1. Confidential | Copyright © 2014 TriZetto Corporation 1

2. 2 Advancing the Architecture via Real-Time Accumulators DeWitt Angevine, Architect

3. Confidential | Copyright © 2014 TriZetto Corporation 3 Agile from the start - User Stories As a health plan, I want to be able to pay claims on my core administration system and have any resulting changes in deductibles and limits reflected in my pharmacy benefits management system. As a health plan, I want to be able to pay claims on my pharmacy benefits management system and have any resulting changes in deductibles and limits reflected in my core administration system.

4. Confidential | Copyright © 2014 TriZetto Corporation 4 Business Drivers  ACA Impact A recent ACA mandate to comply with maximum out-of-pocket limits for an individual and a family is driving a need for improved synchronization of accumulators between plans and vendors.  Batch vs. Real-time Most plans using Facets have batch interface with their PBM vendors to synchronize accumulators. Latency between processing and updating systems can cause accumulators to be out of balance.  Reduced administrative cost  Real-time synchronization between Facets and an ancillary benefit platform like pharmacy benefit manager (PBM) reduces the administrative time required to handle accumulators that are not accurately synchronized at the time of claims processing.  Compliance  Enables plans to support ACA requirements for MOOP.

5. Confidential | Copyright © 2014 TriZetto Corporation 5 Architecture Requirement - User Stories I need a way to apply transactional updates to Facets accumulators based on transactions occurring in an external system. I need a way to create transactional updates to be sent to an external system that reflect all changes to accumulators resulting from Facets processing.

6. Confidential | Copyright © 2014 TriZetto Corporation 6 Putting it together with messages  Scenario 1 – PBM Pays Claim  PBM generates transaction message  “Add 100 to Accum 1 for member X”  Message is put on a queue for delivery to Facets  Facets receives message and adds 100 to Accum 1  Scenario 2 – Facets Pays Claim  Facets generates transaction message  “Add 100 to Accum 1 for member X”  Message is placed on a queue for delivery to PBM  PBM receives message and adds 100 to Accum 1

7. Confidential | Copyright © 2014 TriZetto Corporation 7 Defining the Groundwork for Messaging The Solution Should….  Enable the REST pattern  Standard HTTP codes  Use JSON as a message format  Be Messaging Infrastructure Agnostic  Enable communication with multiple messaging vendors through the use of pluggable components  Be Asynchronous  Keep messaging infrastructure out of the claims transaction bracket.

8. Confidential | Copyright © 2014 TriZetto Corporation 8 REST API – AccumUpdate and Accum  Implemented on Microsoft ASP.NET Web API  Does not use FXI Broker engines  Supports multiple accumulator updates for a member in one message.  Uses Lock Token optimistic locking with re-try logic.  Standard HTTP codes  Standard MS log formats for error and trace logs.  Can be configured to use SAML tokens and Facets EXTU validation.  Inquiry support to “GET” current accumulator values.

9. Confidential | Copyright © 2014 TriZetto Corporation 9 Defining a message { "Status": { "Message": [] }, "GroupId": "group1", "SubscriberId": "subscriber1", "MemberSuffix": 1, "MemberAccums": [ { "AccumType": "C", "AccumSuffix": “SFX1", "AccumNo": 1, "PlanYear": 2013, "AmountOne": { "UpdateValue": 100.00 } ], "FamilyAccums": [ { "AccumType": "C", "AccumSuffix": “SFX1", "AccumNo": 1, "PlanYear": 2013, "AmountOne": { "UpdateValue": 100.00

10. Confidential | Copyright © 2014 TriZetto Corporation 10 Response Message – 201 Created "Status": { "HttpStatusCode": "201", "Message": []}, "GroupId": "group1", "SubscriberId": "subscriber1", "MemberSuffix": 0, "MemberAccums": [ { "AccumType": “C", "AccumSuffix": “SFX1", "AccumNo": 1, "PlanYear": 2013, "AmountOne": { "PriorValue": 250.00, "UpdateValue": 100.00, "FinalValue": 350.00 } ], "FamilyAccums": [ { "AccumType": "C", "AccumSuffix": “SFX1", "AccumNo": 1, "PlanYear": 2013, "AmountOne": { "PriorValue": 400.00, "UpdateValue": 100.00, "FinalValue": 500.00

11. Confidential | Copyright © 2014 TriZetto Corporation 11 Response Message – 400 Bad Request "Status": { "HttpStatusCode": "400", "Message": [ { "MessageCode": "100003", "MessageLevel": "Error", "MessageContent": "Group not found", "MessageResolution": "GroupId was not found on our records. Correct and resubmit.", "ResourceInformation": [ "AccumUpdate.GroupId = ‘badGroup'" ],

12. Error Logging

13. Confidential | Copyright © 2014 TriZetto Corporation 13 Message Publishing  Updates to Accumulator tables are captured at the Database Access Class level.  Messages are persisted to the database using the Facets Document Storage Model.  Windows Service responsible for picking up Messages and delivering them to the proper Queue.  System Parameter to Enable Publishing.  Configuration by Group and Accumulator to only publish required data.

14. Confidential | Copyright © 2014 TriZetto Corporation 14 Asynchronous Message Publishing Online Claims Batch Claims Accum Maint DB Access Interceptor Message Store Synch Service MQ Connector Messaging Bus

15. Confidential | Copyright © 2014 TriZetto Corporation 15 REST API – Configuration  Ability to configure the solution without use of a GUI.  Configuration consists of a Group ID as well as a valid set of accumulators for the Synch Solution.  REST services to maintain configuration.  Add an accumulator (POST)  Delete an Accumulator (DELETE)  Update an accumulator (PUT)  Get a Group configuration (GET)

16. Confidential | Copyright © 2014 TriZetto Corporation 16 Prototyping Future Development Models  Agile Scrum  Rapid build  Build on Demand  Turnover to QA on Demand  Test Driven Development  Fully Automated Units tests  Fully Automated Integration Tests  Continuous Integration  Code must pass all Unit and Integration tests before turnover to QA.

17. Confidential | Copyright © 2014 TriZetto Corporation 17 Workshop Survey We would like to extend you an opportunity to provider candid feedback. During the workshop you should’ve received an e-mail notification for you to take an on-line survey. If you could take a few minutes to complete at this time, we would greatly value your feedback. For your convenience, the survey will be available throughout the remainder of the conference should you not be able to complete immediately.

18. Confidential | Copyright © 2014 TriZetto Corporation 18 Thank You!