Salesforce.com Powered Healthcare Decision Support

Cloud Based Decision Support System

Table of Content

● About Ansera

● Objectives of Decision Support System

● Life Cycle Management of Authorization process, Medical Guideline process

● Authorization Process Workflow

● Ansera Performance Features

○ Creating An Authorization○ Applying Guideline ○ Decision Letter○ Portal Side

● Analytics Capability

● Technology

○ Section 508 Compliance○ Security○ Reliability

● Project Management

○ Our Products

One Embarcadero Center, Suite 500 San Francisco, California 94111 USAOffice: +1 (415) 315-1679 Fax : +1 (415) 276-1924

About Ansera

Backed by over 30 years of experience in the healthcare industry, Ansera delivers the most innovative enterprise class cloud technology available for medical claims processing. We enable health care organizations to make better decisions and improve the quality of health care outcomes through operational efficiency and state-of-the-art cloud computing technology.

Our medical, insurance, and technology industry backgrounds and real world experience are the backbone of our Decision Support System (DSS), an interactive cloud-based platform that helps decision makers compile useful information from a combination of raw data, documents, and personal knowledge to identify and solve problems and make decisions.

Ansera orchestrates integrated workflows across the healthcare management cycle from patient visits and coding to authorizations, processing, and payment – enabling a whole new way of collaboration.

Innovative technology and exceptional talent create a winning combination where everyone benefits. Ansera. Data Transforming Decisions.


Services

Comprehensive ServicesAnsera offers a wide range of professional services including implementation, custom development, training, and support – all available to meet your specific business requirements.

Ansera’s enterprise-grade platform and cloud-based technology deliver comprehensive performance, availability, and scalability.

Ansera offers a wide range of professional services for a complete medical decision support solution.Ansera’s Agile methodology, needs assessment, design and development, integration, migration, testing, training, and user acceptance procedures ensure delivery on time and on budget.

Ansera’s Salesforce platform enables easy user configuration, enriched with workflows, task lists, security settings, data storage, and reporting.

Training & SupportHealthcare is a dynamic industry facing challenges and opportunities in how assessment, delivery, and reimbursement are managed. Ansera’s innovative technology and services can help you stay on top of the industry’s rapid changes.

With customized training and support – we are here to help.


Solutions

Healthcare Expertise

Backed by over 30 years experience in the healthcare industry, Ansera delivers the most innovative enterprise class cloud technology available for medical claims processing.

Leading Edge Solutions

Ansera’s advanced Decision Support System (DSS) is the foundation of our revolutionary healthcare tool for insurance companies, third party administrators (TPAs), stop loss insurance companies, accountable health care organizations (ACOs), and providers.

Our Decision Support System (DSS) combines the use of analytic techniques with data access and retrieval functions that are easy to use, flexible, and adaptable to the rapidly changing health insurance industry.

Use current ICD-10 codes, insurance provider guidelines, documents, physicians notes, and raw data to manage the claims process efficiently and accurately. We can even help you integrate Ansera with other applications. No one else offers the breadth of data in once place.


Objectives of Decision Support System

Ansera Answers

Provide the right information at theright time in healthcare delivery cycle

Ansera Standardizes

Eliminate human error and paperwork adopt to healthcare market changes with speed and scale

Ansera Organized

Make factual decision on claims reviews and streamline medical management processes

Ansera Accelerates

Reduce manual processing drastically and speed up your medical management process


Life Cycle Management of Authorization and Guideline process

Authorization Life Cycle START

Saved

Authorization Life Cycle START

Authorization created by internal user

Authorization created by portaluser

In Review

D.S.S Apply

Guideline

Decision ApprovedDenied

Generate Letter

STOP

Generate Letter

STOP

BillingNegotiation


Authorization Process Workflow

Status Description Detailed Explanation

Save Authorization created All required fields have been entered and saved. Waiting on New queue

In Review Authorization has not submitted Authorization has not submitted yet still on New queue, after submittion Authorization will move Validation queue

Decision Guideline has been applied Guideline has been applied for an Authorization and system will make a decision as Deny or Approve..

Deny /Approve Decision Letter has genereted According to decision a Decision letter has been generated

Billing Authorization will be sent Billing queue After Deny letter generated Billing information will be filled .

