Neighborhood Health Plan Streamlines Information Access and Rapidly Progresses Toward HIPAA Compliance with Novell exteNd

With 135,000 members across Massachusetts, Neighborhood Health Plan (NHP) faced two tough challenges. First, NHP needed to leverage the Web to automate critical patient referral and eligibility processes and provide accurate information to its members and providers. Second, with important deadlines fast approaching, NHP sought to provide a path to compliance with transactions and privacy regulations defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for its providers and members. NHP turned to Novell® exteNd™, an award-winning integrated suite for rapidly delivering highly interactive solutions that integrate existing information assets, to meet these challenges.

Getting information to the right place at the right time, securely and accurately, is critical to NHP's ability to effectively and successfully serve its constituents. NHP selected Novell exteNd for a number of projects that have resulted in unprecedented access to information for NHP's provider community. Most recently, NHP deployed exteNd Composer, Novell's award-winning XML integration server, to create a Web services-based interface between NHPnet.org and the New England Health Electronic Data Interchange Network (NEHEN). The link allows NHP's community healthcare providers to access the Medicaid eligibility information that resides in NEHEN via HIPAA-compliant transactions through a secure portal interface, http://www.NHPnet.org.

Designed to supplement and eventually replace a proprietary point-of-service system that currently generates responses to Medicaid queries, the new system integrates NHPnet.org with NEHEN's EDI infrastructure to provide broader, more accurate information to the querying member in a more timely fashion. The new system also enables a phased implementation of HIPAA, allowing NHP to accommodate different compliance timetables among its community participants.

"NEHEN wasn't designed to meet the needs of the small healthcare practices and groups that define our membership," said Marilyn Daly, R.N., director of eCommerce and clinical applications for NHP. "Novell exteNd provides our members with a completely Web-enabled solution that resolved an issue which otherwise could have cost a significant amount of money and threatened their solvency."

The NEHEN project is the latest milestone in a series that began with the complete re-design of NHPnet.org, NHP's personalized Web portal that now enables member institutions to automate critical transactions online. NHP leveraged several of the key features of Novell exteNd Director, including its business rules and content management capabilities, to create a robust portal in less than three months. As a result, NHP's member healthcare providers are able to transact referral notifications and eligibility verifications in a secure, reliable environment, streamlining processes that were often tedious and error-prone due to the manual data entry into back-end systems that was previously required.

Since launching the Novell exteNd-based NHPnet.org, NHP's user base has grown to more than five times its previous size, with more than 70 percent of NHP's 120,000 members now being managed through NHPnet.org. Sixty percent of NHP's referral volume now comes through NHPnet.org, which has dropped the cost for conducting eligibility verifications from approximately $8,000 per year in a paper-based system to roughly $200 per year using http://www.NHPnet.org.

"This was a high-risk project that, had we failed, would have pushed us back to pen and paper," said Daly. "Novell exteNd has allowed us to create an environment that enhances information access and quality of service to our members, and did so while educating a team at NHP that had no proficiency in Java* or Web technology in general."

Eventually, NHP plans to expand its portal's capabilities to include case management and claims status inquiry functionality, as well as integrate http://www.NHPnet.org with NHP's corporate Web site, which is currently outsourced.

"NHP's use of Novell exteNd is a testament to how the products can enable an organization to enhance the quality of its service and still maximize its existing resources," said Fred Holahan, Novell's vice president and general manager of eBusiness integration products. "With HIPAA compliance on the horizon, Novell exteNd has enabled NHP to truly differentiate itself and provide an unprecedented level of service to its members."