Capitated managed healthcare has been the secret behind the dramatic growth of the Medicross group of clinics, and crucial to its success has been an Informix Red Brick-based data warehouse configured by Knowledge Integration Dynamics (KID).
"Managed healthcare is our lifeblood," says Dr Carlo Berti, IT GM, business support systems at Medicross. "Without access to a sophisticated data warehouse database such as Red Brick, and the assistance of KID, we would not be able to derive full value from our managed healthcare system." Medicross, wholly owned by the FedHealth Group, is one of the largest primary healthcare clinic operations in South Africa, with 52 centres nationally.
Capitation is a method of payment for health services in which a doctor is paid a fixed amount for each person served, regardless of the actual number or nature of services provided.
"Red Brick allows us to engineer and review file extracts at the end of each month, which go into an intermediate data warehouse," says Berti. "From there we can extract crucial information and run queries or practice audits, all of which ensures that best use is made of facilities and services.
"We run a calculated risk with a capitated product. As such, having a data warehouse which can provide us with all the relevant information in an efficient and timely manner is vital," Berti adds. "We need to know exactly how many patients doctors are seeing, who is using what, when, where and how all of this enables managed healthcare."
Red Brick is also used to run drug utilisation reviews and disease outcomes studies. "A manager will ask for certain data, KID will tell us how to extract the relevant information and the costs, and if justified, we go ahead," says Berti.
Medicross had installed Red Brick some time ago, but was not maximising the system until KID was called in for review and redesign. "We were getting next to nothing out of the data warehouse," recalls Berti. "KID performed an audit and advised that it was being used just as one big table. Nothing was indexed, so even the simplest of queries took two days or more to run."
Acting on a brief, KID reconfigured the data warehouse over a six-month period. "KID has a consultant on-site on a permanent maintenance contract," says Berti. "He champions the warehouse, consults the users, tells us what we can get out of it and resolves all queries."
The benefits of the system redesign were immediate. "The most beneficial project for us is the practice audit," says Berti. "This involves running profiles on doctors and their treatment, what medicines they dispense, the average rate per visit, what the consumable usage amounts to, and all other services such as the usage of the radiology department.
"We also run drug utilisation reviews, and can easily identify the top 100 products, who they are being prescribed by and under what medical conditions they are being dispensed. We can easily pick up any distortions or abnormalities in the dispensing of products, and can subject any doctor`s dispensing routine to a peer review," says Berti.
The system also tells Medicross the costs of each theatre operation, which can be compared to the set costs against which the clinic is measured. "This enables us to determine fixed fees for the medical aids so we can show value for money," says Berti.
In addition, Medicross has started a coding system for each patient`s visit to the doctor, according to the type of complaint or illness. "This will allow us to determine the incidence of any illness, which will be of great value to us in our negotiations with medical aids."
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