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Medscheme Transforms Claims Management Efficiency using FICO Decision Technology

Vlad Poptamas

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  • Medscheme has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day, based on FICO® Blaze Advisor™ decision rules management system
  • Medscheme won the 2018 FICO® Decisions Award for Decision Management Innovation
  • Medscheme is one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector

Medscheme, one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector, has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day. The innovative solution, powered by FICO® Blaze Advisor™ decision rules management system, reduced claim interventions by 15 percent in a six-month period, and has dramatically reduced the time needed to change business rules and strategies.

For its achievements, Medscheme won a 2018 FICO® Decisions Award for Decision Management Innovation.

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“Our vision is to create a world with sustainable healthcare, and at the heart of our business is processing medical claims of members and healthcare providers,” said Denise Sleem, general manager and project lead at Medscheme. “By modernizing our claims management capabilities, we have become more agile, more efficient and more effective, which means members and healthcare providers get faster answers on claims.”

“Our focus is on efficient and effective administration services that are optimized and responsive to varying medical scheme needs at any given time,” said Andrew Wright, executive manager for Shared and Support Services at Medscheme. “We thus need to constantly challenge the way we work and where we wish to invest in enhancing our broader healthcare administration capabilities that will ensure they are relevant into the future.

“Furthermore, Medscheme requires flexibility in its claims capability, which is especially important today as we bring on board new clients with thousands of members with their own set of rules. Our claims engine needs to easily accommodate the variety of client scheme needs and integrate seamlessly with our core administration system, with very little room for errors or delays.”

Transforming a Legacy System
In rebuilding their claims management system, Medscheme had clear requirements. They needed modern, scalable technology that could support their needs into the future, integrate well with the rest of their IT infrastructure, and meet stringent SLAs for claim review times. The new system had to make rules and policies visible, be accessible to business and technical teams, and be much easier and quicker to change.

“The business rules that informed our decisions in our claims processing were mostly locked up in code, data and people’s minds,” explained Sleem. “We had to discover them, document them and move them swiftly into the new system. FICO has been a terrific partner for us in this effort.”

Medscheme created a framework using cloud-native technologies including Kubernetes, Docker and Spring Boot, within which the FICO Blaze Advisor decision rules system runs. “This environment is extremely scalable, and can be used either on-premise or with any of the big three cloud provider spaces, and can be run in a hybrid model as well,” said Drikus Britz, lead solutions architect at Medscheme. “The solution allows for zero downtime deployments within a day should the need arise. We are running in an active-active mode across multiple data centers, allowing for almost zero downtime during disaster recovery situations for real-time claims.”

Due to the high volume and complex rules associated with medical claims, Medscheme needed to think carefully about performance. “We use Hazelcast to cache information related to our clinical data that does not have a high frequency of change,” Britz said. “This allowed for the decision engine itself to remain stateless, while having frequently used information a lot ‘closer’ to the engines, which drastically improved speed. To further improve performance, we enhanced the components that serialize and de-serialize the incoming and outgoing requests to and from Blaze Advisor. We also have moved to a semi de-normalized object model inside Blaze Advisor, which gives us the most efficient way of rule writing and execution at runtime.”

Clear Benefits to Modernization
Medscheme has recorded a number of benefits of their new system:

  • Fast processing of an average of 400,000 claim lines per day
  • Easy to respond to a query about a decision, due to fully documented business rules
  • Claim interventions reduced by 15 percent over a six-month period
  • 99.9% uptime — a stable product on a stable platform with the ability to do online deployments
  • Ability to respond quickly to market changes and varied client requirements
  • Multiple resources able to work on multiple changes to the decision services code at a time
  • A consolidated rules management repository enables flexibility and traceability of decisions
  • More agile rule capabilities for changing benefit designs, allowing for increased volume and complexity

“We are impressed by the technical ingenuity of the Medscheme team,” said Nikhil Behl, vice president of marketing at FICO. “This is a fantastic solution to a common problem — modernizing a legacy system to improve efficiency and customer satisfaction.”

FICO® Blaze Advisor™ decision rules management system gives businesses maximum control over high-volume operational decisions. Blaze Advisor provides companies with a scalable solution that delivers unprecedented agility and actionability for smarter business decisions. FICO Blaze Advisor is part of the groundbreaking FICO® Decision Management Suite for building and deploying decision management applications.

