Learn about health plan integration hub solution from IBM that provides a modular, flexible approach to support migration to ICD-10. It is built on a com-prehensive platform for code and policy translation and is designed to be a single trusted source of healthcare information. For more information on IBM Systems, visit http://ibm.co/RKEeMO. Visit http://bit.ly/KWh5Dx to 'Follow' the official Twitter handle of IBM India Smarter Computing.

1. IBM Systems and Technology
Solution Brief
Healthcare
Health plan integration hub
Highlights
●● ● ●
Adopt a flexible, modular approach to
ICD-10 conversion
●● ● ●
Gain visibility into potential impacts and
apply analytics capabilities
●● ● ●
Benefit from secure, reliable technology
provided by IBM System z
●● ● ●
Build a platform for future code and policy
transitions
Converting to ICD-10 means that the number of medical codes used
for diagnosis and treatment information will grow from 14,000 to
over 140,000. As healthcare evolves as an information-based industry,
health plans will increasingly need the information generated from this
conversion to support priorities such as administrative and medical cost
reduction, chronic disease cost containment, new product and services
development, fraud prevention and benefit plan customization.
The health plan integration hub solution from IBM provides a modular,
flexible approach to support migration to ICD-10. It is built on a com-
prehensive platform for code and policy translation and is designed to be
a single trusted source of healthcare information. Solution capabilities,
available in pre-integrated, configurable modules of IBM software, sup-
ported by IBM services and IBM® System z®, facilitate integration and
access to enterprise information. Organizations can select the capabilities
that best meet their needs to accelerate testing, ensure cost neutrality or
achieve other desirable business outcomes.

2. 2
Solution Brief
HealthcareIBM Systems and Technology
Adopt a flexible, modular approach to
ICD-10 conversion
Leveraging the integrated software capabilities of IBM and
the enterprise power of System z—as well as comprehensive
ICD-10 services offerings—provides health plans with all
the tools needed to adopt a scalable approach for managing
regulatory change. We offer three distinct sets of capabilities:
●● ●
Workflow management, code and policy governance: Enables
orchestrated workflows for rules authoring and management
to build complex mapping solutions such as interactions with
medical policy and benefit rules, sharing of mappings and
rules between departments, collaboration between users dur-
ing the mapping resolution process, and robust governance
for management approvals.
●● ●
Business analytics, dashboards and reports: Enables out-of-
the-box dashboards and reports, and a framework to easily
add or configure new dashboards or reports to support
informed decision-making.
●● ●
Business rules authoring and governance: Enables benefit
plan rules authoring capabilities, allowing benefit plan spe-
cialists and analysts to redesign rules based on ICD-10 codes,
and then turn these rules into business requirements for
benefit plans.
Implementing the health plan integration hub begins with
business needs identification and leads to configuration of the
modules you select, as well as testing, validation and deploy-
ment. Our solution can make code and policy conversion both
smart and cost-efficient. It will allow you to orchestrate and
manage each step of this complex transition process, including
monitoring and managing workflow and resource deployment
for mapping and policy integration. Business intelligence capa-
bilities include managing the transition effort, determining cost
and revenue neutrality, and offering support for processing and
exception handling.
Our solution is designed to meet your specific needs, allowing
you to manage the migration at your own pace. The underlying
toolset can be configured to align with your remediation
approach and your workflow, and integrate with your preferred
mapping tool. As a result, you gain implementation flexibility
regardless of which ICD-10 adoption strategy you choose—
whether an ICD-10 crosswalk, a complete transformation of
processes and systems, or something in between. Our solution
can also grow and change with your needs. Built on a service
oriented architecture, it can extend to include additional
applications and databases and encompass a growing library
of workflows, business rules, dashboards and reports.
Gain visibility to potential impacts and
apply analytics capabilities
Our solution can increase business flexibility and improve
control through clear visibility into the potential impacts of
ICD-10 migration. It incorporates the IBM Transformation
Accelerator and Manager for ICD-10, providing integrated
capabilities at each ICD-10 touchpoint, from front-end transac-
tional systems to testing environments and data warehouses.
Our solution enables continual enhancements during design,
testing and deployment. It can also apply the IBM Rational®
product suite to find codes, rewrite and test applications to
support ICD-10 changes, and track and trace changes to ensure
they work. Embedded audit capabilities aid execution and docu-
ment changes. We can also conduct testing as an independent
third party.
In joint planning with you, we take into account not only
pending ICD-10 milestones but also how the information
generated can be used to increase business value. As your
migration progresses, you can take advantage of business analyt-
ics capabilities to support activities such as testing and cost
neutrality verification as needs change over time. Richer data

3. 3
Solution Brief
HealthcareIBM Systems and Technology
for advanced analytics, transaction management and trend
analyses can help ensure that benefits and payments conform to
the intent of the original medical and benefit policies. And the
data can strengthen positioning for future policy and code
translations, while providing the foundation for expanded
information management capabilities going forward.
Benefit from secure, reliable technology
provided by IBM System z
The health plan integration hub solution is well-suited for
organizations that use System z to support business functions
such as premium billing and payment processing, claims intake
and adjudication, and claims processing. Taking advantage of
proximity to data in transactional systems as you convert to
ICD-10 provides the ability to more easily integrate and access
data for use in testing environments or data warehouses. When
data resides on a single platform, performance, throughput
and efficiency objectives can be more easily maintained and
potential security exposures can be reduced.
If you choose to apply business intelligence and analytics capa-
bilities in support of your conversion, software products such as
IBM Cognos® and IBM SPSS® are optimized to perform well
on System z. Application performance will be consistently high,
due to the System z compute-intensive analytics processing
capabilities.
Our solution can protect and extend your investment
in System z. Adjudication on IBM z/OS® and policy transfor-
mation on Linux on System z can be managed as a single
integrated workload. Performance and availability goals can be
assigned to combined operational and new business require-
ments so you can benefit from the secure, reliable technology
environment and management efficiencies that System z
provides, reducing total cost of ownership. Administrative,
medical management and compliance information can be
integrated, accessed and analyzed on the same platform,
allowing continued benefits from the high performance
technology environment provided by System z.
Build a platform for future code and
policy transitions
Your ICD-10 migration is an ideal time to invest to create
transformative value. The health plan integration hub provides
more than a holistic approach to ICD-10 conversion. Its
powerful and robust capabilities provide an extensible platform
for business process management, analytics and collaboration.
Workflow and policy governance capabilities can position you
for future policy and code translations, as your needs evolve.
IBM offers the deep healthcare business process expertise,
extensive experience in ICD-10 implementations and an
extensible technology platform to support this transition with
reduced risk.
For more information
To learn more about the health plan integration hub, please
contact your IBM representative or IBM Business Partner,
or visit: ibm.com/healthcare
Additionally, IBM Global Financing can help you acquire the
IT solutions that your business needs in the most cost-effective
and strategic way possible. We’ll partner with credit-qualified
clients to customize an IT financing solution to suit your busi-
ness goals, enable effective cash management, and improve your
total cost of ownership. IBM Global Financing is your smartest
choice to fund critical IT investments and propel your business
forward. For more information, visit: ibm.com/financing

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