eQHealth Solutions Scales with InRule®

eQHealth Solutions is a not-for-profit healthcare IT and services company. With over 25 years of experience, their offerings have continually expanded and include a variety of Web-based software solutions and medical management services. Their clients include insurers, self-insured employers, Medicare, state Medicaid agencies and other risk based entities. Their wide ranging product offerings include solutions for population management, patient health information integration, business intelligence, care coordination, utilization review, and quality improvement and wellness services.

The market is rapidly evolving for healthcare organizations. eQHealth is engaging with a growing number of commercial clients on top of their core government contracts, and the company is growing along with the industry. In fact, the company has grown 20-30% over the past five years. It has seen tremendous success because it is truly a total medical management solutions company

eQHealth’s flagship offering is eQSuite®. eQSuite® is a web based IT platform environment composed of three main modules: business intelligence, clinical integration, and population management. Advanced analytics, integration of provider EHR and EMR data, identification of high risk/high cost patients, managing health costs through utilization management, and a flexible care coordination platform is all part of eQSuite®.

eQSuite® is delivered as a software as a service model, fully customized for each client based on its own specific business logic. In healthcare, the rules are always changing; semiannual or even quarterly updates to the business logic are expected. In the early versions of eQSuite®, hard-coded rules made for countless hours spent maintaining, revising and keeping up, as well as specialized skill sets for the developers. Particularly as the eQHealth client base grew, it was essential to maintain – even reduce – turnaround times; the company sought to automate rule authoring and management.

As it embarked on the search for a solution, eQHealth sought a scalable solution from a vendor that was a tightly integrated Microsoft partner that worked well with .NET, fit well with its existing code repository, and offered the ability to author and change rules in a user-friendly way. The solution needed to allow eQHealth to utilize the right resources to author and maintain rules, as business analysts deliver them to developers.

When eQHealth discovered InRule Technology, it found a true partner.

Solution
eQHealth was pushing the limits of rules, but InRule® made the testing and vetting process easy. Its support team was very responsive, and the technology has been able to scale and keep up with eQHealth’s growth since implementation. With InRule, eQHealth can quickly and easily change rules and calculations in eQSuite with less effort, cost, and risk than programming.

All of the eQHealth products leverage InRule to some extent, from Word authoring to the Windows-based authoring tool, to the code repository and check-in/check-out functions. InRule speeds availability of an extensive inventory of rules throughout eQSuite, and workflow logic, member eligibility and limits, notifications in the care coordination system, and general requirements are all configurable on the client end.

However, clients must still deliver changes for development. The next step in the evolution of eQHealth change management is for the clients to become empowered to manage rules themselves: authoring rules within eQSuite will be in the hands of the client.

Results
“InRule has made it remarkably easy and more cost-effective to write and manage rules than the traditional hard-coded logic approach – it has been able to scale and keep up with our growth,” said Sean Marchiafava, Chief Information Officer of eQHealth. “Our team is able to focus on true functionality, rather than rules. In fact, we’ve accelerated our application development capacity at least 30%. InRule has been essential to our development strategy, and it has had a real impact on our bottom line.”

By leveraging InRule in lieu of hard coding, eQHealth has realized significant, quantifiable return on investment. Its team has increased its efficiency, leading to 12% savings in hours. That efficiency directly affects the bottom line: the saved hours are worth $112,320 annually, or a total savings of $224,640 in the first two years after eQHealth rolled out InRule.