Published on 30 Sep 2009
"It is nearly impossible to expect a person to learn, recall and adapt to the ever-changing federal and state regulations for child healthcare programs. . . . Implementation of IBM WebSphere ILOG JRules can remove this knowledge barrier, ease the screening process and streamline application procedures" - A leading provider of services to the health and human services industry
Leading Health and Human Services Industry Solution Provider
Business Process Management (BPM), Service Oriented Architecture
This company provides outsourcing, consulting and information technology services to government agencies. It also supports private-sector health organizations in their effort to strengthen strategic performance and growth. The company has more than 1,000 employees at over 44 sites nationwide.
This company works with state governments to provide this coverage to children and pregnant women. Qualifying them, however, can be a difficult, time-consuming process. To clear their applications more quickly, the company offers advanced software solutions that include the Child Health Administration Management Program System (CHAMPS).
IBM® WebSphere® ILOG JRules shortens the development time for adding new decision criteria by about 35 percent, and produces a clear application that enables users to readily understand the organization and logic of CHAMPS. Moreover, JRules’ pure-Java code fully backs CHAMPS as a Web-based system. With assistance from IBM Professional Services and training from IBM Education Services, two company developers built CHAMPS in just six months. The application was developed for the Windows platform.
Halves process time for healthcare applications Limits human error Speeds policy implementation
This leading company operates a variety of government health programs ranging from Medicaid to Medicare, to State Children’s Health Insurance Program, to universal healthcare programs.
The state of Virginia’s eligibility rules are constantly changing to meet political, social and economic conditions. To meet the state’s requirements, this company needed to easily manage, modify and store the business rules applied by CHAMPS.
The company selected JRules to power CHAMPS, which automatically applies a wide range of regulations for Medicaid assistance, income, age, citizenship status and family composition. JRules lets company personnel quickly convert new policies into rules and integrate them with the application. The business rule component also provides management tools for storing and modifying rules. When an existing policy is changed, the company can immediately update the policy’s rules in CHAMPS.
The company uses JRules to capture regulations as business rules and apply them in real time. The IBM ILOG business rule component also helps the company reduce its development time by as much as 35 percent. The business rule technology helps ensure healthcare administration personnel consistently apply regulations and always use the latest ones. CHAMPS processes four to five applications per hour—twice what can be done manually. It is also Web-based so that satellite offices can access it from throughout the state.
With JRules, CHAMPS quickly checks insurance applications and always applies the latest policies and regulations. To receive assistance, an applicant must meet conditions set by industry organizations, and federal and state authorities. The business rules used by CHAMPS cover at least eight different policy areas, including Medicaid and income restrictions.
Powered by JRules, CHAMPS cuts the time for processing applications for state-sponsored low-cost health insurance by 50 percent. At least a half-hour was needed to clear an application with the old, manual system. Personnel at Virginia’s healthcare administration often needed training as well, to stay current with new regulations. CHAMPS processes four to five applications an hour, and ensures the consistent implementation of policies with JRules. Also, less staff training is needed, as new policies are introduced with JRules through CHAMPS. The results have been better service and significant cost savings.
Products and services used
• IBM® WebSphere® ILOG JRules
IBM products and services that were used in this case study.
WebSphere ILOG JRules
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