Integrated it helps drive membercentric approach

When Sechaba Medical Solutions deployed Tapestry, an IT platform from the US, in 2001, many in the medical aid industry watched with sceptism but Sechaba’s chief information officer, Eric Rantsho remained upbeat.

“Three years had already been spent testing the system and when Tapestry finally arrived, people were still saying ‘we’ll wait and see’,” says Rantsho. “Our view was how can a system which is used by Kaiser Permanente, Harvard and Disneyland be wrong and we decided to give the sceptics a run for their money.”

Tapestry, a platform within the Epic Software suite, interfaces with Sechaba’s existing Epic system which has a global reach of 1bn lives or patientson its database, thousands of end-users and 175 clientssupported by a staff of 3500. “By the time we went live we were doing fine despite some teething problems. That was the first time we were taking claims electronically from the SA switch. After going live we were operating in a totally integrated platform,” Rantsho explains.

“We’re not knitting a system in the background just to create an impression or appearance that it’s an integrated system - ours isfully integrated, functionally technically and otherwise. For instance,all aspects of the Admin and Managed Care processes are embedded in the same platform, we don’t have to do anything to interface.”

“The great thing about Tapestry,” says Rantsho, “is that it is fully customised for the SA medical aid environment. The system enables its clients such as Sechaba to offer end-users, including medical aid members and hospitals as well as other service providers, a fool-proof real-time connection.”

Rantsho sees the system as a boon in many ways: He believes it has created a major data warehouse which enables Sechaba to draw a range of reports. “This isan absolute imperative inthe management of benefits for client schemes,” he says. It also re-invents itself every year which, for an example, takes into account what the clinical requirements are in so far as the handling of claims is concerned.

“Because the system has an extensive client base and a global reach of 1bn users (lives), the critical mass that comes with this is unparalleled.”

Rantsho and his colleague Dr Tumi Seane, who heads the managed-care unit, tout the system as member-centric. “Through this system we’re able to isolate events and trigger a response that can help patients prevent certain diseases. It can pick up trends and recommend solutions,” Seane explains. “The entire health-care industry has a lot of catching up to do if we’re to bring the “prevention is better than cure” mantra to life and Tapestry is bringing us one step further,” he says.

Turning to the administrator’s call centre operations, Rantsho says the company has introduced virtualisation which minimises the waiting period for members. “Once finalised, we'llbe able to swing call centre activities from one branch to anotherseamlessly, as and when necessary. If one branch experiences problems, whether Eskom, Telkom or any other, we can always switch calls to the next available operator anywhere in the country. We’re trying to cut queues without carrying additional costs, this is something that benefits members,” he says.

Rantsho’s big test is the African expansionary project that Sechaba is currently taking a stab at. Should Sechaba score some deals in that market, it will use its SA infrastructure as a back office.