Executive Summary

The Arizona Health Care Cost Containment System (AHCCCS) is the state’s Medicaid program. AHCCCS works closely with 34,000 health care and service providers to meet the care and coverage needs of Arizona’s 1.3 million Medicaid recipient-members. The organization’s mission, as its name indicates, is to provide members with quality care while controlling costs in every way possible. To help attain these objectives, AHCCCS recently deployed a mainframe Web-enablement architecture that uses HostBridge to create CICS web services to stream legacy CA Ideal applications to modern Web portals for members, care providers, and hundreds of employees.

Challenges

Since its founding in 1982, AHCCCS has earned national acclaim for its managed care concept and become a model for other state programs. To handle its information-driven processes, AHCCCS relies on an IBM mainframe running CA Ideal applications. The applications represent decades of human and financial investment, and they are woven inextricably into day-to-day business operations.

AHCCCS maintains a call center with 100 staff to handle interactions with clients and health care providers. Trained in the intricacies of the CA Ideal applications, call center staff have for many years had primary responsibility for accessing and maintaining mainframe-based Medicaid records. Nearly every update to the system, even as simple as an address change, was handled by call center personnel, often during one-to-one phone conversations.

While the call center remains an essential point of contact for customers and care providers, times have changed dramatically. Like users everywhere, AHCCCS’s information stakeholders – members, partners, and employees – expect self-service access to accounts, records, and functionality to an extent scarcely imagined just ten years ago. And they demand this access through browsers running on home and office computers, laptops, and the latest tablets and smartphones.

AHCCCS business and IT managers understood that they could gain significant benefits by providing users with modernized access to Medicaid applications – greater customer satisfaction, workforce productivity, and process efficiency. By reducing dependence on call center staff for every interaction, they could also cut costs – and help fulfill their mission. AHCCCS set out to modernize their mainframe applications. The key question was how to maximize outcomes while minimizing risk and cost.

Requirements

AHCCCS had two modernization options – migrate applications to a new platform or repurpose existing mainframe resources as web applications. It quickly became apparent that migration would require rewriting decades-old applications, and be operationally disruptive and prohibitively expensive. Determined to keep the mainframe and web-enable its legacy CA Ideal applications, AHCCCS had one other infrastructure factor to address – their use of Microsoft .NET to develop and deploy web and other business applications. AHCCCS needed an integration solution that would most efficiently and effectively bridge their two main platforms.

AHCCCS defined the critical requirements its integration solution would have to meet:

• Install on the mainframe for high performance and precise rendering of source applications
• Enable integration of CA Ideal applications without screen scraping or application rewrites
• Support open standards – XML, SOAP, REST, JavaScript – for rapid CICS web services development and flexible integration with .NET and external systems
• Offer flexible licensing options enabling a “grow as we go” series of solution rollouts over a period of years

Solution

AHCCCS found its solution in HostBridge – mainframe integration software with a JavaScript engine for quickly and easily creating CICS web services, uniquely suited for integrating CA Ideal.

HostBridge installs on the mainframe, usually under CICS*. Running as a System z program, it delivers the performance and scalability required to handle the highest transaction volumes. HostBridge auto-converts mainframe data streams to XML for use in the HostBridge Eclipse IDE and incorporation in Web services. Within the IDE, HostBridge displays XML reproductions of mainframe screens. Developers use these XML screens to navigate live applications as they write reusable Web services.

Another capability that factored in AHCCCS’s decision was the HostBridge JavaScript Engine (AKA HostBridge Process Automation Engine). Since AHCCCS relies on Microsoft .NET, its developers were already well versed in JavaScript and would be able to use HostBridge to accelerate mainframe Web services development.

HostBridge also ensures the most reliable, highest-fidelity integration of CA Ideal and CICS applications. Unlike screen scrapers, which use mainframe screen geometry to locate fields, HostBridge uses field names. Since field locations often change in CA Ideal applications, this capability would help AHCCCS ensure that its Web applications would run without interruption for all users.