 

Photo source: SOURCE FICO

Artificial Intelligence

Bright Pattern Announces AI-Powered Omnichannel Quality Management Solution

Vlad Poptamas

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Bright Pattern, the most powerful cloud contact center with AI for innovative companies, today announced the release of Bright Pattern Omnichannel Quality Management (Omni QM). Omni QM is embedded in the Bright Pattern Omnichannel platform, and allows quality management on all channels in a single interface. This eliminates the need for costly integrations, improves useability and manageability, and drastically reduces costs all while delivering unparalleled functionality. Bright Pattern is the first to deliver the power of easy, personal omnichannel conversations together with omnichannel quality management.

Most companies only monitor their voice channel, sampling a very small percentage of interactions. Bright Pattern Omni QM is built for a digital world with quality assurance for new digital channels like chat, text, bots, or messengers. Omni QM is native to the platform and does not require expensive bolt-on systems.

Industry analysts from Forrester have cited the importance of AI and its future evolution as part of the customer experience platform, and in response Bright Pattern has embedded omnichannel quality management directly into its omnichannel contact center platform: “Increasingly, artificial intelligence will become embedded in contact center applications, leading to the emergence of a cognitive contact center,” noted Art Schoeller, Vice President and Principal Analyst of Forrester Research.

Bright Pattern’s Omni QM provides unique functionality for today’s digital world including:

  • Omnichannel quality management to monitor every interaction on every channel
  • “Micro-level” quality monitoring for the scoring and grading of individual interactions
  • “Macro-level” quality management to monitor by channel, journey type, and customer segment
  • AI-powered quality management for automatically identifying key interactions to “act in-the-moment”
    • Automatically detect and route interactions to quality managers for scoring and training
    • Automatically detect and route poor interactions to retention specialists to resolve customer issues in-the-moment

We created Bright Pattern to offer the easiest, most powerful cloud contact center platform for businesses of every size.”, noted Konstantin Kishinsky, Founder and CTO of Bright Pattern.  “Just as we were the first to natively include all channels in a single platform to make seamless omnichannel conversations possible, we are now the only cloud contact center provider to offer omnichannel quality management for every channel and every interaction as part of our platform.”

 

SOURCE Bright Pattern

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Artificial Intelligence

Volumetric Display Market Size Worth $705.9 Million by 2025 | CAGR: 28.5%: Grand View Research, Inc.

Vlad Poptamas

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The global volumetric display market size is expected to reach USD 705.9 million by 2025, registering a CAGR of 28.5% over the forecast period, according to a study conducted by Grand View Research, Inc. Several in-built features such as visualization of holographic aerial images in free space, 360-degree spherical viewing angle, autostereoscopic capabilities, and motion-based depth cues are likely to drive the market over the forecast period.

Volumetric displays are widely preferred across several industries such as military and defense, healthcare, media, communication, entertainment, and aerospace owing to their built-in features. Massive investments in R&D by prominent market players such as LightSpace Technologies Inc. are estimated to create a significant opportunity for players to gain a substantial market share over the coming years. Moreover, these investments are majorly focused on improving overall in-built features of volumetric displays, which will cater to growing consumer demand for enhanced visual experiences during gaming and other applications. Robust deployment of 5G network infrastructure is further anticipated to spur the adoption of volumetric displays to provide seamless connectivity and enhanced experience to customers during video calls.

Key suggestions from the report:

  • By type, the static volume segment captured the major market share in 2018 owing to its features such as aerial images in free space, 360-degree spherical viewing angle, and motion-based depth cues
  • The swept volume segment is expected to witness rapid growth owing to significant investments by market players to develop advanced products within this category
  • In 2018, the medical segment attained a market size of around USD 50.0 million and is estimated to register substantial growth owing to increasing adoption of this technology in healthcare for viewing 3D imaging by extracting stored data from Magnetic resonance imaging (MRI), Computed tomography (CT), and other systems
  • North America accounted for the largest share in the global volumetric display market and is anticipated to exhibit the highest CAGR of more than 30.0% over the forecast period. The growth is due to rapidly increasing defense and healthcare spending to deploy modern technologies to obtain improved visualization during critical situations
  • Companies are aggressively investing in R&D to develop new products with enhanced features to strengthen their market position and enhance their product portfolio
  • Key players in the market include Lightspace Technologies Inc.; Voxon Photonics Pty Ltd.; The Coretec Group Inc.; and Holoxica Ltd.

