Startup Launches Innovative Healthcare App Quickly and Affordably in the Cloud

OverviewCustomer: Cambia Health SolutionsCustomer Website: www.cambiahealth.comCustomer Size: 11,000 employeesCountry or Region: United StatesIndustry: Healthcare—Other health-related services

Customer ProfileWellero™ is part of the Cambia Health Solutions family of companies that provide a range of products and services, including healthcare IT, retail healthcare, health insurance plans, life insurance, pharmacy benefit management, consumer engagement, and wellness.

Business SituationConsumers need faster and easier insight into healthcare service costs, including actual out-of-pocket expenses and how these vary between providers.

SolutionWellero developed a cloud-based solution with Windows Azure that includes an app for consumers to pinpoint service costs and process payments—and a provider portal that streamlines business processes.

Benefits Reduced costs by at least US$275,000 Cut time-to-market in half Increased scalability and agility Boosted consumer insight and control Helped providers improve services

“Microsoft keeps our software up to date, spins up new compute instances as needed, and makes sure our systems are adequately protected. For us, Windows Azure is invaluable.”

Ryan Johnson, Lead Developer, Wellero

Wellero wanted to create a new offering that gave consumers, healthcare providers, and insurers more insight into service costs and responsibilities. To achieve this, Wellero needed an affordable IT infrastructure and a flexible development platform to expedite time-to-market and help simplify regulatory compliance. After comparing technologies, Wellero chose the Microsoft platform including Microsoft Visual Studio 2013 and Windows Azure. As a result, Wellero brought its new offering to market twice as fast; saved at least US$275,000 in its first year of business; and boosted its scalability and corporate agility. The company was also able to create two versions of a unique mobile app that gives consumers more information and control over healthcare costs—and gives providers a single point-of-access to the solution to exchange data and enhance services.

SituationWellero was founded in 2012 as a subsidiary of Cambia Health Solutions, a total health solutions company based in Portland, Oregon. The subsidiary’s purpose is to meet requirements from organizations like the American Medical Association that have called on insurers to provide physicians with better tools to automatically determine a consumer's payment responsibility before treatment.

Healthcare is one of the few industries where consumers often do not understand how much money a service will cost until weeks after they have had the service performed. Wellero wanted to change that by developing innovative IT offerings that could help providers and patients establish the costs of services fees before or at the time of delivery. Ryan Johnson, Lead Developer at Wellero, says, “We really wanted to eliminate the drawn-out cycle that people typically face when paying for a doctor’s visit and getting compensation from their insurance company.”

To achieve its goals, Wellero decided to create a mobile app that patients can use to: Find a doctor based on specialty,

location, reviews, and costs. Obtain a detailed invoice at the time of

service that includes all pertinent medical codes and related fees.

See how much money their insurance company will pay for service charges.

Understand how much money they could save if the provider offers discounts for paying cash on the day of service.

Process the payment using their own mobile phone.

And because its app would help facilitate healthcare appointments and payments, Wellero decided to design its app as a consumer’s single point-of-access to healthcare records and expenses. So regardless of where people lived or what insurance company they used, with the Wellero app they could instantly pinpoint

when they last had a procedure—such as a tetanus shot—or find out how much they had spent on healthcare over the last five years.

Wellero also decided to create a portal that healthcare providers could use to enter data about service fees, and streamline admissions and check-in processes for registered Wellero users.

As with any new business idea, success is often closely tied to rapid time-to-market. Wellero needed to select, procure, and deploy a completely new infrastructure as quickly and affordably as possible including web servers, storage hardware, and database software. To create the mobile app and portal, engineers also needed to choose a software development platform, including a framework and language. The entire solution would need to provide excellent scalability and help simplify compliance with federal healthcare regulations including the Health Insurance Portability and Accountability Act (HIPAA).

