PillowPH

Building a HIPAA-Compliant Data Management Platform and Enabling a PBM Vendor Transition for Pillow Pharmahealth PillowPH

HIPAA-Compliant Platform

Secure foundation for managing PHI across claims, eligibility, and pharmacy data.

70,000+ U.S. Pharmacies Connected

Nationwide network enabling real-time claims and coverage validation.

5 Microservices

Modular architecture separating data ingestion, processing, and reporting.

Industry

Pharmaceuticals & Healthcare

Pharmacy Benefits Manager (PBM)

Provided Services

Software Product Development

DevOps & Cloud Solutions

Data Engineering

Application Support & Maintenance

Core Solution

Data Warehouse + Reporting Platform

Tech Stack

RedShift/Java/Spring Boot/Spring Cloud/

Angular/PostgreSQL/ Amazon S3/AWS/ Kubernetes/ArgoCD/Prometheus

Microservices Architecture

[ company introduction/ ]

Pillow Pharmahealth is a HIPAA-compliant pharmaceutical benefits management (PBM) / healthcare claims processing organization.

The services manage claims, eligibility, and pharmacy data through AWS-hosted infrastructure and include benefit plan design, administration, network management, and analytics reporting. The company’s data ecosystem spans multiple healthcare domains, requiring precise master-data alignment and interoperability across PBM and EHR systems.

~600

Field data objects

70,000 U.S.

Pharmacies real-time claims processing

Business Goal

Pillowᴾᴴ needed a centralized reporting and analytics platform to match industry standards and eliminate manual data collection. The system had to process claims from ~70,000 U.S. pharmacies in real time, providing visibility into co-payments, billing, and insurance program changes.

Executive Summary

MEV partnered with PillowPH to build a HIPAA-compliant claims processing platform for managing multiple healthcare data feeds (claims, eligibility, and pharmacy data consolidated into unified records). 

Five years later, MEV helped Pillowᴾᴴ to migrate its claims data feed to a new PBM vendor, optimized its AWS environment, and launched a long-term modernization roadmap.

As a result, PillowPH gained:

01:

Automated and scalable claims processing, supporting more partners and faster reporting cycles.

02:

Improved data accuracy and compliance, reducing legal risk.

03:

User-friendly reporting, enabling partners to act more easily.

04:

Stability and future readiness, supported by a detailed infrastructure improvement plan.

Make your healthcare data work together.

MEV builds secure, compliant, and interoperable data ecosystems.

Book a Free Consultation

[ challenges/ ]

The Core Challenges Solved

C1:

The Early Challenges Included:

Pillowᴾᴴ relied on manual workflows that slowed operations and increased the risk of errors and HIPAA compliance issues.

Absence of any automated processing system or data pipelines
Manual data handling prone to delays and reporting errors
Need for a scalable architecture to support multiple external partners
Compliance with HIPAA and secure management of protected health information (PHI)

Reliance on mock data and sequential data loading for initial development.
Processing large, complex data objects (~600 fields)
Managing unrelated and inconsistent data sources
Reconciling duplicate or mismatched entities across feeds to maintain a single source of truth (golden record).

C2:

Five Years Later:

Pillowᴾᴴ re-engaged MEV for a PBM vendor migration to avoid service disruption.

Urgent migration to a new PBM feed with minimal downtime
Integrating a new encrypted data feed into a legacy system without schema changes
Lack of a development or test environment for validation

Data inconsistencies in the new provider’s feed
Maintaining HIPAA compliance and data integrity throughout the transition
Outdated infrastructure that had run for over four years without maintenance

[ how we did it/ ]

Solution & Implementation

01.

Data Management Platform Building

MEV built a scalable, HIPAA-compliant claims processing platform to automate manual workflows and ensure data accuracy.

Key steps included:

Secure AWS Infrastructure: Designed and deployed a cloud environment with built-in encryption, access control, and compliance with HIPAA requirements.

Data Management System: Constructed an ETL layer to collect and normalize claims, eligibility, pharmacy, and MediSpan data - implementing matching and merging logic to ensure entity resolution and master-data consistency.

Enterprise Database & API Layer: Developed a structured PostgreSQL database and API interface to standardize data access and improve interoperability with external partners (including EHR/FHIR-ready integrations).

Custom Reporting Module: Built a reporting layer enabling partners to generate precise, easy-to-understand insights from claims and eligibility data.

Automated Workflows: Eliminated manual processing, reducing error risk and ensuring timely delivery of daily, weekly, and monthly reports.

02.

Adapting to a New Vendor

PBM vendor migration, combining reverse engineering, and ETL updates to ensure seamless continuity.

Key steps included:

System Discovery: Investigated legacy automation and data flows.

Feed Integration: Mapped the new vendor’s encrypted claims feed to the existing PostgreSQL schema, ensuring compatibility without reworking ETL pipelines.

Infrastructure Duplication for Testing: Cloned the production environment to safely validate workflows ahead of the switchover.

Encryption Validation: Verified compatibility of encryption keys and data processing scripts with the new vendor’s format. Applied PHI data-governance checks and validation routines to ensure every data element remained encrypted and traceable throughout the migration.

Controlled Switchover: Executed the final cutover from the old to new feed with continuous monitoring to prevent downtime.

Infrastructure Audit: Assessment of the aging AWS and Kubernetes setup, highlighting necessary upgrades (ArgoCD, ALB Ingress Controller, EKS versions) for long-term resilience.

03.

Ongoing Maintenance and Support

Through MEV’s Maintenance and Support services, the platform continued to evolve, gaining stability and room to expand its partner network.

Key steps included:

Proactive monitoring and issue prevention: Continuous performance tracking to minimize downtime.

Regular updates and optimization: Ensuring system stability, scalability, and compliance over time.

Steven B. Drucker

Founder & CEO at Pillow PH

MEV came in and formed an incredible development team for PillowPH. They not only helped us define our data warehouse system but they also designed and built it out for us. MEV focused on building out a complete system for us that met HIPAA compliance and offered protection for our clients sensitive data. We are still partnered with MEV to this day and thankful to have a team available to build-up.

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