HostBridge provides AHCCCS and its developers with a Web services solution that maximizes mainframe performance, supports legacy applications with utmost fidelity, ensures rapid deployment, and bridges the mainframe-.NET gap via flexible, standards-based Web services.

* HostBridge can alternatively run inside z/OS but outside of CICS. In this case, all HostBridge processes and HostBridge Web services/integration scripts are eligible to run on the System z Integrated Information Processor (zIIP).

Initial Web Apps for Healthcare Providers, Medicaid Recipients

Given its need to develop Web applications for multiple user groups, AHCCCS planned a series of tactical solution rollouts. They would thus be able to prove concepts, test designs and applications, and deploy their Web solutions over several budget years. AHCCCS initially Web-enabled two mainframe-based processes – newborn registration by hospital personnel and basic account access for members.

Whenever a Medicaid-recipient mother gives birth, the baby is automatically covered by Medicaid. But the child must be registered to be eligible. In the past, newborn registration was handled over the phone. A hospital staffer would dial AHCCCS, connect with a call center representative, and provide basic information about parents and child. The call center rep then accessed the parents’ account, entered information about the infant, processed the registration, and gave the hospital employee the new ID. Not only was the process laborious, but babies are not always born during regular business hours. So either the call center had to maintain extra staff through overnight and weekend hours, or registrations had to wait till the next business day.

To remedy the situation, AHCCCS built a Web page providing hospital personnel with direct access to the Medicaid application. By filling out a simple Web form integrated with the mainframe, hospital staff can now register newborns, day or night, without a call-center middleman. This simple, efficient solution was the birth of AHCCCS Online.

AHCCCS designed its second Web solution for members, giving them basic self-service access to their Medicaid accounts. The initial iteration of the AHCCCS Online members’ portal also gave recipient-members that ability to manage and update many of their own records – again without assistance from call center personnel.

Growth of AHCCCS Online

The two initial Web solutions were developed and went live in a matter of weeks. Since then, AHCCCS Online portals for members and care providers has expanded significantly. Today, the member portal, shown below, allows members to manage their accounts, update personal information, verify eligibility, enroll in plans such as Behavioral Health or Medicare – including Part D prescription drug plans – and more.

FIGURE 1. THE CURRENT AHCCCS ONLINE MEMBER PORTAL.

AHCCCS has similarly expanded the AHCCCS Online portal for health care providers. Here, physicians, nurses, administrative staff, and others – working in hospitals, offices, clinics, or any location – can instantly access members’ health plans to check eligibility, update patient and treatment information, submit claims, check claims, and perform many other information-based tasks.

Together, the two portals currently receive an average of 77,000 hits per day. These Web enablement solutions have reduced workloads and improved productivity in the call center, increased user satisfaction, and enabled AHCCCS to leverage its legacy business logic in modern, self-service Web applications without incurring the risks and costs associated with migrating to a new platform or rewriting business code.

Extending Web Access to Employees

The success of AHCCCS Online proved the concept’s value and encouraged the AHCCCS IT team to turn its attention to a second major solution – a Web application designed for call center personnel and others who work directly with members and care providers. About two years after launching AHCCCS Online, the team completed and deployed the Web AHCCCS Verification of Eligibility Site (WAVES), modernizing CA  Ideal applications for the employees who use them most. For call center staff, the transition from legacy access using green screen-style terminal emulation to a full-featured, user-oriented Web interface has been nothing less than revolutionary.

Like many legacy applications, CA Ideal applications adhere to the old screen-by-screen, one-transaction-at-a-time model. This in itself slowed down call center personnel and processes. Further complicating matters was the unique complexity of AHCCCS’s CA Ideal applications, in which screens are accessed and navigated based on codes – thousands of codes, for medical procedures, treatments, coverage levels, account information, and more. Call center personnel trained for months to learn the codes and application navigation. And despite their training, they still had to proceed one screen at a time and, whenever they encountered an unfamiliar code, reference a massive book of codes they kept always at hand.

Today however, thanks to WAVES, they have mouse-click access to all the information they need on Web screens designed for intuitive interaction.

