HMS
- 1. Migrating TRACR to the .NET framework Proposal Operations Management 512-555-1234 @hmsy.com www.hms.com
- 2. Agenda • Introduction & Background • Business Needs & Pain Points • Solutions • Benefits • Next Step www.hms.com
- 3. Background HMS Services - Cost Avoidance and Program-Integrity Over 50% of yearly HMS revenue is driven from the following activities – • Data Mining. Experienced data analysts utilize proprietary analytics, COTS software, and advanced modeling tools to identify overpayments and target providers, claims, and patterns for review/audit. • Reviews. HMS Staff perform structured onsite and desk reviews/audits of targeted providers and claims. Audits/reviews are supported by sophisticated software, operational process, and quality assurance protocols that help ensure efficient, consistent, and defensible results. The activities are driven by the use of the TRACR process developed by HMS. www.hms.com
- 4. TRACR TRACR is a “eligibility audit” solution running in FoxPro which produces customer deliverable data. The software application portion of the TRACR process involves – • Maintaining a National Eligibility Database of health plan eligibility data provided by over 1,000 insurance providers. • Database contains over 1.2 billion unique records from various sources, including: • Insurance carriers • Third Party Administrators • Pharmacy Benefit Managers • Unions • Medicare and TRICARE/Champus Using the TRACR process, HMS matches eligibility files to identify instances where program beneficiaries receive health coverage benefits from other sources. www.hms.com
- 5. Client Requirements from TRACR HMS understands the importance of accurate, timely cost avoidance data for healthcare programs. By discovering new coverage information, HMS clients avoid paying future claims, resulting in savings worth many times the value of payments recovered retroactively through typical “pay and chase” activities. As the national leader in cost avoidance, HMS verifies over 2.3 million insurance policies each year, resulting in billions of dollars in savings annually to our clients. Through the use of the TRACR software, HMS offers a unique approach which has been proven to: • Immediately contribute to the management of healthcare costs in a manner that is business-oriented and innovative. • Ensure that dependents are eligible to receive healthcare benefits. • Produce results that are easily measured and generate an exceptional ROI for HMS’s customers. • Complement existing and future strategies to contain healthcare costs. • Provide guaranteed savings throughout clients’ benefit cost structure including health, prescription drug, dental and vision plans • Remove ineligible dependents and save dollars • Verify only eligible dependents are covered, saving dollars • Improve plan health www.hms.com
- 6. TRACR Business Needs TRACR is currently supported by FoxPro 9.0 which is a discontinued product by Microsoft • As hardware and operating system software continue to advance, the 32-bit architecture of FoxPro is not guaranteed to work with emerging systems. • The technical aspects of the software and hardware, require a human element. Since Microsoft has now retired Visual FoxPro, there are fewer remaining skilled professionals who really understand and are proficient with this development tool. • While the conversion of your FoxPro application may not be an immediately pressing problem, it is still prudent to plan ahead. Making plans sooner means having adequate time for redevelopment, testing and deployment for your new solution. www.hms.com
- 7. Pain Points Current process is 25% more expensive to implement due to the manual element. • The process currently being implemented by HMS has fewer functions, is slower, produces less data, and has a higher “bad record” output rate as a result of being subject to human error. • Utilizing the current TRACR process places HMS at a severe disadvantage against their competitor for this product offerings. • Business analysis must process the data at a fixed location: restricted to demographical location because of locally stored data • Software limitations - TRACR is currently supported by FoxPro 9.0 which is a discontinued product by Microsoft. • No Software or Security Updates • No Technical Support past 2014 (Current plan HMS has is Pay-For-Support) • Unable to support Web Services (ASP Model) • No Direct Replacement requiring complete redesign of the interface. www.hms.com
- 8. Requirement HMS must consider migrating TRACR to a new mainstream software platform. The TRACR process conducted in FoxPro will sooner than later have to be replaced. The longer HMS waits, the more extensive and costly the process becomes. www.hms.com
- 9. Solution that Delivers Recommend converting to Microsoft Visual Studio .NET. .NET is the most closely related platform to FoxPro; part of a series of related development technologies and not just an individual language. With .NET it is possible to create both traditional desktop applications as HMS’s business analysis have traditionally used as well as browser-based applications capable of running on an internet server. Browser-based applications can potentially extend the reach of the TRACR application by providing access to a wider geographic area as opposed to the traditional internal office network in Austin, TX. For the back-end data storage, it’s recommended that HMS goes with Microsoft SQL Server. SQL Server has quickly become an industry standard being used by companies around the globe. It’s interoperability makes it capable of working with other products and technologies and at the same time it is highly secure and scalable. www.hms.com
- 10. Measurable Benefits .NET technologies are the most popular Microsoft development products • Great resource pool of talented programmers capable of working within that environment. • Migrating to .NET and SQL could have comparative advantages over other software solutions available in the market place. • In a position to adopt the most current technologies and therefore spring boarding themselves back in front of their competition. • 25% cost savings over the current solution. www.hms.com
- 11. Next Steps Independently deployable phases provide a smoother transition from the old FoxPro application. Planning HMS’s IT Team will prepare a detailed plan of how the actual conversion will take place and works with the business analysis staff to define any new functionality desired as a result of the final converted system. Data Upsizing Upsizing is the process of moving the current FoxPro data from individual data files to a new database server. Phased Development • Develop – Product development will take place. • Test – Tested and re-tested to verify each corrective action is effective, a determination for deployment readiness is made. • Deploy – Deployment and end-user training and documentation. www.hms.com