Multi-channel Appeals Management Application (VAM)

A highly configurable solution, delivered in a short time frame, that supports multiple client-specific workflows and types of entities — Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs and others

Challenge

The client needed an app that would help payer entities process appeals and grievances in a legally-compliant way. The solution had to provide a high level of customization to fulfill requirements specific to various types of risk-bearing entities (Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, etc). It also needed to service multiple clients, and be highly configurable based on each of our client’s clients particular needs.

Our client built the first product in their portfolio as economically as possible, and the quality matched the cost, with a lot of “spaghetti code” under the hood. That is why they needed this second product, which we were to build, to lead the way from the technological side. The client wanted us to design and develop a technical platform on top of which all their future products could sit with easy integration between the apps enabled by default.

Multi-Channel-Appeals-Management-Applicatio

Solution

The biggest challenge we faced (that put the entire project at risk) was the fact that the requirements were delivered to us as an MS Access mockup, which contained only about 20% of the actual scope of the project. 

Working in lockstep with the client’s Chief Compliance Officer in an Agile fashion, we were able to crystalize the remaining requirements, and help our client define and prioritize product features. 

On the technical platform side, we had to deconstruct the existing product to understand the app’s inner workings and architecture. Based on the findings and our client’s long-term plans, our team made recommendations on the technical architecture and the approach that would allow the most flexibility for future product integration. 

The key areas in which we made recommendations were the structure and design of the shared data store, common security model, rules engine, and UI enhancements.

The technology stack we selected for the web solution included Java with Spring and Hibernate frameworks for the backend, jQuery, RequireJS, and Handlebars for the rich client frontend, and a powerful rules engine based on Drools for automated case-processing and decision-making.

The solution, that was named Virtual Appeals Manager (VAM), included a fully configurable workflow with support for detailed customization of all its aspects, extensive reporting based on Jasper Server, and automated daily ingestion jobs for importing large data sets from third-party systems.

benefits

  • Using the Agile Scrum project management methodology, we successfully managed the project through its entire lifecycle and delivered a solution that exceeded the client’s expectations for the dollars spent.
  • We were able to create an MVP in 6 months, enabling our customers to start collecting their ROI. 
  • After 9 months, the client had the 1.0 version that they could begin deploying to customers. 
  • The solution is highly configurable and customizable so that it can support multiple client-specific workflows, and multiple types of entities like Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, and others.