FIGURE 2. THE WAVES PORTAL IS NOW USED BY EMPLOYEES THROUGHOUT THE ORGANIZATION.

WAVES is a Web portal providing easy access to the breadth of information and functions call center users need to interact quickly and effectively with members and care providers. Each tab within the WAVES portal presents data that has been aggregated from numerous mainframe screens and efficiently organized in logical categories – Demographic, Eligibility/Enrollment, and so on.

With all relevant information presented in a single view, call center users no longer have to know which CA Ideal screen to go to or traverse dozens of screens to complete a transaction. Instead, on a call, they can simply report what they see before them or update multiple fields and then submit changes with a single click. Nor do they have to remember or look up codes. Within each tabbed page, users are provided with an automated “glossary” so they can find codes right on the current page. They simply mouse-over a code they don’t recognize, and the definition pops up.

WAVES has streamlined nearly every operational process that occurs in the call center. Workers are far more efficient and productive, and interactions with members and care providers go more smoothly for everyone involved. For call center personnel, WAVES is the far superior access option. For other employees, it is the only feasible option.

Though designed specifically for the call center and customer-facing employees, WAVES is available to everyone in the agency who might benefit from access to the deep stores of data and application logic on the AHCCCS mainframe. Now surpassing 20,000 hits per day, the WAVES Web enablement solution has modernized the user experience for all AHCCCS employees – and the way the organization does business.

Applications for External Partners

In addition to its major Web-enablement initiatives, AHCCCS has used HostBridge as a key component in two more solutions for external partners.

Together with the Arizona Department of Economic Security and KidsCare, Arizona’s Children’s Health Insurance Program (CHIP), AHCCCS have developed Health-e-Arizona, a one-stop portal that provides citizens with a wide range of resources related to health care and healthy lifestyles as well as enrollment in various state-managed health and nutrition programs.

The AHCCCS mainframe houses Health-e-Arizona’s backend customer applications and data, and the AHCCCS .NET web server hosts the Web portal, with HostBridge providing the Web services that bridge those two core resources. Currently receiving upwards of 50,000 hits per day, the Health-e-Arizona web site is just one example of the extensibility and flexibility of AHCCCS’s SOA model.

AHCCCS also provides a mainframe-based, HostBridge Web services-enabled Web application for Medicaid recipients in Hawaii. In the early ’90s, the two states reached an agreement whereby Arizona shares mainframe capacity and its CA Ideal application resources with its sister state. While carrying out its own Web initiative, AHCCCS developed and now delivers the Med-QUEST Web site for the Aloha state as well.

Architecting a Mainframe Web-Enablement Solution

HostBridge is a pivotal component of a “layered” Web enablement solution that now provides all AHCCCS users with modern access to legacy applications and data. The solution extends from the System z mainframe and CA Ideal applications, through the HostBridge Web services engine, to the .NET-based Web server, and ultimately to the desktops, laptops, tablets, and smartphones – with their array of browsers – used by state employees, health care professionals, service providers, and Medicaid members.

As noted above, the complexity and unfamiliarity of AHCCCS’s CA Ideal applications were a prime motivator behind the organization’s Web enablement effort. That complexity had to be addressed in the design of the Web enablement solution. With an application rewrite off the table, the question was how to repurpose CA Ideal business logic and data to make it usable by modern people and reusable as services by ever-evolving technologies.

The most basic approach to Web enablement would be screen-by-screen display of the legacy application in a Web browser. Of course, given the difficult nature of AHCCCS’s Ideal applications, such an emulation-style approach would defeat the purpose of improving application usability. AHCCCS needed to find a way to simplify application access by rethinking mainframe navigation and generating a true Web presentation – crystal clear and highly intuitive. The first step in doing so was to aggregate large numbers of CA Ideal screens onto a single Web page or tab.

AHCCCS’ programmers set about designing transactional screens that aggregate very large numbers of CA Ideal screens organized according to the higher-order principles noted in the WAVES solution above – eligibility, account information, and so on. This aggregation allows AHCCCS to identify, organize, and unify otherwise disparate screen information for presentation within a single Web page/tab – and eliminate screen navigation**.

