From Overloaded Call Center to Scalable Cloud Ecosystem

Introduction

The Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States, providing care for more than nine million Veterans nationwide. As extensive as the VA is, it recognizes that providing the best care for its beneficiaries sometimes means connecting Veterans with non-VA providers located in the communities in which Veterans live and work. Through its Patient-Centered Community Care (PC3) and Veterans Choice programs, the VA connects eligible Veterans with appropriate non-VA care providers.

To enable these connections—and ensure seamless care delivery—VA needed a robust online infrastructure capable of scaling in line with program demand.

Challenges

Back in 2013, the VA tasked Health Net Federal Services (HNFS), a provider of purchased care through the VA’s PC3 and Choice programs, with connecting Veterans to appropriate care outside of the VA. However, VA quickly found that demand for this private healthcare was exponentially higher than anticipated at the contract’s outset. In fact, the volume of calls received in the first few months of the program proved to be far more than the call center representatives could handle in a timely manner. The overwhelmed system needed to scale up—fast.

Scaling demanded a shift to a FISMA-compliant PC3 hosting environment capable of supporting mission-critical healthcare administration systems and custom data integration solutions. This complex task was made tougher still by a Congressional order that set a 90-day timeline for the VA to address growing wait times for Veterans seeking care. HNFS knew it needed a contractor that could deliver a secure, scalable solution on an exceptionally tight deadline.

Solution

HNFS turned to Cognitive to develop a cloud-based ecosystem that could securely host, manage, and integrate software applications, and their associated data, in support of VA’s purchased care mission. This included management to safeguard the health information and personally identifiable information of 8.2 million Veterans, data that was essential for streamlining referrals and authorizations, claims, provider management, and medical documentation across providers and payer systems.

To meet the intense timeline requirements, Cognitive applied an agile methodology to identifying, prioritizing, and testing functionality. Work continued with development of a call center queue that could streamline the process of onboarding Veterans through the Choice program. To further ease the burden on call center representatives, Cognitive developed a web-based provider search tool capable of managing many of the steps necessary to coordinate care with non-VA providers.

Critical to the success of the project, the search tool functionality was enhanced by a number of system integrations. For example, integrating a provider directory with Google Maps and American Medical Association APIs simplified the search for appropriate care providers. Integrations between the HNFS Provider Portal and the Plexis Quantum Choice claims management system enhanced collaboration between providers and payers. Other integrations streamlined workflow for providers, such as through the use of optical character recognition APIs to move paper referrals and authorizations more easily through the online claims management system.
As the program’s volumes surged, the Amazon Web Services (AWS) GovCloud environment gave Cognitive the flexibility needed to address hosting capacity and scaling issues quickly and cost effectively.

Results

In line with Congress’ directive, Cognitive successfully scaled the VA’s new systems environment and software within an astonishing 30 days. The system proved capable of delivering essential support for an additional 1,500 call center representatives and accommodating as many as 4,200 concurrent online users. Armed with a wealth of integrated software tools at their fingertips, representatives were empowered to efficiently respond to a wide array of questions and more rapidly connect eligible Veterans to appropriate healthcare providers.

Not only did Cognitive meet its tight 30-day timeline, but it ensured the system maintained 100% uptime during its first year. This combination of functionality and speed ensured that the VA could deliver upon its commitment to excellence in serving America’s Veterans.

Customer Quotes:

“We could never have done this without Cognitive.” – Donna Hoffmeier, Vice President, VA Services & PCCC Program Manager

“Thank you for helping us deliver this very important program update to the VA and to Veterans everywhere. We couldn’t have done this without Cognitive.” – Pam Bohall, VP, Claims Administration & Enrollment Services

“You guys rock it and deliver every single time!” – Nathan Johnston, Staff VP Information Technology

“You are all doing better than well. The communication, the organization, and the teamwork is allowing us to continue to check more and more boxes as we press on.” – Kelly Tan @ HNFS/Centene