Sujith Nair, Senior Application Development Manager, shares his experiences working with a healthcare customer and the performance challenges common during open enrollment season. He also discusses how customers could use Azure, or the Microsoft Cloud, to manage such bursting compute scenarios.

What are enrollment cut-off dates in health insurance?

Obamacare, or the Affordable Care Act , implements state specific health insurance exchanges which are online price comparison websites where consumers can purchase health insurance. Open enrollment in all marketplaces started on November 15th and ends February 15th. Once the cut-off dates are over, you can get coverage through this program only if there is a life change which will give you a special enrollment period or if you qualify for Medicaid or CHIP.

Why is this such a huge performance challenge for most providers?

Though there are many rules on qualifying for healthcare, the main rule that drives more traffic into insurance exchanges is that if you miss open enrollment you won’t be able to get coverage again until the next open enrollment period without qualifying for a special enrollment period. To get coverage effective Jan1st, you should enroll by Dec 15.  As there is no incentive to sign up on Nov 15 instead of December 15, the December 15 cut-off date will have the highest demand and that will be a Black-Friday for health insurance. Jan 15 and Feb 15 also will have equal traffic from folks who missed the deadlines.

The same systems which were built to accept few hundred (< 500) enrollments throughout the year is suddenly experiencing huge volumes (7K-12K/day) on specific cut-off dates. Health providers are requested to scale the systems 24 times as envisioned. Moreover, the systems that they have were developed several years ago and does not have  scalable Architecture as those that are developed in recent years. Many systems has been owned through acquisitions and a lot of business logic is built into these systems which makes it difficult to re-write in a short time frame and may take years before a fully scalable architecture are implemented by most of the providers.

Performance optimization help

Premier Support actively worked with Healthcare customers to optimize the performance of their systems through Architectural guidance, Code reviews, T-SQL reviews, and Performance Testing.  Premier Support for Developers used a FAST based approach for performance optimization.

FAST approach – Find bottlenecks, Analyze root causes, Speedup/Solve and Test changes and compare results is an iterative methodology that has been proven to be a successful in performance optimization projects.

What can be done for the future?

Though the performance optimization work helped these customers get ready for their immediate performance challenges at hand, a more scalable solution that can enable customers to be ready for sudden bursting scenarios such as Black Fridays and future growth would be using hybrid solutions that leverage Windows Azure cloud services.

Hybrid Approach

In a highly regulated industry like insurance, companies can still consider a hybrid approach where the scalability needs can be met leveraging a private cloud in your data center. When you extend your own data center to meet the cloud you have a hybrid cloud model which provides the ability to make use of external resources whenever you need them or are ready to use them. The Microsoft hybrid cloud combines Microsoft Azure, Windows Server, Windows Azure pack (WAP) and Microsoft System Center, giving you Microsoft’s enterprise-grade technology in both your company’s own datacenter and our global datacenters.

This hybrid approach will help build next generation of enterprise systems that can work well on different devices and leverage on-premises and cloud resources when required. This will help insurance companies take advantage of the agility, scalability and elasticity of the cloud during changes and peak loads, have secure data on-premises and improve efficiencies to reduce cost and compete in the insurance market.

If you are interested to learning more about developing hybrid capability, doing a proof-of-concept (POC), or have performance challenges in your applications, please contact your Application Development Manager (ADM) or Premier Support for Developers.  If you need help with performance optimization and testing of your systems, be sure and see our previous post on ITSM testing services.