Negotiate Authorization will be sent Negotiate queue

After Deny letter Authorization can be sent to the Negotiation queue if needed

Stages of an Authorization:


Ansera Performance FeaturesAuthorization Workflow Management

When the Internal User enters the system Console Page will be appear as seen . On the top hand side there are 4 dropdown menu. First one is Reviewer as shown with red lines. It includes All option and Reviewer list option

Second Dropdown menu is Status. User can view All clients or only one specific status.



Another drop down menu is Clients. User can access All clients or one specific client.

There are 3 console pages, user can reach different console pages using drop down menu and also drop down menu includes shortcuts such as Guideline Maintenance, Claims, Clients, Dashboards, Reports, New Requests



User can filter the Authorizations by Status.


Ansera Performance FeaturesCreating An Authorization

In order to create new Authorization Click on plus button as shown

Fill the fields and Save then Submit


Ansera Performance FeaturesContent Upload

User can upload multiple files for an Patient and can print fax sheet


Ansera Performance Features

Guideline Management

User can apply Guideline by using Decision button as shown



Guideline Search

User can search Guideline and at the same time User is able to view Recommended Guidelines depending on Health Plan



Applying Guideline

Guideline page contains Patient Detail. Additional Details, Indications and Contraindications.

To apply a decision User should select Indications and Contraindications and then click Apply Decision button.



Decision

According to the results of selection, system generates a decision as Denied or Approve



Portal Side

Clients are able to submit cases from Portal side with using green button as seen.

Patients can be searched as shown and also Clients can view Status, submit files and communicate with using client conversation box.



Portal Side

Client can communicate with using Client Conversation box as shown .



Configuration

● Advance Currency ManagementAdvanced dated currencies

● Analytic SnapshotAnalytic snapshots allow users to run reports and save the report results as records on custom objects. Unlike reports, users can schedule analytic snapshots to summarize data at specific times, and work with the summarized data similarly to how they work...

● Approval ProcessOOTB Workflow including the rule setup and workflow actions (email, field update, task create)

● ConsoleThe console is a tab that combines a listview and related records into one screen with different frames so that users have all the information they need when interacting with Salesforce

● Customer PortalSetup and configuration of the customer portal

● DashboardIncludes creation of dashboard, setting the running user, and adding to profile home page

● Email Template

● Translation WorkbenchIncludes setup but not actual translation services translating from English to another language

● Email to SalesforceEmail to Salesforce allows you to automatically log emails you send from third-party email accounts as activities on lead and contact records in

● Org Wide Configurable SettingsSetup of users, custom user fields, roles, approvers, public groups, hierarchies, profiles, queues, and the sharing model. Also includes settings for tags, user interface, search preferences, ideas. Activity settings and other general administration co…

● Home Page and DashboardEach profile can have their own home page. Configuration of home pages with the addition of OOTB components such as dashboards, activities, custom links, approval queues.

● Page Layout ConfigurationsPage Layout for an object, including sections, related lists, main page and related list button placements, custom URL links, profile and record type attachments to layout

● Partner Portal

● Security ControlsSharing Settings, Field Accessibility, Password Policies, Session Settings, Network Access, Single Sign-On Settings, View Setup Audit Trail, Expire All Passwords, Delegated Administration, Remote Site Settings, HTML Documents and Attachments Settings

● Validation Engine



● Apex Logic Apex classes - general functionality, custom controller, controller extension, externally exposed web service class

● Static ResourceThe build or compilation and upload of a static resource for us in Visual Force pages. Includes flash files, ActiveX controls, javascript code libraries, zipped images, style sheets, etc.

● Validation - ApexObject on save event based Apex trigger to implement a validation. Complexity based on number of objects and fields, business logic.

● Visual Force Component

● Visual Force Email TemplateCustom visual force based email template. The complexity is dependent on the complexity of the layout and number of objects called.

● Visual Force SitesSetup of and activation of Sites. Does not include the individual visual force pages which must be tracked individually.