**Using the HostBridge JavaScript (Process Automation) Engine, developers can write single Web services that automate highly complex transaction micro flows, executing dozens or even hundreds of screens as one process. But given the fragmentary nature of AHCCCS screens, with no clear path through a defined transactional process, aggregation in CA Ideal was the optimal choice.

HostBridge XML/Web Services

Once the aggregated CA Ideal screens had been created, AHCCCS Web developers went to work with HostBridge, taking full advantage of its ability to auto-generate XML from mainframe screens – in this case, the newly aggregated CA Ideal screens. Within the HostBridge Eclipse IDE, an XML rendering of each aggregated mainframe screen is displayed in all its depth and complexity. Developers use these XML screens together with HostBridge JavaScript to write scripts that embed the XML in any type of Web services.

At runtime, the HostBridge JavaScript Engine receives requests from user computers, calls the aggregated CA Ideal screens, processes them, and delivers their data as Web services to the Web application running on the .NET server. And most Web services now reside in libraries for sharing and reuse.

HostBridge makes both mainframe access and Web services scripting easier than any other integration product. Given their familiarity with and knowledge of JavaScript, the AHCCCS Web developers were able to start writing services with no training in new programming languages or protocols. In fact, far more time is spent analyzing the logic of legacy applications than Web-enabling them with HostBridge.

Benefits: Platforms, People, Profitability

Adopting HostBridge as its Web services standard and the final piece in its Web enablement architecture, AHCCCS was able to forge a complete Web enablement architecture and achieve its mainframe modernization goals. The organization continues to leverage its mainframe to ensure the highest performance, reliability, and scalability for its business applications. It also continues to leverage existing CA Ideal business logic and data – and improve returns on the decades of human and capital investment in its legacy Medicaid applications. Instead of spending tens of millions of dollars on new applications and platforms, AHCCCS has revitalized its mainframe with HostBridge Web services as a key part of a modern, dynamic Web solution for today’s recipient-members, health care providers, other partners, and its own employees.

The benefits of AHCCCS Online and WAVES for users are clear. With easy, Web-based, self-service access to vital information and processes, satisfaction is at an all-time high for 34,000 health care personnel and 1.3 million Medicaid members. People no longer wait in call queues and no longer require call center assistance for every query or update. Accessing the information and functionality directly and instantly, they are more efficient and productive with their personal or professional time.

The same holds true for AHCCCS employees, particularly those who interact with members and providers. As call volumes have decreased, call center representatives have experienced dramatic increases in efficiency, productivity, and cost containment.

For AHCCCS and its employees, one outcome of the Web enablement strategy is particularly remarkable. Before WAVES, training a new call center employee took three intensive months devoted to learning the huge number of procedural and business codes as well as the navigation and characteristics of the CA Ideal applications. By eliminating this training, new employees are productive from day one, and AHCCCS has reduced one operating expense. Assuming a salary of $30,000 per year and a staff turnover of 10 percent per year, the savings on training amounts to $75,000 annually (three months of a $30,000 salary equals $7,500 times 10 employees).

With HostBridge, productivity has similarly improves among developers, for added cost savings. Using HostBridge JavaScript to write mainframe Web services accelerates development cycles by three to four times compared to other Web services tools. For AHCCCS, HostBridge simplicity has enabled faster development and faster time to market with new Web enablement solutions.

FIGURE 3. MOBILE VERSIONS OF AHCCCS ONLINE AND WAVES ARE NOW IN DEVELOPMENT.

Future

AHCCCS IT teams continue to build out the AHCCCS Online and WAVES solutions. Farther out on the horizon, AHCCCS is considering a broad-based health information exchange, or HIE. As a statewide provider, AHCCCS is well positioned – particularly with its powerful, scalable Web enablement infrastructure – to build an information hub that integrates data and functionality from hospitals, clinics, pharmacies, laboratories, and other care providers, as well as from other insurance providers or any organization whose mission is quality care and coverage.