The Crucial Role Linux on z Systems Plays in Health Insurance Enrollment

Imagine trying to fill a prescription at the pharmacy only to discover that, due to some unknown error in some faraway IT system, your health insurance coverage isn’t available. At best, this could be a minor frustration, but at worst it creates a serious medical hardship that puts policyholders at risk.

Access to care is one of many challenges on Mike Giglio’s plate. He’s a z/VM Systems Engineer at Healthplan Services, a Florida-based provider of sales, benefits administration and technology solutions to health insurance carriers. One of his major responsibilities involves implementing the technology that underpins federal and state health insurance exchanges, through which customers buy coverage.

The Affordable Care Act introduced the concept of exchanges as a way to enable insurance providers to sell coverage to individual consumers, rather than just employer groups. States can vote whether to implement their own exchange and in states without a marketplace, customers can buy coverage through the federal exchange or directly from a carrier.

Through Exchange Link, its proprietary software, Healthplan Services oversees the transfer and processing of important coverage information between state and federal exchanges, insurance carriers and individuals. That way, when you make a change on your policy, like adding a beneficiary, every important stakeholder is notified and your coverage is updated.

During his recent session at SHARE in San Antonio, Mike explained the unique challenges of coordinating all of this, and why it wouldn’t be possible without the scalability and performance of Linux-powered z Systems mainframes.

The Challenge

Customers apply for health insurance through the open enrollment period, which extends from November through the end of January each year. It’s without a doubt the busiest season for policy changes, and during those three months, an incredible number of transactions pass through Exchange Link for processing and three-way verification between the carriers, customers and exchanges.

Quality of service is crucial during these three months. It’s a highly visible time for the exchanges – the media covers technical slip ups with tenacity, said Giglio. Customers, naturally, want the peace of mind of knowing their changes were processed and that coverage will continue for another year. Their medical care depends on it. So it’s important that the infrastructure that underpins the exchange is efficient, productive and fast.

The Model

Without Linux running on z Systems mainframes, Healthplan Services would have a hard time making all of this work, Giglio said. In fact, members of the team believe it would be impossible to process all of those transactions without the performance and efficiency of z Systems.

Giglio explained that the company spreads workloads and middleware across four environments: a z/VM single system image that runs IBM WebSphere Application Service (WAS), another that runs IBM WebSphere MQ, IBM Integration Bus and IBM WebSphere Translation Extender, and two z/VM images that share the workload of IBM DB2 for Linux, Unix and Windows.

Capacity is, of course, a huge challenge for Healthplan. So Giglio works hand-in-hand with a Linux Administrator to provision and build a scalable server environment that relies on a satellite server as a model and a configuration process that customizes each subsequent server based on network requirements, size and other factors.

The goal is to have capacity on demand and scale up firepower during those three very busy months of the year. Dashboards and monitors help Healthplan address capacity as needed. Giglio said he’s able to track workloads by insurance carrier, seeing which ones drive up workload the most. He can also identify which processes are driving up workload in Linux, and in the future hopes to monitor sub-processes that contribute to increases.

Every year, the challenge gets bigger. Giglio said overall capacity has grown an astounding 1,300 percent since Healthplan Services started its exchange program three years ago. Continued growth is expected as existing insurance carriers expand their subscriber base and new carriers are added.

Through it all, Giglio and Healthplan Services are able to exploit the power of Linux on z Systems to give the business steady quality of service. That way, when an insured individual goes to the drug store to pick up a prescription, they can take advantage of the health insurance coverage they paid for.

To learn more about how Healthplan Services relies on Linux-powered z Systems mainframes to support insurance exchanges, replay Mike Giglio’s presentation at SHARE in San Antonio. And don’t forget to register now for SHARE Atlanta 2016, July 31-August 5.

Recent Stories
A Legacy of Wisdom: The Dr. John Ehrman Interview – Part IV

Advice for Women in IT, From Women in IT

SHARE Pittsburgh Preview: Greg Caliri on Measuring and Monitoring Performance