Overview

As a point of compliance, health insurance companies are required to provide a directory of providers to members. U of M Health Plan had been sending a file of provider data to a third party and paying them to create provider directory PDFs from the data. If a member wanted a directory, they would submit a request in the member portal website and a print request would be sent to the same third party vendor, who would print and mail a hard copy to the member.

Requirements

• Output must be a file that can be downloaded by a member
• Themable branding based on line of business
• Pagination and Table of Contents
• Providers must be listed in multiple sections grouped by characteristics like location and languages spoken
• The process must be automated with as little human interaction as possible

Solution

• Query details about providers that are a part of the U of M Health Plan
• Group and order the query results in the business logic using custom data class objects
• Utilize Microsoft Word for document format because it has page number and Table of Contents object fields built in
• Build a document template with common content among directories, and then use EPP library to manipulate colors and inject content.

Overview

The Provider Incentive Program (or PIP) is a bonus payment made to providers based on overall provider performance. Providers receive a report every month detailing their measure calculations and their patient rosters, and then a report at the end of the program year with their payment dollars. These documents were being generated by Crystal Reports. The interface for adding to or updating reports was not user friendly, making any change to a report time consuming. Crystal Reports also dropped support for their Visual Studio integration years ago, making the program extremely unstable. As a result, it became impossible to make any changes to the reports.

Requirements

• Remove dependency on Crystal Reports
• Keep the original layout of the reports while increasing the ease of modifying reports in the future
• Generate PDFs for distribution to providers detailing their member visits
• Calculate incentive dollar payouts
• Create pie charts of key visit metrics

Solution

• Use a templating engine (Scriban) to reduce code redundency and increase maintainability
• Create html templates for the structure of the report, with CSS styling and JavaScript for charts
• Run calculations and inject variable data into template and render the template in a headless Chrome window using Puppeteer
• Capture the rendered html as a PDF and upload the file to the Member Portal

• Query source-of-truth database for provider data
• Send SOAP API requests to Facets endpoint

• Add automated data integrity testing and file format testing