By Michael Josephs, CIO, ISG Services
Collectively with our valued clients, ISG Services will process more than 16M workers’ compensation medical bills in 2014. This effort consumes a significant amount of data that has multiple uses including, but not limited to state reporting, predictive analytics, outcomes-based networks and other cost containment initiatives. Industry demand for large terabytes of data continues to grow.
The need for increased agility and flexibility are causing companies to explore cloud technology as a practical alternative to traditional methods of platform and service delivery. A growing number of offerings promise more cost effective data centers and infrastructure services when utilizing the “public cloud” for the delivery of medical information via software-as-a-service (SaaS) platforms. The primary value of these outsourced services tends to focus on elastic pricing (i.e., paying only for services consumed rather than large up-front costs) and increased agility in meeting spikes in demand. Although these are valuable considerations to traditional platform hosting, these offerings may come with significant challenges, particularly as it relates to securing personal health information (PHI).
Technology Investment Conversion
Most providers of large SaaS platforms have made a substantial investment in their infrastructure to deliver, balance and secure scalable services, which are typically capitalized over a 3 to 4 year period. The conversion of a capital expenditure-based investment to an operational expenditure model has to be carefully scheduled and part of an acceptable depreciation calendar with phased migration.
Platform Maintenance and Support
The planning of database administration activities onto a separately managed, highly transient outsourced environment can introduce schedule and support complexities. Existing scheduled maintenance windows pre-arranged with SaaS platform users must be layered on top of and around those provided by the third-party public cloud service and their re-provisioning activities. In environments that require frequent platform updates and enhancements, coordinating downtime and infrastructure administration can pose real challenges.
Technology Compatibility
Information technology platforms supporting multiple clients that are not fully multi-tenant configurations can undermine the value of the highly virtualized public cloud architectural paradigm. Further, some public cloud or platform-as-a-service (PaaS) providers place constraints on database sizes or technology platforms, which can require refactoring projects in advance of a migration.
The above challenges are all tractable, and can be addressed with planning or implementation projects. However, when it comes to adequate data protection assurances, these public cloud models simply are not viable today.
Data Protection Standards
By and large, the infrastructure-hosting community has selected the Health Insurance Portability and Accountability Act (HIPAA) to serve as a target for services aimed at the healthcare community. In reality, this is a little like being in a gun fight and aiming for the ankles. Forty-six states have issued their own data privacy rules, which go well beyond HIPAA guidelines.
Even though the public cloud holds promise, most of the success thus far has been in the retail domain, with increasing adoption in basic financial services. There remains a substantive chasm for readiness in the healthcare application and data management domain. As a technology company collaborating with industry-leading vendors, partners and clients, we continually evaluate the opportunities available and believe the vendor-owned and managed private cloud opportunity provides the most viable and secure platform delivery solution for the needs of the workers’ compensation industry.
Part 2 will include the necessary quality tools required to successfully and accurately load state and third party fee schedule data for payment guidelines into a medical bill processing platform.
About Michael Josephs
Michael Josephs joined ISG Services in 2006 and has held the role of CIO since 2008. Josephs is responsible for the creation and delivery of ISG’s technology platform, which encompasses the areas of project management, information systems, technology infrastructure, release management, product management, application development, software quality assurance and technical services. Prior to joining ISG Services, Josephs served as director of technology development at E*TRADE Financial and was also the CIO for Triad Financial Corporation, a subsidiary of Ford Financial. He holds a Bachelor of Science degree in computer science from the University of Maryland.
About ISG Services LLC
Operating as the nation’s leading healthcare technology company, ISG Services offers a suite of software and services that enable highly targeted data-driven interventions to achieve meaningful impact on outcomes and financial performance. ISG Services utilizes extensive data analytics to identify gaps in care, quality or integrity, and applies the appropriate resources to ensure rapid resolution. Our valued clients process their workers’ compensation medical bills through the ISG Services affiliates including well-known affiliates StrataCare, the nation’s premier workers’ compensation bill review software and service provider, and Bunch CareSolutions, offering award-winning, innovative managed care solutions. For more information, please visit: www.stratacare.com or www.bunchcare.com.