Healthcare company cuts the cost of injection therapy by 90 percent with IBM WebSphere Business Events

Thanks to a new class of specialty pharmaceuticals known as biologics, millions of patients are experiencing relief from conditions such as rheumatoid arthritis, cancer and allergies. But unlike oral medications, biologics must be injected, which creates a problem for many patients who need to receive the drug therapy on a regular basis. Until recently, options for delivering injection or infusion therapy have been expensive and inconvenient.

Doctors, for instance, often charge their full office visit fees for an injection and only offer appointments during weekdays so that patients have to take hours off work. Hospitals are even more expensive, and “walk-in” clinics may not have personnel who are properly trained to deliver injection or infusion therapy.

Enter a new healthcare company that works with 10,000 clinics nationwide where medical personnel are trained to inject the biologics, as well as vaccines.

These clinics, which include urgent care, clinics, and community pharmacies in 50 states, typically operate with 40 percent of their capacity underutilized. The company reserves these underutilized hours for patient injections, injections trainings and vaccines. Patients are scheduled through the Internet to the location closest to them and the time that’s most convenient, even in the evening or on the weekend, and the appointment is booked directly into the clinic of choice. The company charges a small fee for the service and arranges for health insurance plans to pay for most of it, leaving the patient with a small copayment—far less than what doctors and hospitals charge.

Looking for Business Event Processing software

“We started with a great idea, but it totally depended on our being able to implement a real-time software solution that would monitor, sense and respond to the entire patient care process ensuring everything was in order,” says the CIO of the company. Once the patient has made an appointment for an injection, the company has to confirm that the clinic’s certification and training are up to date, that the drug is available and received at the location and that the insurance company has agreed to pay. If any of those conditions have not been met, the software must be able to escalate the problem to the human level so that other arrangements can be made.

“In order for us to operate on the scale that we wanted to, the vast majority of administrative tasks had to be automated,” says the CIO. “I needed a complex logistics system with monitoring and I stumbled onto Business Event Processing [BEP].” BEP is a type of software that understands the information contained in the events flowing through an organization and acts on them. “Financial markets use BEP extensively,” the CIO says. “That’s how the credit card company knows to call you if an irregular transaction has been made with your credit card.”

Through his Internet research, the CIO discovered IBM WebSphere Business Events (named AptSoft Director for BEP at the time), a BEP product. “I looked at their demo online which pertained to a financial services situation, and I replaced the financial terms with healthcare terms. I found that I could use that model to monitor locations for clinical and operational readiness, to make sure that all of the events that need to occur for a patient to get a specific therapy, have happened and we would receive data back on the outcome of that event. We chose the product and it has worked out extremely well.”

The company has built all its applications on IBM WebSphere Business Events—all the applications that drive the business. Aside from the event processing application, the company has created applications for locating clinics, detailing the patient’s insurance plan, clinical configurators, and monitoring the resources at the clinic.

The intuitive user interface of WebSphere Business Events provides drop-down menus for programming the logic of the events that must take place and their dependencies.

Exponential revenue growth

Today the company is in the process of increasing the number of clinics it deals with from 10,000 to 15,000. Through agreements with major health plans and employers, the company now offers more than two million Americans access to convenient, affordable health care for biologic services.

“We started off two years ago with nothing but an idea, and this year we’re doing a huge amount of business,” says the CIO. “And all of that is directly attributable to WebSphere Business Events.”

Healthcare solution for less time and cost

Prior to his work at the company, the CIO worked for a healthcare company building an application that was similar to the one he is working on for this company, but less complex. His team had 40 developers and the project took 18 months. At the company, the CIO and one other developer worked for six months to create the original product that launched the business—that’s 98% reduction in effort and 1/3 the elapsed time."

The IT staff at the company numbers seven people. “We’ve kept costs very low even though we’ve grown astronomically,” says the CIO. “Today, when we want to sign up a new health plan, add clinics or enhance the application to include additional events, we can do the necessary programming with WebSphere Business Events in days or weeks rather than months, keeping the cost of doing business low.”

90 percent less cost for treatment

The cost to patients for treatment is as much as 90 percent less than the cost of treatments in doctor’s offices and hospitals. “In one case, we saved a patient $800 per month,” says the CIO. And the complex process of enabling this service is handled automatically, virtually eliminating administrative overhead.

Most importantly, the company has shifted the healthcare model to one that is consumer driven. “The consumer has the incentive to make the right decision,” says the CIO. “This is really the best medicine for the healthcare crisis.”