter-Gather)

Enabled connection pooling on MuleSoft

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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Summary

Cloudhub helped us be project ready in a very short time

OOB features on API Gateway minimized development effort

RAML first approach for better REST APIs. Enabled mock services for parallel development.

Standardizing on logging, exception handling and alerting frameworks ensured consistency across projects

Leveraged Anypoint Exchange private library to upload sample projects/template to help developers

Increased adoptability and reusability of APIs across enterprise by documenting on API portal

The information contained herein is CONFIDENTIAL AND PROPRIETARY. Do not disseminate, distribute or copy.

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What’s next?

Setup Anypoint MQ

Operational housekeeping Build Process to Archive Logs Build health checks for APIs and boundary systems

Will be hosting close to 100 integrations by Q2 2017

Q&A