● Apex Class - Email Services

● Apex Class Web ServiceApex class using the Webservice keyword to expose the class to external

● Jitterbit Orchestration

● Data Export SchedulerConfiguration of the data export email scheduler for backup purpose

● Excel ConnectorThis includes setup of a template spreadsheet in EXCEL with the connector to SFDC. The template spreadsheet will be used to update records in SFDC

● Mobile Application Integration

● Outbound MessageConfiguration of the outbound soap message including the workflow rule that triggers the message

● Single Sign-OnHighly dependent on network infrastructure and single sign on design and architecture. Delegated or Federated authentication. Federated authentication is a single sign-on method that uses SAML assertions sent to a Salesforce

● Visual Force Canvas

Customization Integration



Analytics Capability

Reports

Performances across your organization can be tracked

with reports. The powerful reporting framework of

Salesforce Platform enables us to present data driven

results of your system. An example of a Report from

Ansera can be seen below



Analytics Capability

Dashboards

Dashboards are great tools to visualize risk and performances. Customized

dashboards and reporting provides you the big picture with instant update. Some

Dashboard examples can be seen below


SaaS ( Software as a Service )

Software as a service (or SaaS) is a way of delivering applications over the Internet—as a service. Instead of installing and maintaining software, you simply access it via the Internet, freeing yourself from complex software and hardware management

SaaS: The PayoffSaaS customers have no hardware or software to buy, install, maintain, or update. Access to applications is easy: You just need an Internet connection.

Benefits of SaaS

Historically, companies were required to buy, build, and maintain their IT infrastructures despite exponential costs. SaaS gives companies an alternative. Now, they can plug in and subscribe to services built on shared infrastructure via the Internet. The SaaS model has flourished in recent years because of the many benefits it offers to businesses of all sizes and types.

Here’s what’s driving customers to take advantage of SaaS solutions:

High Adoption SaaS applications are available from any computer or any device—anytime, anywhere. Because most people are familiar with using the Internet to find what they need, SaaS apps tend to have high adoption rates, with a lower learning curve.

Lower Initial Costs SaaS applications are subscription based. No license fees mean lower initial costs. Having the SaaS provider manage the IT infrastructure means lower IT costs for hardware, software, and the people needed to manage it all.

Painless Upgrades Because the SaaS provider manages all updates and upgrades, there are no patches for customers to download or install. The SaaS provider also manages availability, so there’s no need for customers to add hardware, software, or bandwidth as the user base grows.

Seamless Integration SaaS vendors with true multi tenant architectures can scale indefinitely to meet customer demand. Many SaaS providers also offer customization capabilities to meet specific needs. Plus, many provide APIs that let you integrate with existing ERP systems or other business productivity systems.


Why SaaS is Popular for the Enterprise ?

The popularity of SaaS is steadily increasing because it simplifies deployment and reduces customer acquisition costs. With SaaS, developers can support many customers with a single version of a product. This approach, called multi-tenancy, allows companies to scale as fast and as much as needed without replacing costly infrastructure or adding IT staff.

Why SaaS is Popular with IT ?

A recent survey of a thousand IT professionals by Forrester Research found that they are turning to hosted (SaaS) products as a way to offload management of non-mission-critical applications such as HR and CRM. Plus, the subscription-based SaaS pricing model can keep IT budget costs consistent or lower than packaged or homegrown software.

How is SaaS Different ?The SaaS business model and underlying technologies differ from those of traditional software vendors and products in several ways:

No Vendor Lock-inBecause SaaS applications are subscription based, customers can always choose not to renew if they’re dissatisfied, making providers more accountable.

No Large Up-Front InvestmentWith SaaS applications, customers avoid the large initial investment in an IT infrastructure and the day-to-day responsibility of maintaining that infrastructure.

No Maintenance HeadachesSaaS customers all share the same provider infrastructure, which centralizes administration and updates. Plus, integration is simpler because there’s no need to support several platforms and multiple versions.

No Steep Learning CurveSaaS applications use a familiar Internet interface, so customers expect the ease of use and constant innovation of the consumer Web, helping to drive adoption.

No Outdated SolutionsSaaS applications are innovating at a rapid rate because developers are focused on what’s next rather than on maintaining numerous versions of old code. SaaS vendors use the same technology architecture as the best consumer Web: companies like eBay, Google, and Yahoo!, which enables the same levels of continuous innovation.


Salesforce.com is committed to providing on-demand enterprise applications accessible to all individuals. This includes users working with assistive technology, such as speech recognition software and screen readers. Salesforce.com follows the internationally recognized best practices in Section 508 of the Rehabilitation Act and the Web Content Accessibility Guidelines (WCAG) 2.0 Level AA to the extent possible.

i. Section 508 Compliance

ii. Security

Salesforce.com understands that the confidentiality, integrity, and availability of their customers' information are vital to their business operations and their own success. They use a multi-layered approach to protect that key information, constantly monitoring and improving their application, systems, and processes to meet the growing demands and challenges of security.

