Humana presented at InterConnect 2017 on their use of business rules on z/OS. Humana is a 3M member health insurer and a user of IBM Operational Decision Manager (ODM), IBM’s Business Rules Management System and has been focusing on using it to modernize some of their key mainframe systems – something that Humana is focusing on as part of its efforts to reuse existing assets. ODM runs on IBM z/OS for batch, CICS, standalone rules or WAS on z/OS, allowing them to run business rules on their mainframe systems. Using ODM allows Humana to reuse these assets while also transforming their development approach to be more responsive, more aligned with the business and more consistent to ensure compliance and manage risk.
Humana uses ODM for Medicare, Claims, Enrollment and Dynamic forms:
- Humana has 700 Medicare plans that have to be reviewed for CMS compliance. A .Net application integrated with the decision service answers the CMS questions with an SLA of 2 seconds. The environment allows the business to manage the 1,700 rules in the application using ODM Decision Center. This improves the change cycle from months to weeks.
- Claims processing handles multiple procedure payments and member cost sharing, for instance. Run as Cobol CICS and batch systems with 500+ rules and decision tables. 3.5M ruleset executions daily. Manual rules that could not be coded in COBOL now in ODM, increasing the rate of STP and driving savings. Savings in first week exceeded cost of development!
- Enrollment for large and small group – about 30+ rule applications to reduce enrollment from a week to real time.
- Dynamic forms is for authorization, generating custom questionnaires dynamically. 70+ questionnaires can now be developed and tested by the business. Complete audit trail and ability to make rapid changes have been key.
- Humana runs ODM on z/OS.
- Rule Designer (IDE) is used develop the vocabulary, templates, rules etc. This is tested and then pushed to Decision Center for ongoing business user management.
- Decision Center is used across all environments. This allows business user engagement in a thin client environment and can be synchronized with the technical environment. Decision Center supports deployment, versioning etc and becomes the single source for rules. The support for testing and simulation are key and very popular with business users. They use both the Enterprise and Business Console, though the Business Console is the standard go-forward environment. All this runs on Z Linux, letting them take advantage of the integration of Z and DB2, the power of Z etc.
- Decision Center is used to deploy Decision Services to the various environments Humana used – z/OS,Linux on Z etc.
- The Rule Execution Server Console is used to monitor executing rules, trace rule execution and manage the deployed services.
- They take advantage of the Java/DB2/z integration and performance tuning to maximized the performance of their rule execution. They mix and match decision services deployed for interactive or batch services, integration with COBOL or CICS etc etc. Lots of options for integrating the decision services into the mainframe environment.
Moving forward they are looking at some changes for high availability workload management as well as embedded batch for improved performance. Plus they want to complete the move to proper Decision Services from traditional rule applications.
Overall ODM on z/OS has delivered several benefits:
- Cost savings
- Improved time to market and business engagement
- Single source of rules
- Incremental adoption