Specialist enterprise software solutions developer nVisionIT has responded to a challenging brief from its client Afrox Healthcare for a contract management system (CMS) by delivering a flexible and reliable solution based on the Microsoft .Net platform.
Afrox Healthcare is a leading provider of private hospital services in southern Africa. The group owns and manages some 60 acute care hospitals and same-day surgical centres and has a shareholding in several other hospitals, oncology units and other high technology facilities, offering 6 500 private beds to patients in SA and Botswana.
The challenge put to nVisionIT was to develop a system that would track and control the movement of contracts - which determine pricing and billing of healthcare services - between Afrox`s 60 hospitals, and the various providers of medical aid insurance in SA.
Craig Timm, Afrox Healthcare`s Emerging Technology Manager, says the company had been using an off-the-shelf product from the US to manage this critical function. "However, licence fees for the product were high, while support was poor owing to the time difference between SA and the US," he explains.
Furthermore, the solution was somewhat inflexible, making the application of new business rules a difficult and sometimes impossible task. The system had also neared the limit of its scalability, an issue for the growing Afrox Healthcare group.
Managing the contracts between medical aids and its hospitals is a crucial business function for the organisation, explains Marna de Kock, business analyst at Afrox Healthcare. "Basically, this function ensures that we receive payment from the medical aid companies, and the vast majority of our patients settle their bills through medical aid. Clearly, the more efficient this business process is, the better we can collect payment - thus it plays a pivotal role in ensuring profitability for the group," she says.
Timm continues: "We engaged with nVisionIT to provide us with a solution that could provide effective communication between the many parties involved in the management of contracts between the hospitals, the patients and medical aids. While we provided the functional specification owing to our understanding of the desired system requirements, it was up to nVisionIT to turn the specification into reality."
nVisionIT senior software developer Conrad Lang picks up the story: "The system we designed had to be highly scalable as well as reliable, as the faster the hospitals could resolve medical aid claims, the faster they would receive settlement for services rendered. Furthermore, the system had to be highly robust, as the electronically exchanged documents - which are transferred between modern and legacy applications - couldn`t go missing or Afrox Healthcare would potentially fail to collect monies owed to it," he explains.
Additionally, the system had to allow for a great deal of flexibility to cater for the many variables involved in contracts with medical aids - rates for certain treatments are negotiated and can change easily, rates charged to various medical aids differ, and as contracts move up and down the system, changes are made that have to be resolved before settlement will take place.
"Contracts change every year and increase in complexity. The old system was simply unable to facilitate the required level of flexibility," adds Timm.
The development team opted to create the CMS using Microsoft BizTalk Server and Microsoft Visual Studio .Net. It caters for the wide number of variables required by the hospitals, and incorporates a powerful rules engine. Explains Lang: "If any part of the process is interrupted, BizTalk redoes that step. "The system creates an XML document that is matched with medical aid using customised rules that take account of discounts and exclusions, as well as materials used, the type of contract, price changes and many other variables."
The functionality the CMS solution delivers has significantly improved the contract process for Afrox Healthcare, says De Kock. "The considerable flexibility of the system allows us to cater for almost any variation in the contract, while the manpower required to manage contracts has been reduced significantly. Also, contracts are communicated in real-time, whereas with the previous system, contracts were processed in batches. There is therefore faster resolution of any queries, and ultimately, Afrox Healthcare gets its payments completed faster," she says.
The solution also delivers greatly improved performance - where the legacy system processed 6 000 documents in a full day, the CMS is capable of handling 20 000 contracts in just one hour.
Furthermore, says De Kock, the dedication of the nVisionIT team resulted in rapid delivery despite the complexity of the project - from start to finish, the development team required just two months.
Concludes Lang: "This system is testament to the advances that have been made in software development technology on the Microsoft platform. With flexibility, performance and reliability key success factors, the .Net and BizTalk platforms have proven that they are more than up to the task."
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nVisionIT is at the forefront of solution innovation on the Microsoft platform. Customers include leaders in distribution, facilities management, financial services, healthcare, insurance, IT services and telecoms.
The company, part of the proudly South African initiative and a Technology Top 100 finalist, is a Microsoft Gold Partner and has won national and global awards for its expertise in .Net solution architecture and development. nVisionIT`s methodology, solution offerings and toolsets ensure rapid development and deployment of solutions that generate effective returns.
nVisionIT is also a Microsoft Business Solutions partner with expertise in Great Plains and the Microsoft CRM offering.
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