This might have been your experience in the past: upon arriving at the hospital, you handed over your laminated card to the records officer. It took him over an hour to search for your folder only to return and say, “Madam, please, there was a relocation and so we can’t find your folder.” Please buy a new folder. ”
What has become of all your medical history, you would wonder? You have just lost potentially life-saving data, and the hospital has lost valuable data which could improve their healthcare delivery. If all patients had their medical records at their fingertips, it could be the revolution that our healthcare system needs.
As a bridge to healthcare between providers and patients, Premier Health Insurance has embarked on a digitalization drive that has enhanced the service delivery experience for our clients by making technological resources available to our health service providers. At the same time, through our digitalization efforts, we are giving our clients access to medical information and resources never before available in the country. The essence of digitalization is to use technologies that will change processes and unlock new possibilities.
Digitalizing Claims Processing and Submission for Our Service Providers
Hitherto, health service providers were provided with claims booklets for recording patients’ biodata and details of the services provided, including charges. The detached sheets were compiled and sent through courier or hand delivered to our head office irrespective of the location of the hospital or clinic. These sheets were entered into our enterprise software. The paper-based system created several challenges for both the service providers and Premier Health Insurance Ltd. For the service provider, claims could be lost in transit, and for us, there was a never-ending pile of sheets in our office. The whole system was inefficient and needed an overhaul.
Premier Health Insurance Ltd. provided a claims processing software at no cost to all our service providers. The software’s development, deployment and training for healthcare providers’ staff were all financed by Premier Health Insurance Ltd. The software has capabilities for benefit eligibility inquiries, authorization requests, and compiling and submitting the claims online to our internal systems for further processing.
This means our members who need surgeries are spared the hustle of picking up an authorization form from the hospital or clinic and submitting it to our office for endorsement. The software digitally performs this process.
The additional value to our health service providers is that they submit the claims from the comfort of their offices and the data analytics provide feedback on the quality-of-service provision by giving them statistics on returning patients with the same diagnosis.
This digitalized solution has eliminated the bottlenecks with the paper-based process by saving time for all the stakeholders. The promptness of claims submission has afforded Premier Health Insurance the opportunity to pay claims promptly.
Our clients have access to information via the Premier Health Insurance App.
Having laid a solid data foundation by digitalizing the claims submissions, the company proceeded to empower our members by rolling out the Premier Health Insurance App which is available on the Google Play Store and Apple Store.
A Premier Health Insurance member who downloads and logs onto the app is welcomed with an exquisite dashboard which shows their benefits for dental, optical, diagnostic, and other outpatient and inpatient benefits. The digitized handbook on the Premier App gives up-to-date information on all our providers. The artificial intelligence incorporated into the app would even recommend providers closest to a member.
Another important feature of the Premier App is that it also gives members access to their medical data. Once a member visits a provider in our network, the app lists all the services offered by the health service provider and their corresponding tariffs. The Premier App thus serves as a digital folder and it is not lost in case of a relocation or fire outbreak. This data could be referred to by the new healthcare provider, which will help with subsequent diagnosis and treatment.
Additionally, the Premier App uses big data and artificial intelligence in its analytics and recommends articles and health tips based on your diagnostic data. For instance, hypertensive members would receive articles and health tips on hypertension and other cardio-vascular conditions. This gives a personalized experience when using the app.
Since the advent of COVID 19, some of our accredited facilities have mooted the idea of incorporating telemedicine into their services. Over thirty service providers have presented various telemedicine platforms. Our next big step is to provide a more comprehensive telemedicine platform where all our providers can plug in. This is our nascent step towards digitalizing patient-doctor consultation and interaction.
Conclusion
In the last ten years, Premier Health Insurance has pioneered digitalization in the quest to bring efficiency to our operations. We are willing to invest in digital technologies that will benefit Premier Health Insurance Limited as well as our partners who provide healthcare to our members. For us, digitalization should bring convenience and efficiency, ultimately leading to better healthcare delivery.
