Statewide Service Delivery System

A national healthcare provider of specialty healthcare solutions turns to Software Consortium to design and implement a system to manage healthcare services for the disabled in the State of West Virginia.

Background: Software Consortium was the prime contractor to a national provider of specialty healthcare solutions covering more than 20 million members and offering customized, integrated solutions across two product lines – care management and behavioral health services.

The client was contracted to support a State’s program for Mentally Retarded and Developmentally Disabled Persons (MR/DD) to provide a process for the fair and equitable allotment of available waiver funds and to provide a system for selecting services support and providers.

Software Consortium played a key role in the project by providing the Senior Architect and senior software development team to lead the project design and development.

Technical Challenge: Software Consortium provided full-lifecycle development, deployment and maintenance of the system. The application is designed to allow purchase and management of healthcare services for disabled individuals by providers and State representatives. The system includes safeguards to assure that beneficiaries develop individual service plans that meet the individual’s health and safety needs. It also provides a comprehensive plan so that beneficiaries know the effect of their choices on their personal budget. The system services referrals, transfers, discharges, demographics and medical and prior authorizations.

The system was designed and developed with significant workflow components to support State regulatory requirements. It allows providers to interact with the system either via web or EDI while maintaining strict security guidelines for highly sensitive information.

The technology used was standardized on the Microsoft .Net platform. The Application Architecture is n-tiered and supports full availability and failover. Some highlights include:

  • The Website is secured using Microsoft’s ASP.Net Provider; EDI is secured using SFTP with compressed and encrypted message content.
  • Database Design (Microsoft SQL Server) and data extraction & migration from previous incompatible release.
  • C# Coding (along with AndroMDA, Log4Net, NHibernate, Spring.NET)
  • BizTalk Design and Coding to implement EDI, translation and workflow components.

Conclusion: Through the work of Software Consortium, the client implemented a fully functional and innovative, state-of-the-art system that provided a foundation along with modules and components that can be reused, marketed and amortized across other State Health Department clients. To date, the client has successfully implemented this solution in nine more states.

The client was delighted with the quality of Software Consortium’s work and their manager stated, “I don’t think there was any other team that could have done this.”

During the project, Software Consortium was also called upon to provide additional development resources to other critical client projects, due to the consistent client satisfaction levels achieved with our team members.

To learn more about Software Consortium’s broad experience, please contact us.