HP will help Blue Shield of California modernize its claims management and membership systems.
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HP Enterprise Services has signed a five-year contract with Blue Shield of California (BSC) to help the health plan better manage its membership and claims processing systems, with the goal of bringing products and services to its clients faster and at a lower operating cost.
According to executives, BSC is moving to a client-server architecture that will support outreach initiatives to members via the Web and through mobile connectivity. Additionally, the health plan is transitioning its 3 million members onto TriZetto's Facets, an enterprise-wide software solution for health plan administration. The Facets system automates membership enrollment, premium billing, claims adjudication, customer service, and other administrative functions.
To help with the upgrade, HP said it will continue to provide application development and management services for more than 100 of BSC's existing core administrative data and corporate systems. BSC, which has more than 400 applications across the enterprise, said HP will manage the HP-outsourced applications using tiered service levels, designed to help BSC better manage its application environment.
BSC has been an HP client for 43 years. Currently, the BSC core administrative systems reside on mainframe and midrange servers hosted in an HP data center supported by HP Managed Mainframe Services and HP Server Management Services. For disaster recovery, Blue Shield uses HP Continuity Services with data mirrored in primary and secondary sites for data backup and restore operations.
"The new contract positions BSC to begin to take advantage of HP's experience in consolidating data centers," William Ritz, a spokesman for HP Enterprise Services, told InformationWeek Healthcare.
According to Ritz, HP will provide consulting services in areas like infrastructure as a service and will offer help to integrate and run complex distributed systems. BSC is also considering the role mobile health apps can play in engaging its members to take greater responsibility for their care.
"BSC believes a patient-centered approach builds upon industry trends in consumer-oriented services. These include social media, mobile applications, and less structured data. This new contract will organize the core underpinnings required to allow expansion of self-service to patients in a manner that best suits them," Ritz said.
Ritz also noted the new agreement creates a governance structure that allows BSC and HP to collaborate on new approaches to analyzing critical data to support the patient-centered approach. The agreement also enables BSC to tap into HP's experience in the areas of structured and unstructured data, which is becoming increasingly important as healthcare delivery organizations adopt ICD-10 transaction codesets, as well as establish new accountable care organizations (ACOs) that tie reimbursement to performance measures.
Last October, BSC provided nearly $20 million to 18 California hospitals, health systems, clinics, and physician groups seeking to participate more effectively in ACOs. BSC will help these ACOs and other health delivery partners align their systems to gain access to batch systems, online information, and claims, membership, and other database systems.
"In order for all of the delivery partners to realize the promise of ACOs, BSC recognizes inherent inefficiencies in the technologies and electronic exchange of our various solutions," Dave Arnold, VP of IT for BSC, told InformationWeek Healthcare. "BSC hopes that investments by all parties in practice management system integration, strengthened security, and standards compliance will yield quick adoption among our evolving business models."
HP also will provide application services using its global delivery system to connect existing centers with software professionals across BSC projects.
According to Ritz, BSC has taken advantage of HP's global delivery capabilities in selected countries around the globe. These include HP's global application maintenance and development resources, which have helped BSC lower its administrative costs.
"BSC anticipates further expansion of patient/consumer services outside normal business hours and requires a global service model that aligns with those changes," Ritz said.
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