SolutionRather than build its own physical infrastructure, Wellero decided to use the cloud. By doing so, it could maintain a stand-alone infrastructure that was separate from the Cambia Health data centers. The company would also be able to get its infrastructure up and running in a few hours and significantly reduce startup costs and risks, factors that are important to the success of a young company.

After reviewing competing cloud services, Wellero chose Windows Azure. Johnson explains, “We looked at several clouds including Amazon and Windows Azure. One of the biggest selling points for Azure was its HIPAA compliance. At the time, no other cloud service provider was willing to sign an agreement stating it would manage data in accordance with HIPAA.”

Another reason Wellero chose Azure is that developers were already familiar with the

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“We have already saved $275,000 by opting to use Windows Azure instead of building and maintaining our own infrastructure.”

Ryan Johnson, Lead Developer, Wellero

Microsoft platform and development tools including the Microsoft .NET Framework and Microsoft Visual Studio. With Windows Azure, Wellero could also take advantage of platform-as-a-service (PAAS), infrastructure-as-a-service (IAAS), and hybrid cloud options to meet different needs.

For example, to support its mobile app and provider portal, Wellero uses numerous PAAS offerings including Windows Azure Cloud Services, Queues, and Service Bus. As a result, developers can focus exclusively on solution development because Microsoft engineers manage the infrastructure. Conversely, engineers use Windows Azure Virtual Machines (an offering in IAAS) to control the size and number of their development systems. And in the future, if Wellero decides to run some systems on-premises while keeping others in the cloud, it can do so with the hybrid-cloud option in Windows Azure.

In March 2012, developers began to create two versions of its mobile app: one that runs on the Android operating system and the other on iOS. The mobile app and provider portal are supported by two web roles and one worker role that developers created using the Microsoft Visual C# development tool and the Windows Azure software development kit (SDK):

One web role uses the Microsoft ASP.NET Web API framework to expose an API that drives the mobile apps.

Another web role uses Microsoft ASP.NET MVC to support the provider portal.

The worker role facilitates all batch and resource-intensive processing tasks.

To support its offerings, Wellero developers use data services in Windows Azure PAAS that include:

Windows Azure Tables, which contain all personally identifiable information

including subscribers’ health history and services in an encrypted format.

Windows Azure SQL Database, which contains nonpersonal metadata.

To simplify development and collaboration, Wellero developers use Microsoft Visual Studio Team Foundation Server (TFS), which runs on a Windows Azure Virtual Machine. They also use MSTest.exe, a built-in command-line utility in Visual Studio 2013 to customize and run tests.

After a six-month pilot, Wellero launched its mobile app and portal in January 2014. After just one month in production, Wellero had 564 consumers and eight healthcare providers register.

BenefitsBy developing and running its solution on the Microsoft development and cloud platforms, Wellero significantly reduced its initial costs, accelerated return on investment (ROI) and time-to-market, created a highly scalable solution that gives consumers more insight and control over healthcare costs, and sped compensation cycles for providers.

Reduced Initial Costs by at Least $275,000 and Sped ROIBy choosing to run its infrastructure on Windows Azure, Wellero dramatically contained startup expenses. Johnson says, “We have already saved $275,000 by opting to use Windows Azure instead of building and maintaining our own infrastructure.”

By keeping its initial costs to a minimum, Wellero also accelerated ROI. Hanny Freiwat, Co-founder of Wellero, says, “We knew that choosing Windows Azure would give us rapid ROI because we’d get such a scalable model and only pay for what we use. We wouldn’t have to deal with hardware life spans and depreciation.”

Wellero is also minimizing costs with Windows Azure PAAS. “We save money and time by having Microsoft manage our

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“When you take a Microsoft product like the .NET Framework and use it with another Microsoft product like the Azure SDK, you’re pretty much guaranteed a good experience, and that’s exactly what we saw.”

Ryan Johnson, Lead Developer, Wellero

virtual machines in Azure,” says Johnson. “Microsoft keeps our software up to date, spins up new compute instances as needed, and makes sure our systems are adequately protected. For us, Windows Azure is invaluable.”

