Veterans Administration (VA) Patient-Centered Community Care (PC3) and Veterans Choice Programs (VCP) for Health Net Federal Services (HNFS)

Executive Summary

Cognitive Medical Systems implemented the FISMA-compliant IT hosting environment, developed data integration solutions for healthcare administration and claims management systems, and developed custom web-based applications used by HNFS to manage VA PC3 and VCP (also known as Choice). VA’s PC3 and Choice programs provide private healthcare to compliment the VA healthcare system.

Challenges

VA is the largest integrated healthcare system in the United States, providing care at 1,250 facilities for over 9 million Veterans nationwide. VA awarded the PC3 program to HNFS in 2013 in order to outsource specialized care to providers in the community to augment services available at local VA facilities. At the outset of the contract award, the volume of Veterans referred to providers outside of VA was anticipated to be low. However, due to the Veterans Access, Choice, and Accountability Act passed by Congress and mounting pressure on VA to address long wait time issues, the Choice contract was awarded to HNFS in 2014 to expand private healthcare services available to Veterans. The volume of Veterans referred to HNFS for private healthcare surged exponentially and remained much higher than initial requirements due to the high demand for Veteran healthcare services outside of VA facilities.

How We Helped

Cognitive successfully implemented the FISMA-compliant PC3 hosting environment, with mission-critical healthcare administration systems and custom data integration solutions in the Amazon (AWS) GovCloud within the aggressive 90-day transition-in period. Cognitive worked very closely with HNFS business leaders to understand the unique requirements of the VA PC3 and Choice programs in order to develop custom web-based applications to address specific business requirements around healthcare appointing, medical documentation administration, and medical claims processing. As the program volumes surged, the AWS GovCloud environment gave Cognitive the flexibility needed to address hosting infrastructure capacity issues quickly and cost effectively.

Custom applications and system integrations:

  • Provider directory integrated with Google Maps and American Medical Association (AMA) application programming interfaces (APIs)
  • Integration service between the Availity Provider Portal and the Quantum Choice (QC) claims management system
  • Integration service for paper referral/authorizations with optical character recognition (OCR), parsing, and automatic API calls to claims management system
  • Integration service between the QC claims management system and the InContact Auto Dialer phone system

Outcome

Cognitive has continued to provide IT hosting and custom software application services for HNFS in support of the VA PC3 and Choice programs in the AWS GovCloud environment since 2013. Cognitive is committed to going above and beyond contractual requirements to provide excellent customer support at all levels of the organization, including Help Desk support for end users and business solution support for senior leadership. As an expert in the AWS GovCloud hosting space, Cognitive continues to support HNFS, and its new parent company Centene, with its existing Federal programs, and will continue to support future opportunities.