Troy Medicare

Building a HIPAA-Compliant Data Warehouse for Troy Medicare

Troy Medicare's Journey to a Real-Time HIPAA-Compliant Data Warehouse

Case study by: Emma Ungureanu, George Voicu, Andrei Ismail

Troy Medicare, a distinguished HMO Medicare Advantage Plan, partnered with Vitamin Software to optimize its data capabilities. Troy Medicare strives to achieve its goal of transparent and fair pricing with the help of data by monitoring, reviewing, and tracking information from numerous sources about beneficiaries, care providers, and pharmacies. Recently, they aimed to upgrade their data management system to monitor better and improve healthcare delivery, ensuring members receive optimal care at reduced medication costs.

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The Challenge of Complex Data Management in Healthcare

Troy Medicare faced a complex challenge: needing a secure, HIPAA-compliant data infrastructure that enhanced the beneficiary experience while maintaining a strict 15% profit margin.

Troy’s collaboration with various entities, including providers and pharmacies, is centered on delivering quality healthcare while adhering to HIPAA and federal reporting requirements. They required a system capable of processing diverse data types from multiple partners under stringent regulatory standards. Any lapse in achieving these goals could compromise their operational efficiency and quality of service.

Vitamin Software's AWS data warehouse for Troy

Why Troy Medicare Chose Vitamin Software

Troy Medicare needed someone who understood the complexities of HIPAA compliance and was an expert in building secure data warehouses using AWS services. Vitamin Software team prides itself on secure data management in healthcare. It is a certified AWS Partner, specialized in data cleaning and processing using EDI data format standards like X12 - 834, FHIR, and HL7v2 for fixed format data files like DTRR, FEFD, HCCMODD, PDE, and P2P.

How Vitamin Software Responded

In response to Troy Medicare's requirements, Vitamin Software architected a robust, user-centric data warehouse leveraging the robust capabilities of Amazon RDS and AWS Elastic Beanstalk. This advanced solution adhered to stringent U.S. data residency and HIPAA compliance mandates, providing a secure, scalable environment for data storage and processing. Implementing the BOTS framework, a versatile EDI translator, Vitamin Software seamlessly integrated diverse data formats into Troy Medicare’s internal dashboards, optimizing data accessibility and utility for enhanced decision-making processes.

The Results

Vitamin Software, a consultative and reliable partner, provided expertise in secure data management and specialized data processing. Our solution ensured capital efficiency and helped Troy adhere to the Medical Loss Ratio (MLR) requirements, maintaining a regulated margin of 15%.

The successful partnership allowed Troy Medicare to successfully navigate its initial operational phase, including the first open enrollment period. The new system enabled Troy Medicare to monitor partner activities efficiently, reducing the time spent on data management and enhancing healthcare delivery quality.

Need Help Keeping Complex Data in Compliance?

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Further insights on MLR requirements are available in the Brookings article: Profits, medical loss ratios, and the ownership structure of Medicare Advantage plans.

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