Cut Time-to-Market in Half Wellero is quite happy with how much it has achieved over the last year. “Developing our code was simple using the .NET framework and the Windows Azure SDK,” says Johnson. “You can mix frameworks and SDKs, but when you take a Microsoft product like the .NET Framework and use it with another Microsoft product like the Azure SDK, you’re pretty much guaranteed a good experience, and that’s exactly what we saw.”

Engineers also saved time by using other Microsoft tools. Johnson explains, “With Microsoft Team Foundation Server, we’re more productive because we can ensure all code checked into source control builds and passes all unit tests. In addition, we can kick off automated integration tests at any time, distribute reports, test faster, and test more often. We also find regression bugs in minutes after they are created, which is much faster than other tools we’ve used in the past.”

Because they quickly get the resources that they need, engineers are more efficient. “If we had to set up and manage a data center, and had to use development tools that weren’t from Microsoft, it probably would have taken us at least twice as long to achieve what we did today,” says Johnson. “What’s great about Azure is that we can spin up more virtual machines and tear them down as we see fit. If we have a large queue of check-ins or if we want to run all of our integration tests at once, we can spin up a few more build servers and distribute the work load.”

Increased Scalability and AgilityBy taking advantage of Windows Azure PAAS, Wellero can keep its focus on clients

and services rather than on managing infrastructure. Regardless of the number of people who use the app or portal, their location, or the amount of data being managed by the solution, Microsoft personnel add resources as needed to deliver consistently fast performance and high-availability levels. “Even if we need to host our application on both coasts, with Windows Azure I just click a few buttons, wait about ten minutes, and it’s done,” says Johnson.

Increased Consumer Insight and Control over Healthcare Costs Today, when consumers register with Wellero, they can immediately start to make sense of their benefits, see the providers who have registered with Wellero, and view other information including providers’ ratings and available discounts for paying cash or on the day of service. “People can drill down and find out what their out-of-pocket costs will be for a service at a specific doctor’s office based on their specific insurance policy,” says Johnson. “Having this insight makes it easier to manage budgets and see if it makes sense to hold off on a particular service.”

And if consumers want to pay before they leave a doctor’s office, they can do so using the Wellero app. “Our users benefit from a plan-agnostic mobile healthcare platform that allows them to pay their bills and keep their own records with real-time access,” Johnson explains.

Helped Providers Improve Services and Speed Compensation Cycles By registering with Wellero, providers can increase visibility into potential clients and use the offerings to boost service levels. For example, if both provider and patient are registered with Wellero, providers can obtain a patient’s insurance information directly from the portal. In addition, a patient can use the mobile app to check in for an appointment so he or she doesn’t have to wait in line.

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“If we had to set up and manage a data center, and had to use development tools that weren’t from Microsoft, it probably would have taken us at least twice as long to achieve what we did today."

Ryan Johnson, Lead Developer, Wellero

Wellero is also helping providers to reduce time spent on managing paperwork and claim denials. “Now providers can use

Wellero and Windows Azure as a single source of information about service costs and insurance contracts, so that staff do not have to manage costs and policy information in each patient’s electronic medical record,” says Johnson. “This will make administrative processes a lot easier and will save time.”

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Software and Services Windows Azure Platform− Windows Azure− Windows Azure infrastructure-as-a-

service (IAAS)− Windows Azure platform-as-a-service

(PAAS)− Windows Azure software

development kit (SDK)− Windows Azure Cloud Services− Windows Azure Queues− Windows Azure Service Bus

− Windows Azure SQL Database− Windows Azure Tables− Windows Azure Virtual Machines

Microsoft Visual Studio− Microsoft Visual C#− Microsoft Visual Studio 2013− Microsoft Visual Studio Team

Foundation Server 2013 Technologies− Microsoft ASP.NET− Microsoft .NET Framework 4

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published March 2014

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