One of SA`s largest private medical schemes, Medihelp, is enjoying a number of benefits from the implementation of a workflow system for managing and automating the document-intensive processes existing within the company.
Adoption of the SourceCode K2.net system, which integrates with Microsoft-based application development platforms, has seen the organisation enhance identified processes considerably. Although these processes were clearly defined and effective, the human interaction caused the processes to be very time-consuming, and also created room for error.
Medihelp enlisted the assistance of IT infrastructure, solutions and services provider, Datacentrix, for the project.
Says Walter Kloppers, Medihelp`s workflow project sponsor: "The decision to utilise K2.net as a workflow tool was based on the need for a solution that would be user-friendly and easy to develop and maintain. User buy-in was essential."
Previously, the company had used physical leave files, resulting in the HR office having to deal with masses of paper and a lengthy leave application administrative process. Here the employee filled in a paper form, which was approved by two levels of supervisors, processed by the HR department and, finally, captured onto the payroll system. "Not only has the time taken to complete this process shrunk to a three-day cycle, it is now also completely paperless."
The integration of K2.net into Medihelp`s Payroll system allows users to check leave history and approval status at any time - previously it was extremely difficult to attain an exact assessment of leave status due to unprocessed applications. The type of leave is now also categorised.
As a result of the positive user feedback on the leave application system, Medihelp next introduced the workflow system to its MediChron chronic disease management programme where members register and their details are uploaded before they are able to obtain their medicine.
Before K2 was introduced, Medihelp at times experienced a backlog of documents linked to the chronic medicine programme. According to Kloppers, the backlog had an impact on service levels but with the workflow system implementation this has been turned around to a 24-hour response time.
An additional complication was the introduction of Prescribed Minimum Benefits (PMB) in early 2004. In terms of legislation, all medical schemes in SA were compelled to grant benefits for a range of diagnoses, chronic conditions and medical emergencies as from 1 January 2004, without applying limits or co-payments.
These benefits grant additional coverage for 270 diagnoses, 25 chronic conditions and all medical emergencies. PMB make provision for the consultations, medicine, hospitalisation and care costs of a member who suffers from any of the listed conditions.
Although PMB offers benefits for members, they are subject to various conditions. In Medihelp`s case, a member who suffers from one of the listed chronic conditions has to register his/her condition as a PMB condition with Medihelp. This, says Kloppers, made it crucial for PMB to be developed as part of the workflow system within three months to meet the prescribed deadlines.
"Medihelp was one of the first schemes to implement PMB correctly. The K2 solution allowed us to meet the stringent cut-off date."
Medihelp also recently went live with K2 on the client management process and can now capture member details such as membership numbers, verify these details against the mainframe and populate fields and background information, resulting in less capturing errors. This also forms part of the move towards a paperless environment.
With a single point of entry into the workflow system, Medihelp`s call centre can access all necessary information, including member background and status of documents, which has also enabled the company to decrease duplicate enquiries and turnaround time.
With an administration cost among the lowest in the industry, Medihelp can now offer more streamlined, comprehensive and prompt service to members and service providers, with employees gaining electronic access to working documentation within seconds.
According to Kloppers, Medihelp`s decision to partner with Datacentrix was based on a lengthy request for proposals (RFP) process. "We knew that in Datacentrix we had gained a partner that could offer the right solution, using the best methodologies, with the necessary infrastructure and skilled project team for our specific needs."
In addition, the company also integrated its fax solution with K2.net, permitting members to send urgent fax enquiries to the priority help line, which can now be dealt with in the shortest period of time, and as a result
has further decreased the paper chain.
"In order to become a more competitive company and provide an improved service to customers, it is essential to empower staff to operate more efficiently," says Datacentrix service delivery director, Eugene van Rensburg.
"By improving a business` processes using workflow, staff can add value by focusing on specific business issues and service levels in performing their duties.
"As a managed partner of SourceCode, developer and distributor of K2.net, Datacentrix could provide the necessary level of skill and knowledge to make Medihelp`s project the success it is today," he says.
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