Cloud Engineering for Medicaid and Risk Adjustment

This case study outlines the enhancements made by Harbinger to a health data management system for a US-based client that serves Health Plans. The client aimed to integrate Medicare and Medicaid into a single system while simplifying Risk Adjustment. The existing Medicare Claim Processing system was upgraded to include Medicaid Claim Processing, utilizing significant cloud engineering on AWS to improve scale and performance. The study details the challenges faced, such as underutilization of cloud resources and suboptimal performance in processing Risk Adjustment records. Harbinger's solution involved optimizing the cloud infrastructure by implementing various AWS services, including Amazon Redshift for data processing and Amazon SQS for communication. The case study presents specific improvements in processing times for different claim volumes, demonstrating the effectiveness of the optimizations made. The results indicate enhanced performance, scalability, efficiency, and accuracy achieved through the strategic use of cloud technologies.