BigCheese and Avedian combined their expert knowledge of AWS cloud services and DRG-based technological solutions to allow the Health Insurance Administration of the Argentine province of Córdoba (APROSS) to implement a cutting-edge platform in record time. Using services such as Amazon Elastic Compute Cloud (Amazon EC2), Amazon Redshift, Amazon DynamoDB, and Amazon Simple Storage Service (Amazon S3), APROSS built its new Data Lake in the cloud and can now execute advanced data analytics and establish new payment models that translate into better quality of services provided.
Digital Transformation and Health Policy
A new management of APROSS began in 2019, focusing on digital transformation, health prevention and promotion, and the expansion of the provider network, oriented towards a new paradigm. For several decades, health systems had been centered on institutions: hospitals, providers, organizations. It was time to embrace a new global trend and migrate towards a system centered on people and their needs.
“It’s not about setting aside professionals, clinics, or laboratories; it’s about aligning the interests of all actors in the system around the health needs of the population”, explains Nicolás Carvajal, president of the APROSS board. “We used different systems and databases; information was scattered or non-existent; processes were complex and slow. All this made decision-making extremely difficult. We needed to integrate the data, reconcile it, clean it up. And it was defined that the unit of information accumulation would be the member”, he adds.
With digitalization, simplification of processes, and focus on the individual, the administration could manage the budget effectively and pay appropriate fees so that system providers could meet the health needs of the inhabitants, and the province could direct resources to health prevention and promotion, thus also covering the healthy population.
“We can configure services, medical benefits, medication provision, all based on the member's needs.”
Nicolás Carvajal President of the APROSS Board
Diagnosis-Related Groups
In its transformation journey, APROSS found a strategic ally within its own province. From the capital of Córdoba and with presence in five countries, AVEDIAN has positioned itself as one of the three leading companies in the world in the development of clinical-economic management solutions for health institutions based on Diagnosis-Related Groups (DRG).
“DRGs are a patient classification system characterized by grouping episodes through rules and algorithms. For over a decade, we have been researching, innovating, and developing technologies for data processing and integration in the health area, based on our own DRG grouper adapted to Latin American epidemiology. In this way, institutions can perform advanced analytics – process historical data, detect patterns and trends, obtain valuable information – and implement payment and contracting models based on results”, comments Guillermo Tabares, CEO of Avedian.
The challenge for Avedian was the magnitude and complexity of APROSS with its rich ecosystem of providers: more than 250 clinics, sanatoriums, hospitals, and monovalent centers, and more than 3000 direct access doctors and other health professionals to meet the needs of more than 630,000 members. It was necessary to process a very large historical data set, with all the transactions generated in the last six to seven years, and then assign the appropriate value to the algorithms.
Accumulated Knowledge In The Cloud
Avedian took on this challenge together with BigCheese, its technological partner and Advanced Partner of Amazon Web Services, operating from Montevideo, Uruguay, and specialized in cloud services and high technology. Contributing their expert knowledge of AWS services portfolio, BigCheese handled the configurations and development of customized solutions to ensure Avedian’s platform responded adequately to the volume and diversity of APROSS data.
International experiences show that implementing value-based payment models, based on diagnosis-related groups, has taken at least three years. Thanks to AWS services, this process was shortened to six months at APROSS. “We were able to move all historical data to the cloud, add computing power for processing, quickly value the algorithms, and immediately move to action by paying under the new model”, highlights Guillermo Tabares.
“We used Amazon Redshift, Amazon DynamoDB and Data Lake on AWS, as well as other services such as Amazon Elastic Compute Cloud (Amazon EC2), Amazon Simple Storage Service (Amazon S3) and Amazon Relational Database Service (Amazon RDS). The orchestration of all these is what allowed us to accelerate the timelines to perform advanced data analytics, which is one of the technical strengths associated with this project”, explains Fernando Martínez, CEO of BigCheese.
