Andrew Wright, Executive Manager: Business Engineering and Solution Design at Medscheme explains how Hyperautomation solutions are the bridge that will transport our healthcare system over the legacy gap.
Thousands of people are interacting with the healthcare administration system every single day. In our Medscheme business alone, we process well over 100 000 claims every day – so there is little margin for error or inefficiency when the health and wellbeing of our Medical Scheme’s members hangs in the balance.
Zooming out, it seems South African industries are in a perpetual state of digital transformation. For the healthcare sector, while we should be ahead of the rest considering the stakes, we are still in the process of overcoming the obstacles of bespoke legacy systems.
To put it into perspective, established healthcare administrators still rely on bespoke legacy platforms designed and developed in the 2000s with the purpose of meeting the changes in the Medical Scheme regulatory environment at that point in time. Built before modern Hyperautomation solutions and cloud practices were even conceived, these platforms have become costly to maintain and lack the ease of integration opportunities, resulting in clunky engagement and poor customer service orchestration.
Why is this such a problem? Legacy systems hinder the speed and agility of implementing innovative healthcare insurance products and care management programmes that support the members of Medical Schemes. Legacy systems, whilst delivering high levels of regulatory compliance, have limited integration capabilities, incur high maintenance costs, and do not enable business agility. Taken to the extreme, this translates to a diminishing ability to meet customer needs. Fortunately, through deliberate business engineering and design, we have found ways to overcome this. One being through modern technology solutions and the much-welcomed world of Hyperautomation.
Hyperautomation refers to the orchestration of advanced technologies such as decision engines, robotic process automation (RPA), leveraging artificial intelligence and machine learning, including natural language processing (NLP) and natural language generation (NLG) to automate service delivery, streamlining administrative processes, data management, and decision-making, enabling more efficient and accurate operations despite the need to still integrate with the core legacy systems.
The rise of Hyperautomation has emerged as a wonderous solution that addresses our challenges – forever transforming the face of healthcare administration as we know it. For medical scheme administrators, this involves automating tasks such as member enrolment, claims processing, pre-authorisation management, case management, contribution and debt management, data consumption, report generation, tariff code loading, and other repetitive and time-consuming activities.
At the beating heart of healthcare administration lies the ability to accurately and timeously process claims. Our Hyperautomation efforts at Medscheme have already achieved significant claims processing improvements. With our systems in place, straight-through processing and time to process claims were enhanced, with 99.2% of healthcare professional claims adjudicated, priced, benefits and limits applied and paid, without human intervention.
Through this modern marvel of technological development, we empower ourselves to enhance services to new levels of efficiency and accuracy at an incredible rate. Now, we can seamlessly integrate and communicate with various legacy and modern systems, facilitating data exchange and interoperability in the healthcare ecosystem. We are also able to free up valuable intellectual capacity in our workforce to focus on high touch, value adding service support for the members of our medical schemes. Medscheme became the first organisation in South Africa's health industry to leverage Robotic Process Automation (RPA) and scale the delivery of a modern Decision Engine. Currently it is scaling its use of Natural Language Processing (NLP) to enable real-time service orchestration across various traditional and digital channels.
Integration with legacy systems relies on a strong partnership with the technology partners in the organisation. The Hyperautomation solutions are however business led and enabled. Our Business Technology Enablement team works seamlessly with our technology partners in realising the solution potential. This partner approach earned our systems and business architects coveted recognition, including the FICO Decisions Award for Innovation of legacy platform integration.
While the direct impact on member satisfaction is yet to be conclusively measured, we are focusing on customer effort scores and survey responses to evaluate the effectiveness of our technology. One area where improved customer satisfaction is evident is in the experience of healthcare providers. Straight-through claim processing has reduced errors, enabling faster settlement of claims and improved provider satisfaction. Our success lies in consistently working to improve customer satisfaction by understanding their points of pain and solving for these.
Healthcare administration will require forward-thinking approaches and intensive systems integration to spur us on to a future where we can all benefit. Hyperautomation offers transformative benefits for those struggling with outdated legacy platforms. Our journey at Medscheme is a shining example of how Hyperautomation can propel healthcare administration into a more efficient and customer-centric future – a direction all consumer-facing industries should be heading in.
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