Section 508 generally requires Federal agencies to ensure that, when developing, procuring, maintaining, or using electronic and information technology, they take into account the needs of all end users – including people with disabilities.

Technology

Access control and physical security

✓ 24-hour manned security, including foot patrols and perimeter inspections✓ Biometric scanning for access✓ Dedicated concrete-walled Data Center rooms✓ Computing equipment in access-controlled steel cages✓ Video surveillance throughout facility and perimeter✓ Building engineered for local seismic, storm, and flood risks✓ Tracking of asset removal

Environmental controls

✓ Humidity and temperature control✓ Redundant (N+1) cooling system

Power

✓ Underground utility power feed✓ Redundant (N+1) CPS/UPS systems✓ Redundant power distribution units (PDUs)✓ Redundant (N+1) diesel generators with on-site diesel fuel storage


Technology

Internal and Third-party testing and assessments

Salesforce.com tests all code for security vulnerabilities before release, and regularly scans our network and systems for vulnerabilities. Third-party assessments are also conducted regularly:

▪ Application vulnerability threat assessments▪ Network vulnerability threat assessments▪ Selected penetration testing and code review▪ Security control framework review and testing

Security Monitoring

Information Security department monitors notification from various sources and alerts from internal systems to identify and manage threats.

iii. Reliability

▪ All networking components, SSL accelerators, load balancers, web servers, and application servers are configured in a redundant configuration.

▪ All customer data is stored on a primary database server that is clustered with a backup database server for redundancy.

▪ All customer data is stored on disk storage that is mirrored across different storage cabinets and controllers.

▪ All customer data, up to the last committed transaction, is automatically backed up to a primary tape library on a nightly basis.

▪ Backup tapes are immediately cloned to a second tape library to verify their integrity, and the clones are moved to secure, fire-resistant off-site storage on a regular basis.

▪ Disaster recovery plans are in place.


Project Management

Ansera follows a very well defined project management methodology for every implementation project.

Various health check points (CRP – Conference – Room – Pilot) are incorporated into overall project management process ensuring successful delivery of the project.

This process is depicted in the following figure:


Project Management

A Typical implementation project consists of the following steps:

• Pre-kick off meeting: user requirements are gathered. Sample forms are transferred to Ansera alongside with relevant data/information according to customer’s processes.

• Kick off meeting: Project stakeholders get together and goes over Scope signed off in SOW. Ansera Project Management Methodology explained. Project organization, escalation paths defined. Type of reports and timing discussed (story status & issues & Last 24/ Next 24). All forms for implementation alongside with all data is provided to Ansera.

• CRP 1: Scope details locked down. User stories and solution approaches shared & finalized. Estimations are signed off. Planning complete.

• CRP 2: A working prototype according to user’s forms and processes is shown. Design is completed and validated. Data elements are modeled. Look & Feel and navigation through forms/questions are signed off.

• CRP 3: Pre-release of the customized ANSERA ! system. All custom functions are working. Sign off on build. Testing and issue resolution begins.

• UAT (User Acceptance Testing) : Verification of solution for system users. Business functionality and proper functioning in place.

• Production Push and Go Live : Product migration to customer ORG and roll out. Final sign off.

• Support : 1 month support provided by Ansera Customers for Live support team. Issues are created as support tickets and resolved following Ansera’s support process.


Project Management

Earn Value Management (EVM) is a fundamental approach to project management and it is a requirement of many U.S. Government agencies (including DoD , DHS, DOT etc.). As Ansera, we incorporate EVM, implementation project in order to provide all levels of management with early visibility into cost and schedule problems. EVM usage in an implementation project helps meeting following objectives:

• Relate budgets to specific implementation task • Provide basis for work progress evaluation against plan • Relate schedule and cost performance • Provide timely information for proactive action • Provide summarization of the overall implementation project for decision making

Use of EVM helps considering past performance of the project and how future performance should be aligned in order to complete the work within approved budget and date. The figure below illustrates this:


Salesforce.com Powered Healthcare Decision Support

Health & Medicine

Transcript of Salesforce.com Powered Healthcare Decision Support