Thus, just over six months after completing the migration of its data to the cloud and its pioneering implementation of DRG solutions in Argentina, which is also one of the first in Latin America, APROSS is experiencing results aligned with those documented in Europe after projects that took three to four years.
“DRGs are a patient classification system characterized by grouping episodes through rules and algorithms. For more than a decade, we have been researching, innovating, and developing technologies for processing and integrating data in the healthcare area, based on our own DRG grouper adapted to Latin American epidemiology. This way, institutions can perform advanced analytics – process historical data, detect patterns and trends, obtain valuable information – and implement payment and contracting models based on results”, comments Guillermo Tabares, CEO of Avedian.
The challenge for Avedian was the magnitude and complexity of APROSS with its rich ecosystem of providers: more than 250 clinics, sanatoriums, hospitals, and monovalent centers, and more than 3000 direct access doctors and other health professionals to meet the needs of more than 630,000 members. A very large historical dataset had to be processed, with all the transactions generated in the last six to seven years, and then assign the appropriate value to the algorithms.
Technological Improvements, Healthcare Improvements
Some of these quantitative benefits include the optimization of healthcare spending by 32%, a 40% decrease in average length of stay over a total of 90,000 annual hospitalizations, and increases of up to 100% in certain fees paid to providers, adjusted according to risk and complexity. But at APROSS, they also highlight that this project is aligned with the three main axes of their management: the incorporation of digital tools, strengthening the provider network, and caring for the population not only in the face of illness.
“The great advantage is data governance, which allows us to implement a true health policy”, says Nicolás Carvajal. “We can configure services, medical treatments, medication provision, all based on the member’s needs. We can know where we need to reinforce our network, both quantitatively and qualitatively, according to the demographics of each region. We can effectively articulate prevention campaigns because we know how our target population is distributed in the province”, adds the president of APROSS.
Advanced analytics and new value-based payment models are tools that APROSS adds to its determined digital transformation strategy, based on which it has implemented applications, services, and self-management portals such as the digital credential, telemedicine service, and the Digital Medical Desktop (EMD) which will be a new validation channel for providers. “We are proud to support that vision with Avedian and AWS solutions”, says Fernando Martínez.
About Apross
Apross is the Provincial Health Insurance Administration, an entity created in 2005 in the Argentine province of Córdoba, which provides health coverage to active and retired agents of the three branches of the provincial government and of the affiliated municipalities and communes. It can also provide coverage to other individuals or groups through voluntary affiliation.
With a community of more than 630,000 members, Apross is the health insurance for the people of Córdoba. It has a network of nearly 15,000 providers and its own reference center: the Raúl Ferreyra Hospital. Additionally, it offers discounts at 1600 affiliated pharmacies.
“The great advantage is data governance, which allows us to implement a true health policy”, says Nicolás Carvajal. “We can configure services, medical benefits, medication provision, all based on the member’s needs. We can know where we need to strengthen our network, both quantitatively and qualitatively, according to the demographics of each region. We can effectively articulate prevention campaigns because we know how our target population is distributed in the province”, adds the president of APROSS.
Advanced analytics and new value-based payment models are tools that APROSS adds to its determined digital transformation strategy, based on which it has implemented applications, services, and self-management portals such as the digital credential, telemedicine service, and the Digital Medical Desktop (EMD) which will be a new validation channel for providers. “We are proud to support that vision with Avedian and AWS solutions”, says Fernando Martínez.
About Big Cheese
BigCheese is a Uruguayan company dedicated to software development and consulting services, formed by a team of engineers and technicians specialized in solving complex problems using the best available technology. Among its services, it offers migration of client platforms to the cloud using Amazon Web Services (AWS).
Teamwork, client relationships, and agile methodologies are the pillars on which it relies to carry out its projects, with custom systems and standard systems with the possibility of customization. It currently manages more than 500 AWS servers and its clients are national and international companies.
Benefits
- Optimization of healthcare spending by 32%
- 40% decrease in average stay over a total of 90,000 annual hospitalizations
- Increases of up to 100% in certain fees paid to providers, adjusted according to risk and complexity.
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