Health Insurance Provider Escapes Grip of Inadequate IT System	Industry Healthcare

A completely rebuilt network solution helped Keystone Mercy Health Plan virtually eliminate downtime, boost productivity and prepare to meet the needs of the future

Everyone knows that technology can improve the way a company does business. But when technology is out of date or inadequate, it can have just the opposite effect. Flawed IT systems can pose a serious liability, hindering efficient operations and bringing productivity down.

That was the problem at Keystone Mercy Health Plan, where an overtaxed network infrastructure paralyzed the company’s ability to process insurance claims on a daily basis.

Keystone Mercy Health Plan, a joint venture between Mercy Health System and Independence Blue Cross, is the largest health insurance provider for Medical Assistance recipients in Pennsylvania. Formed in 1996, Keystone Mercy helps nearly 240,000 people in the five-county region of Southeastern Pennsylvania access quality health care services.

Together with its family of health plans, Keystone Mercy is the largest managed care provider for Medical Assistance recipients in Pennsylvania and the largest multi-state Medicaid managed care provider in the nation with nearly 600,000 members in five states.

The Challenge
Keystone Mercy’s information technology system was in a shambles with a network cobbled together from whatever was the "technology du jour," according to Chief Information Officer Bill Jones. The network would be down for as many as three to four hours at a time, severely limiting employees’ ability to process claims in a timely manner and generating quite a bit of job frustration. In fact, the company’s network was once out of commission for nearly two weeks straight.

Keystone estimated that it lost approximately one million dollars for every day of downtime. Obviously, decisive action needed to be taken to rectify this unacceptable state of affairs.

In the spring of 1998, Keystone Mercy brought in CoreTech Consulting Group to conduct an evaluation. What impressed CIO Jones was CoreTech’s superior ability to make new technology work for its clients, maximizing business benefits while minimizing disruption and risk. The CoreTech approach also takes into careful consideration the impact of new technology on the organization, its people and its processes. In other words, any time any system or application is introduced for the first time, it’s a "new" technology to the people who must use it and the organization that must assimilate it. CoreTech excels at facilitating the implementation of technology and helping companies deal with the effects of technology change. This was exactly what Keystone Mercy needed.

 The CoreTech Response
After only a few days of evaluation, however, it became clear that there would be no simple fix for the Keystone Mercy network. Rather than spend more money on trying to repair it, CoreTech recommended putting those dollars towards building a completely new system from the ground up. "We stopped our work and told Keystone Mercy they should take the money they had budgeted for our analysis, and spend it instead on implementing a new system, " stated Kevin Watkins, Global Practice Manager at CoreTech.

"CoreTech presented us with a plan to not just upgrade but to replace our entire network environment. It included hardware, software and a topology plan," said Jones. "They helped us recognize that we had to make both strategic and immediate tactical changes."

In April 1998, CoreTech and Keystone Mercy began working together to design and implement a network infrastructure that would possess the reliability, performance and capacity required to support Keystone Mercy’s current business needs as well as meet its future requirements.

After weeks of tracing cables, applying tactical fixes, developing processes, designing the network, planning the migration, and ordering and receiving new equipment, the Keystone Mercy-CoreTech team was ready for the upgrade. They worked around the clock to get the new network running and stabilized.

A Better Way of Working
Keystone Mercy began to see the positive results of CoreTech’s expertise right away. For example, CoreTech discovered that Keystone Mercy had been utilizing high-speed data circuits to connect campus buildings, while existing cabling between the buildings was not being used. CoreTech addressed this situation immediately, eliminating the cost of the circuit and providing more than 10 times the performance.

CoreTech’s focus on "knowledge transfer" also factored into Keystone Mercy’s decision to partner with the company. With every client engagement, CoreTech is aware of the need to share its technology expertise with the end-users who will be interacting with the IT systems every day. Keystone Mercy’s IT professionals worked hand-in-hand with CoreTech to design a network that would address all of the companies needs and issues and eliminate the frustration caused by excessive downtime. As a result, Keystone Mercy’s staff found the new network had all the features they wanted and they enjoy better performance at work now. This, in turn, boosted the employee retention rate.

The enhanced expandability of the new network provides support for up to 2,000 users, 240 servers and more than 80 remote locations. With 900 users, 80 servers and nine remote locations currently, the company is well positioned to respond to future demands on the system. Instead of letting the network’s limitations define its business decisions, Keystone Mercy can grow and evolve however it needs to in order to stay competitive - with full confidence that its technology infrastructure is up to the challenge.

Keystone Mercy has also seen its productivity skyrocket. The network has gone from an estimated 27 days of downtime per year to a few hours. The network has redundancies built in that virtually guarantee clients 100 percent uptime, and "that translates into real dollars," says Jones. Plus, by instituting the redundancy scheme, "CoreTech made it possible for us to move into the newer technologies we should have moved towards before."

Moreover, transaction time was chopped in half and the company now boasts its lowest processing backlog in five years - which is as long as they’ve kept track of backlog numbers. Running the daily payroll reports, which used to take 30 minutes, now takes mere seconds.

Ironically, the network moves so quickly, some employees thought it wasn’t operating properly at first. "Accustomed to waiting and watching while scanned images of incoming claims were processed, staff members were alarmed when they stopped seeing this slow progress on their screens," Jones recalled. "In fact, it was just that the images were processing too fast for them to see. The network speed was that much better!"

A Future Full of Opportunity
With the added capacity of the new network, Keystone Mercy can move ahead with various technology upgrades it couldn’t even consider before. And CoreTech will certainly play a key role in making sure these projects succeed.

For example, Keystone Mercy can also look forward to high-speed Internet access, a new messaging system based on Microsoft Exchange, a more secure and reliable method of connecting to external business partners, and dial backup for all remote sites.

"Already, we’ve seen a marked increase in the efficiency and reliability of the network for end-users throughout the company," said Jones. "But the biggest benefits are still to come, as we take advantage of our ability to implement new technologies as they develop. This will make us more competitive as we enter the 21^st century."

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