BCBS

Cloud Federations Drives Scalable and Secure Healthcare Claims Processing with AWS

Challenge: A healthcare organization faced limitations with its on-premises claims processing system. The legacy infrastructure struggled with scalability, hindering efficient processing during peak claim submission periods. Additionally, data storage and management posed challenges, making it difficult to extract valuable insights for cost optimization and operational improvements.

Solution: Cloud Federations, a leading cloud migration and management expert, partnered with the healthcare organization to migrate their claims processing system to Amazon Web Services (AWS).exclamation This multi-phased approach aimed to achieve:

• Enhanced Scalability: Elastic cloud resources in AWS would ensure the system could handle fluctuating workloads seamlessly.expand_more

• Improved Efficiency: Streamlined data processing and analytics would expedite claims processing and provide valuable insights.

• Increased Cost-Effectiveness: Optimized resource utilization and data storage solutions would reduce overall IT infrastructure costs.

Implementation: Cloud Federations implemented a strategic migration plan leveraging a variety of AWS services:

• Phase 1: Assessment & Planning: AWS Migration Hub provided a centralized platform to track migration progress and coordinate efforts across teams. AWS Application Discovery Service helped identify dependencies within the legacy system, ensuring a smooth transition.

• Phase 2: Data Migration & Storage: AWS DMS facilitated seamless database migration to Amazon RDS (Relational Database Service). Continuous replication minimized downtime and data loss. Encrypted backups and processed claims were stored in Amazon S3, with object lifecycle policies archiving older data in S3 Glacier for cost savings. AWS Snowball efficiently transferred large volumes of historical claims data to the cloud.

• Phase 3: Application Migration & Modernization: The primary claims processing application was hosted on Amazon EC2, with instance types optimized for specific workloads. Microservices related to claims validation, adjudication, and payment processing were containerized using Amazon ECS with Fargate, enabling scalability and efficient resource utilization. AWS Lambda serverless functions handled tasks like notifications, data validation, and minor data transformations. Amazon API Gateway managed and exposed APIs for integrations with hospitals, clinics, and pharmacy systems.

• Phase 4: Data Processing & Analytics: Amazon Kinesis captured real-time data streams to enable real-time analytics for identifying fraudulent claims or billing anomalies. Amazon Redshift served as the data warehouse, storing and analyzing historical claims data to identify trends, cost drivers, and opportunities for improvement. AWS Glue and Amazon Athena provided ETL (Extract, Transform, Load) capabilities, transforming data for reporting and analytics purposes.

• Phase 5: Security & Compliance: AWS IAM (Identity and Access Management) strictly controlled user permissions and roles, ensuring only authorized access to specific resources. Amazon VPC with Private Subnets isolated applications and data, enhancing security. AWS Shield and WAF protected the system from external threats and DDoS attacks. Amazon Macie, powered by AI, helped identify and rectify any potential exposure of sensitive healthcare information (PII), maintaining HIPAA compliance.

• Phase 6: Monitoring, Management, & Optimization: Amazon CloudWatch monitored application performance and triggered alerts for anomalies. AWS Trusted Advisor provided recommendations for cost optimization, security best practices, and performance improvements. AWS Auto Scaling ensured resources automatically scaled to meet fluctuating workloads, especially during peak claim submission times.

Results: By migrating to AWS with Cloud Federations' expertise, the healthcare organization achieved significant improvements:

• Increased Scalability: The cloud-based infrastructure effortlessly handles peak claim processing periods without performance degradation.

• Enhanced Efficiency: Streamlined data processing and analytics lead to faster claims processing and valuable insights for improved decision-making.

• Reduced Costs: Optimized resource utilization and data storage solutions lowered overall IT infrastructure costs.

• Improved Security: Robust security measures in AWS ensure data privacy and HIPAA compliance.expand_more

Cloud Federations' expertise in cloud migration and AWS best practices empowers healthcare organizations to achieve a scalable, efficient, and secure claims processing environment.