Medihelp, one of SA`s largest and most financially stable private medical schemes, with healthy reserve levels well within the requirements as set by the Medical Schemes Act, is currently reaping the benefits of data warehousing and business intelligence (BI) technology.
Confirming that more than 70% of the claims processed by the scheme are received electronically, a high percentage in a traditionally paper-based industry, Reinette Fourie, executive manager: IT at Medihelp, says the dictates of the new Medical Schemes Act and rising competition require sophisticated yet stable IT systems.
Medihelp, she says, has succeeded in developing its in-house IT systems to the point where they are fully integrated and adaptable enough to accommodate the demands of a constantly evolving environment.
"For example, the data warehouse at Medihelp was developed a couple of years ago with the assistance of Datacentrix, but our in-house IT team has honed and refined it to the extent that the benefits are being felt across the organisation."
The company opted for the Cognos BI suite, including PowerPlay Transformation Server and Client, Cognos Query, Impromptu Client and Server for internal reporting and Impromptu Web Report for external reporting. Fourie says Medihelp went the Cognos route after evaluating a number of other products because of its compatibility with the company`s Microsoft-heavy backend.
Charlene Sutherland, project leader at Medihelp, confirms that the revitalised data warehouse has received enthusiastic endorsement from users drawn from as diverse disciplines as the marketing and customer services departments, auditing, healthcare management, and those involved in product development.
"System uptime has become of paramount importance for these users. The Cognos products are used in our day-to-day operations and we cannot afford to have systems not working for long time periods.
"Therefore, we decided to review our support structures and find a Cognos Partner with the skills necessary to support our infrastructure. After evaluating a number of companies, we settled on BI Planning Services, a company with a proven track record and, importantly, a skills base that complements that of our in-house team," she says.
Craig Hart, technical director at BI Planning Services, confirms that the company`s total focus on the arena of BI will play an important role in maintaining the stability of and adding value to the continuing development of the systems at Medihelp.
"Our Cognos skills were recognised as unrivalled in this country when we received the 'Cognos Implementation of the Year Award` at Cognos Enterprise 2002 last year for our work at Anglo Coal.
"We have also made prior inroads into the healthcare industry with the implementation of a full data warehousing and BI solution at GPNet which will be completed later this year," he adds.
Other IT solutions at Medihelp include:
An extensive Internet/intranet environment with 800 workstations currently connected to the LAN/WAN. In addition, a general product information and marketing Web site is housed on an in-house server. Medihelp also provides a comprehensive Internet service to members and service providers in a secure environment.
A fully integrated call centre supports the customer relationship management strategy by providing client service of a very high standard to members and service providers.
An electronic document management system consists of member documentation, electronic payment information, electronic claims and scanned images of paper claims dating back to 1997. It also includes a barcode tracking system for claims.
Concludes Fourie: "Our IT philosophy is to keep it simple, integrated and smart. We believe the success, stability and overall user acceptance of our systems is unrivalled in the local healthcare industry and provides Medihelp with a vital competitive-edge going forward."
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