8/2/2019 Amerigroup - API Mangement for Mobile

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AmerigroupCorporationisaFortune500companyandtheninthlargestpublicly

tradedhealthcarecompanyintheUnitedStateswithmorethan1.9millionmembers

in11

states

nationwide.

Founded

in

1994,

Amerigroup

focuses

on

coordinating

local

MedicareandMedicaidprogramsfortheUSgovernment.Infact,oneoutofevery45

MedicaidrecipientsisservicedbyAmerigroupnationwide.Withmorethanfour

thousandemployeesacrosstheU.S.,Amerigroupprocesses24millionclaimsannually

foroperations,prescriptiondrugbenefits,ambulatorycare,andmore.

AstheU.S.federalgovernmentslocalhealthcarerepresentative,Amerigroupaccepts

alleligiblepeople(regardlessofage,sex,raceordisability)anddoesnotdeny

coverageduetopreexistingmedicalconditions.ToaccommodateAmerigroup

memberswhoaredisabled,bedriddenorotherwisecannotgettooneof

Amerigroupsoffices,associatesmakemorethan2millionoutcallsannuallyinorder

toassess

members

health

needs

and

ensure

theyre

getting

the

right

care.

While

Amerigroup

processes

more

than

80percentofinsuranceclaimselectronically,theassociatesonoutcallsrecordmeetingsonpaper,returntothe

officeandkeyinthedata.Aswithmostdataentrywork,thissystemispronetoerrorsthatraisecostsanddelay

processing.Bringingthisaspectofthebusinessonlinewasakeychallengetoprovidingbetter,moretimelycare

formembers.

The Business Challenge

AmerigroupsITgroupheadquarteredinVirginiaBeach,Virginialookedatvariousapproachesthatwouldprovidea

securewayforassociatestomanagememberselectronicallyinrealtimefromanylocation.Asaresult,

AmerigroupdesignedanddevelopedamobileapplicationfortheAppleiPadthatcaninteractivelyassessand

recordthehealthcareneedsofmembersintheirhomesorotherplacesofcare.

Althoughthis

approach

facilitated

mobility,

ultimately

the

iPad

offered

little

more

than

away

to

create

islands

of

informationiftheycouldntconnectbacktoAmerigroupsdatacenterwhereitssystemsofrecordresided.But

transmittingmemberinformationovercosteffectivepublicnetworksraisedanumberofsecurityquestionsfor

Amerigroup.Forexample,thesensitivedatahadtomeetstringentHIPAApatientprivacyrequirementsentailing

encryptionoverthewire,buttherewerealsoquestionsaroundsafelytraversingAmerigroupscorporatefirewall

inordertoaccessitsinternalapplicationsexposedasAPIbasedWebservices.TheITgroupconsideredaVPN

basedapproachbutdidntthinkitstreamlinedenoughtheywantedsomethingthatwouldjustwork.

Enter Layer 7

Inlate2010,AmerigroupputoutanRFPforanAPImanagementprojectdesignedtosecurelyconnectitsinternal

applicationstomobiletablets,andobtainedanumberofresponsesfromvendorsthatpromisedtocoordinatethe

wholeproject

for

them

ifonly

theyd

take

aback

seat

and

just

trust

them.

Amerigroup

selected

Layer

7

TechnologiesnotonlybecauseofLayer7sabilitytoworkcollaborativelywithAmerigroupsITteam,butalso

becauseofLayer7simpressivesecuritycredentials,easeofuse,andflexibilitytomeetthetightdeadlinesofthe

project.Infact,theLayer7Gatewaywasupandrunninginlessthanaweek,providingtheAPIsecurityanddata

routingAmerigrouprequired,effectivelyfirewallingitsJBOSSbasedEnterpriseServiceBus(ESB)whileguardingit

againstintrusionwithstrictAPIauthentication,authorizationandcomprehensivethreatprotection.

Amerigroup by

the Numbers 1.9 million members

$5.2B in revenues (2009)

4,000 employees

49 offices/facilities US-wide

2.2M out-calls to members,

assessing their health needs

24M claims processed yearly

Amerigroup CorporationEnablingMobileMedicaidviaAPIManagement

8/2/2019 Amerigroup - API Mangement for Mobile

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Amerigroup Case Study

Copyright2012Layer7TechnologiesInc.Allrightsreserved.SecureSpanandtheLayer7Technologiesdesignmarkare

trademarksofLayer7TechnologiesInc.Allothertrademarksandcopyrightsarethepropertyoftheirrespectiveowners. 2

The Solution

InproductioninTexassinceFebruary2011,AmerigroupsmobileAPImanagementsolutionservesapproximately

80,000Medicaidrecipientsthroughoutthestate.Initially,fiftycaseworkerswereequippedwiththeAppleiPadin

ordertoproviderealtimeinteractionwithmembersattheirresidencesorplacesoftreatment,butthatnumberis

growing.

Informationis

recorded

interactively

directly

within

the

iPad

application,

and

the

data

synchronized

back

to

AmerigroupsdatacenteroncetheassociatehasaccesstoaWiFior3Gaccesspoint.WhentheiPadapplication

connectsovertheInternettoAmerigroup,theincomingXMLmessagesarescreenedforthreatsbytheLayer7

devicelocatedintheDMZ.TheincominguserisauthenticatedandauthorizedagainstthelocalLDAPbeforebeing

routedviaAmerigroupsESBtoupdatetheappropriatesystemofrecord.Troubleshootingisstreamlinedbyeasy

accesstoLayer7logfilesthatshowrequestsandresponsesastheyhappen,simplifyingdiagnosis,andhelpingto

ensurehighavailability.

The Results

TheiPadapplicationallowsAmerigrouptoimproveitshealthcarecoverageandmemberservices,whileincreasing

theeffectivenessandefficiencyofitsMedicaidprogram.Atthesametime,AmerigroupishelpingTexastomanage

thehealthcareneedsofitscitizens,whilekeepingitmoreaffordablefortaxpayers.

TheAPIbasedsolutionthatconnectstheiPadapptoAmerigroupsinternalsystemsiskeytoadvancingthe

efficiencyandcapabilityofAmerigroupsassociates,allowingthemtoreducetimespentonadministrativetasks

andincreasetimespentwithmembers.Andwithrealtimeinformationgatheredfrommembers,Amerigroups

timetodecisionmakinghasbeengreatlyreduced.

Goingforward,Amerigroupislookingatextendingthesolutiontobusinesspartners,whichincluderadiologists,

testandlabservices,andhospitalsthatwouldthenbeabletosubmitclaimsdirectlytoAmerigroup,further

streamliningandsimplifyingtheclaimsprocess.