Amid all the pressures of COVID-19, healthcare payers and providers are working to reduce high operational costs and provide a more customized user experience. Across the healthcare ecosystem, organizations need to modernize their patient- and member-facing processes and systems to enable personalized engagement, virtual healthcare and triage, more self-service options, and real-time data analytics for better decision making and forecasting.

In their attempt to achieve these goals, however, most healthcare organizations are restricted by their back-end business processes, which often rely on rigid core legacy or monolithic systems with high technical debt and limited integration. Modernizing these systems would require a major investment of time, capital and effort that would be a major obstacle to the rapid pivot required.

We’re seeing healthcare organizations turn to event-streaming technology, which can accelerate the development of solutions that empower efficient business change. Stream computing is the processing of data in motion, or in other words, acting on data directly as it is produced or received. Event streaming enables the analysis or processing of data that is generated from an event, such as scheduling a virtual doctor visit or getting diagnostic test results from a portable diagnostics device, in real time. With customers looking for responsive experiences when they interact with healthcare organizations, it’s become critical to make real-time decisions based on an event.

Bypassing Legacy Complexity

In healthcare, most of the member, provider, claims and encounter data that customer-facing systems rely on is managed and stored in back-end core systems. This makes event-streaming technology all the more important for these organizations. With this technology, for instance, a payer could remotely monitor the health of senior members using wearable devices whose generated data is streamed, processed and analyzed in real-time. Driven by the analyzed data metrics, a preventive screening service could be recommended for the member in the payer care management application.

This is possible because two key objectives are achieved:

  • Near real-time bidirectional flow of data between upstream modern systems and downstream core systems.
  • Event-driven publish/subscribe integration between low-stream and upstream systems.

Health Payer Shifts into a New Gear

We recently worked with a health payer to enable the creation of upstream systems that provide a better customer experience and leverage new technology for virtual care and decision-making. To avoid the burdensome process of refactoring or modernizing the payer’s backend systems, we employed event-streaming technology to create a hub-and-spoke architecture model to facilitate the data exchange and integration among all of the organizations’ processes and systems. This architecture simplified the integration of various health systems and provided a standardized master data exchange outlet across the payer and its partners’ systems. 

Using Kafka streaming technology, we enabled the health payer to publish, in near real-time, member, subscriber and provider information to two MongoDB clusters (i.e., data hubs), one that was on-premise for internal systems integration and processing, and another on the cloud for partners and providers. These MongoDB clusters provide a centralized, role-based, streamlined and consistent view of key data to internal business unit systems, as well as customer- and partner-facing services. By centralizing access to core data, the payer has streamlined business processes in the areas of customer service, member management and claims processing, and can now utilize data analysis and insights to offer members new experience-driven solutions.

With this architecture and event-streaming technology, the payer can now develop modern applications leveraging new technology with access to key member, claims and provider data.  At the same time, it can trigger actions and processing in the backend core systems based on events and actions happening in the newly developed modern upstream systems.

The Way of the Future

We believe healthcare organizations will increasingly turn to event-streaming technology to deliver a customized, real-time experience to their members and patients in a relatively short amount of time. By leveraging the power and flexibility of event-streaming technology, these organizations will find they can build new services and solutions around their core care systems without needing to do a major refactoring of these systems. For many, this will be the way forward in the new post-COVID world.

Hanadi Salameh

Hanadi Salameh

Hanadi Salameh is an Enterprise Digital Architect at Cognizant, who specializes in enabling digital transformation. Her expertise is creating holistic technical solutions... Read more