Rocky Mountain Health Plans (RMHP) strives to create an accountable community that empowers patients to take control of their health. Health information technology, value-based payment models, and improved coordination among multiple health, human services and provider organizations are all essential aspects of its strategy. When RMHP was acquired by UnitedHealthcare in 2017, the two companies recognized their shared heritage of expanding access to high-quality health care and providing significant support to serve the health care needs of local communities. This presented an opportunity to evolve existing processes for integrating and governing large quantities of data from myraid sources.
RMHP was established in 1974 by physicians and community leaders in Grand Junction, Colorado, on the fundamental principle that Coloradans deserve access to high-quality, community-centric health care. RMHP offers health insurance coverage to individuals of all ages and businesses of all sizes, serving every market segment: employers, individuals, Medicare, Medicaid, and Child Health Plan Plus (CHP+) beneficiaries. RMHP serves nearly 225,000 members and offers a robust network of more than 20,000 affiliated health care providers.
The alignment with UnitedHelathcare combines RMHP's community relationships and strong regional presence throughout western and rural Colorado and UnitedHealthcare's state-of-the-art technology and resources. Together, they create a stronger health plan over the long term. Since the acquisition, they have operated as a subsidiary of UnitedHealthcare, but have maintained the RMHP brand, unique community relationships and strong regional presence.
Following RMHP's acquisition by UnitedHealthcare, technology and data process changes were identified. Within these changes was the need to integrate and consolidate vast quantities of subscriber enrollment, medical and pharmacy claims, and health care provider data from a wide variety of sources.
A large technology footprint made data governance very difficult. A legacy data warehouse, local Microsoft Access databases, multilayered processes and manual data intervention not only strained communication between departments, but also consumed resources that could have been spent on analysis and data discovery.
"In the interest of our members and partners, we are continually looking to operate as efficiently as possible," explained RMHP CTO, Nandan Menon. RMHP sought to accomplish three goals:
RMHP turned to a Pentaho solution from Hitachi Vantara to integrate data from multiple sources in a single platform and make data available for analytics in near real time. That solution is Pentaho Data Integration (PDI).
RMHP values that the solution is agile and scalable, and has a flexible architecture that allows IT teams to adapt to changing data ecosystems and new reporting requirements in the future. The lightweight data management solution has an intuitive interface that has reduced development and maintenance coding overhead. Lastly, Pentaho's easy implementation and quick time-to-value makes it fully compatible with agile development methodologies and data governance models.
"PDI's flexibility and easy implementation were key for us," said Menon. "We looked at other solutions, but they required more technical resources than we could spare. PDI was quick and easy to implement. My team implemented the most integral features first and continues to add features and data sources as our data ecosystem and reporting requirements change over time. Its intuitive interface reduces the overhead we would spend on development and maintenance."
RMHP's data environment consists of various data sources, including subscriber enrollment data, medical and pharmacy claims, and health care provider information. This data is in legacy databases, web sources and flat files. PDI is used to integrate these disparate sources into a nonpersistent staging database in a nightly process. The staged data is then loaded to an enterprise data hub via PDI.
Once the data has been loaded, PDI runs a data quality assurance procedure, which confirms the quality of data added, promoting transparency for and communication with the data governance team. The enterprise data hub is optimized for reporting, analytics and dynamic data discovery.
Hitachi Vantara's Pentaho software delivers a reliable "single source of the truth" to the business to guide and improve decision-making. It has allowed RMHP's IT team to run lean and efficiently, adapt to new technologies and easily prototype new solutions without risk. Additionally, Pentaho has enabled the newly merged enterprise to adapt to a complex, rapidly changing healthcare marketplace.
Pentaho Data Integration has invigorated the vitality of RMHP’s data ecosystem. Deploying an agile, intuitive and robust data management solution has helped the insurance provider tackle complex operational challenges and adapt to new healthcare market realities. Deploying PDI in RMHP’s data environment has yielded dramatic results.
Data integration rules are now centralized and streamlined, which reduces the need for time-consuming manual intervention. An automated nightly data integration run frees up analysts’ time. They now have more opportunity to interact with their data, perform additional discovery to supplement standard reporting, and add new perspectives to the data.
A nightly data quality assurance check enhances confidence and transparency between the agile development and data governance teams. New additions to code can be developed quickly and easily, while keeping the production environment pristine. PDI’s agility helps RMHP’s IT team adjust to changing requirements easier.
A single, reliable source of truth also promotes data-driven decisions. With all data residing in the enterprise hub and being checked for quality on a nightly basis, business users trust their data and manage it confidently to develop new and innovative offerings and deliver better service to the entire RMHP community. Data confidence and transparency facilitates communication across the enterprise and provides flexibility for integration of future customer needs.
“Health care can be complicated. PDI has allowed us to adapt and thrive in a dynamic new business environment. Our architecture has the capabilities to handle the ever-changing health care environment and allow us to continue to fulfill our ongoing commitment to our community,” said Menon.