The role of the IT service or solutions provider has become integral and critical to the delivery of affordable, quality healthcare in South Africa and internationally, says Richard Firth, chairman of MIP Holdings. MIP Holdings is an IT solutions company with several clients in the healthcare arena.
"Healthcare funders are in a state of crisis as they fight fire on several fronts," says Firth.
* Firstly, there is the price of healthcare spiralling above the affordability level of the average employed fund member.
* Then there is the rising incidence of highly infectious, life-threatening diseases such as Aids and TB.
* In addition there is the difficulty of meeting the requirements of new healthcare legislation which makes it illegal to recruit members on the basis of their risk profile.
"Against this backdrop, healthcare funders increasingly look to managed care methodologies to help control and limit the outflow of benefit payments and they view Internet technology and business-to-business (B2B) e-commerce as delivery mechanisms for rapid and efficient information and administration services," says Firth.
As a result, IT service providers that specialise in the healthcare arena are finding their value and role in the industry considerably enhanced. "Our role has grown to that of true strategic technology partners where our clients, who seek inventive ways to deliver affordable healthcare to the masses, look to us to provide solution concepts that virtually re-engineer the way they operate, cutting unnecessary activities, procedures and costs from their workflow."
In this regard, years of service and experience in the healthcare industry pay off for players such as MIP. "Start-up healthcare organisations look to us to help them build their new businesses using our intellectual capital in the form of our combined knowledge of IT and healthcare," says Firth. "This often gives us an opportunity to introduce practical solutions for theoretical problems that have plagued healthcare funders for years."
For example, developers writing a new system from scratch can close the myriad loopholes in legacy healthcare systems that offer opportunities for unscrupulous service providers and fund members to defraud healthcare funders. New workflow and control systems are integrated into today`s applications funnelling processes and procedures to enable effective healthcare management.
"Developers of new IT solutions take every care to ensure each step in the claims trail can be audited and approved to ensure members` money is spent on bona fide healthcare services," says Firth.
"We`ve also seen a groundswell of support from all sectors of the healthcare arena to effect this change." More and more, healthcare managers and funders are finding a competitive-edge in the ability to keep a tight reign on the cost flows through the use of mechanisms such as capitation, scientific formulary and chronic disease management.
Capitation is the concept whereby the medical funder pays a medical practitioner a set fee per month per patient. In this way the practitioner benefits from the annuity revenue model, while the funder controls spikes in outgoing funds and ensures all members and dependents are seen regularly enough to prevent late diagnosis of high-cost illnesses. Scientific formulary is the system whereby doctors are encouraged to prescribe the most cost-effective drug to achieve the best outcome for the patient. Through this system, whatever the doctors script is effectively 20% lower-cost.
Effective software solutions enable funders to assess and reward service providers for best practice, by tracking activities such as drug prescription patterns.
Chronic disease management systems enable healthcare funders to assess the risk profile of chronic patients, monitor their treatment and promote their wellness through constant communication, education an the promotion of healthier lifestyles.
"Healthcare concepts such as capitation and managed care are all about data flow and getting the right information about the right patient at the right time," says Firth. "This type of activity can only take place where effective IT systems are in place to provide the tools that enable these new healthcare management procedures to take place quickly and with the minimum of paper work and red tape.
"The technology partner of the healthcare organisation that relies on these loss control management techniques, be it a funder, a hospital, or a doctor, needs a thorough understanding of operational processes and procedures in these environments."
With healthcare service provision at a crossroads between delivering what are perceived as the basic necessities to maintain existing standards, and enabling the benefits expected from the expensive wonder drugs of the future, IT solutions providers are finding exciting challenges and many opportunities to play a role in ensuring the health of the public.
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