First Canadian Health

CGI migrates health claims system without a hitch

When it comes to migrating a complex information system from one company to another, there’s no substitute for experience. By skillfully shepherding First Canadian Health’s claims processing system through this crucial transition, CGI provided continuity at a time when they needed it most.

The Challenge
Canada’s federal health department, Health Canada, operates a program to provide
Native Canadians with drug, dental and medical benefits not available under Canada’s provincial and territorial health insurance plans.

In 1998, Health Canada awarded the contract to administer claims under this program to First Canadian Health (FCH), a joint venture of the Native-owned Tribal Councils Investment Group and Aetna Health Management. The system that FCH used to process and pay these claims consisted of Aetna Canada software applications customized to FCH’s needs, hosted on an Aetna Canada mainframe computer, and supported by Aetna Canada.

In 1999, as part of a broader corporate restructuring, Aetna began negotiating to sell its share of FCH to its partner in this joint venture. But for the sale to go through, Aetna had to find an IT service provider that could take over, host, and support FCH’s system, and make this transition quickly and flawlessly. Aetna called for proposals, and CGI’s response blew the competition out of the water.

The Strategy
CGI’s strategy called for migrating FCH’s system from Aetna’s mainframe to CGI’s Toronto-area data center. Mary Dee-Smylie, FCH’s Executive Director, explains how CGI and FCH went about this task.
“CGI started by doing something I’d never seen before—they sent us a team with extensive experience in smoothly transitioning complex systems like ours. These people knew all the issues to investigate and all the questions to ask. Instead of our having to show them everything, they anticipated our problems and helped us work out the best solutions.

“CGI also sent several experts in our Aetna health management applications to facilitate the transition, plus specialists in other disciplines to enhance our system’s performance.

“The day we cut over to the CGI environment,” she continues, “we saw what a difference all this heavy-hitting talent had made. There was zero downtime. We literally plugged in the new system, unplugged the old one, and kept on rolling.”

The Technology

• Outsourcing services provided: mainframe and applications support, telecommunications, client-server support, disaster recovery, help desk
• Application development tool: MS Visual Basic
• Mainframe environment: IBM S/390 running MVS, AS/400
• Client environment: Desktop PCs on a Novell LAN

The Results
Looking back on the transition and on FCH’s experience working with CGI ever since, Executive Director Dee-Smylie is delighted at what she sees.

“When we first heard Aetna was pulling up stakes,” she recalls, “we felt a little lost. They had provided all our users with such wonderful, close support, and we were scared that no one else could do the same.

“But CGI has really taken us under their wing, addressed all our concerns, and made us feel completely secure. Our objective was to get the same service and certainty from CGI as we had gotten from Aetna, and we certainly have. However large or small the problem, CGI has always been just a phone call away with all the support we need.”

As FCH’s IT outsourcer, CGI now hosts and supports a system that processes over
7 million dental claims per year, while also producing reports for 20 million medical and drug claims processed elsewhere. CGI supports over 100 on-line users of the FCH system, who rely on it for 100% of their job duties.

Thanks to CGI’s best practices and state-of-the-art facilities, and the application enhancements developed by CGI, the FCH system now provides better reliability and performance than ever before, including 99% availability.

Looking forward, Dee-Smylie sees a continued close working relationship with CGI. “Right now, we’re transitioning to a new core health management application, and CGI’s expert knowledge of our data architecture is proving invaluable. We may also eventually partner with CGI to manage health insurance claims for other clients besides
Health Canada.”

“We view CGI as the ideal partner for future ventures where we need world-class support for our mission-critical information technology.”