Case Study

Healthcare price transparency: Implementing an AWS automated data management solution to achieve regulatory data compliance in less than 75 days

UST helped this health insurance association implement an automated data management solution utilizing AWS technologies to provide consumers with clear, accessible insurance pricing information. The solution was deployed in less than 75 days, enabling the company to meet its regulatory compliance deadline and provide healthcare price transparency.

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OUR CLIENT

This national health insurance association provides process management services across all 50 states, several US territories, and some additional countries. With dozens of independent health insurance companies, the organization collectively insures more than 100 million people.

THE CHALLENGE

Data management challenges and a tight deadline for regulatory policy compliance

The company faced regulatory pressure to provide clear and accessible health insurance price information, enabling consumers to easily compare insurance plans and understand the costs of healthcare services. However, the company had an exceptionally high data input volume, comprising approximately 36 insurance plan entities and 13,000 files, with each file totaling two terabytes (TBs) of data. This large data set made rapid price-comparison analysis difficult. In addition, the data was in unsplittable, single-line, zipped JSON input files that were difficult to parse for downstream processing. With the Health Plan Price Transparency compliance deadline looming, the company needed to act quickly to implement a solution to avoid penalties.

THE TRANSFORMATION

Comprehensive data ingestion and analytics solution using AWS technologies

In less than 75 days, UST deployed a robust data management solution that streamlined ingestion, processing, and price-comparison analysis. This strategy consisted of:

JSON file conversions—Files are converted from single-line to multi-line files using the iterative JSON parser (IJSON), ensuring data is structured for efficient downstream processing.
Parallel processing of insurance plan files—Self-terminating Amazon EC2 instances optimize compute-resource utilization while minimizing costs.
An automated extract, transform, and load (ETL) data pipeline—Leveraging AWS Glue, a serverless data integration service, the pipeline efficiently manages and transforms approximately 15 TB of data.
A failover mechanism—This functionality automatically restarts the ETL pipeline from the failure point using metadata stored in Amazon RDS for PostgreSQL, reducing downtime and enhancing reliability.
Flexible, responsive search capabilities—Consumers can search and compare insurance plans by location and cost, using a scalable solution designed with AWS Lambda, Amazon API Gateway, and Amazon OpenSearch.
Streamlined resource management—The solution automatically provisions resources through infrastructure as code (IaC) using AWS CloudFormation, enabling seamless resource management and deployment.

The solution strikes a balance between robust data ingestion and processing capabilities and powerful search functionality, making health insurance data accessible and transparent to consumers. The company can now efficiently process and analyze large volumes of provider data in real time while meeting regulatory requirements for price transparency in coverage.

THE IMPACT

Met regulatory compliance deadline and enabled consumers to make informed decisions with healthcare price transparency

The seamless, automated data management solution helped the insurance company achieve these business benefits:

A scalable data infrastructure—By using auto-scaling AWS cloud resources that adjust based on data volume and complexity, the solution provides optimal performance without manual interventions from the IT team. This enables the company to efficiently handle fluctuating data processing workloads with confidence, especially during the busy insurance open enrolment season.
Increased efficiency and productivity—The automated data processing solution has also reduced the IT team’s reliance on cloud administrators, allowing people to focus on more strategic projects.
Enhanced insurance plan pricing transparency for consumers—Since the solution provides negotiated rates for healthcare services in real-time, including allowed out-of-network costs, plan members can make informed healthcare decisions.
Increased customer satisfaction—By providing immediate access to crucial insurance information, the company met consumer demands for more transparent pricing data, increasing consumer trust.
Avoided non-compliance penalties—Since the solution was implemented in less than 75 days, the company met its regulatory deadline and was not at risk for fines.

If your company is struggling with healthcare data management issues, UST can help; learn how.

RESOURCES

https://www.ust.com/en/industries/healthcare

https://www.ust.com/en/industries/healthcare/interoperability/data-pipeline

https://www.ust.com/en/industries/healthcare/interoperability/compliance-modernization