Read 90 page research report with ToC on “Volumetric Display Market Size, Share & Trends Analysis Report By Display Type (Static Volume, Swept Volume), By End Use (Medical, Aerospace & Defense, Automotive), By Region, And Segment Forecasts, 2019 – 2025” at:
https://www.grandviewresearch.com/industry-analysis/volumetric-display-market

Advances in medical imaging technologies for more accurate diagnosis is expected to offer avenues for the market from 2019 to 2025. Use of volumetric displays in medical imaging applications to create real-time visualization of medical images enables a comprehensive acceptance of the technology across the industry. These are also used in several defense applications, such as visual representation of data related to situational awareness across the sea, space, land, and cyber space during simulation and training. Rapidly increasing defense spending for technological advancements in key countries such as U.S. and China, is also expected to propel the market growth over the forecast period.

Additionally, key market players are focusing on establishing partnerships and agreements with investors in order to raise funding to expand their market presence. However, high manufacturing costs owing to the intricate design of the product is expected to hinder the overall market growth in the coming years.

Grand View Research has segmented the global volumetric display market based on display type, end use, and region:

  • Volumetric Display Type Outlook (Revenue, USD Million, 2015 – 2025)
    • Static Volume Display
    • Swept Volume Display
  • Volumetric Display End-use Outlook (Revenue, USD Million, 2015 – 2025)
    • Medical
    • Aerospace & Defence
    • Automotive
    • Media, Communication, & Entertainment
    • Education & Training
    • Others (Oil & Gas, Mining, etc.)
  • Volumetric Display Regional Outlook (Revenue, USD Million, 2015 – 2025)
    • North America
      • U.S.
      • Canada
    • Europe
      • U.K.
      • Germany
    • Asia Pacific
      • China
      • India
      • Japan
      • South Korea
      • Australia
    • Rest of the World

Find more research reports on Display Technologies Industry, by Grand View Research:

  • Quantum Dot (QD) Display Market – Increasing demand for optimized display devices with better resolution quality and performance has driven the adoption of QD technology across various consumer electronics application areas.
  • Outdoor LED Display Market – Increasing demand for better resolution and affordable solutions is expected to drive the industry over the forecast period. The industry is characterized by rising trend towards interactive media.
  • Head-Up Display Market – Number of shipments of Head-Up Display (HUD) in 2016 was estimated to 3.75 Million units and is expected to witness a significant increase in terms of volume over the forecast period.

 

SOURCE Grand View Research, Inc.

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Artificial Intelligence

Minister Bains announces new cybersecurity centre to help protect Canadians online

Vlad Poptamas

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From left: Ajay Bhalla, President Cyber and Intelligence Solutions, Mastercard; Ajay Banga, CEO, Mastercard; the Honourable Navdeep Bains, Minister of Innovation, Science and Industry; and Ian McKay, CEO, Invest in Canada. (CNW Group/Innovation, Science and Economic Development Canada)

 

Digital technologies are integral to our daily lives. By 2025, there will be 75 billion connected devices around the world. Canadians must be able to trust that their data and privacy are protected online.

Today, while at the World Economic Forum Annual Meeting in Davos, Switzerland, the Honourable Navdeep Bains, Minister of Innovation, Science and Industry, met with Ajay Banga, CEO of Mastercard. They announced a $510-million investment by Mastercard to establish the new global Intelligence and Cyber Centre in Vancouver, British Columbia (of which $420 million is eligible under the Strategic Innovation Fund). The Government of Canada is investing $49 million to support this project. In addition to raising Canada’s stature as a leader in cybersecurity, the project will support 380 jobs and enable the creation of 100 new co-op positions.

The centre will focus on creating technologies and standards to ensure that Canadians and others around the world can safely use any device that could be connected to the Internet—phone, tablet, computer, vehicle—without concern that their personal and financial information could be stolen.

In collaboration with universities, businesses and the public sector, the centre will also create software tools that enable organizations of all sizes to build and integrate cybersecurity technologies more efficiently into their operations.

Quotes

“As Canadians use connected devices more and more, including for sensitive financial services like banking, they want to know that their data and privacy are protected. Our government is investing in a new cybersecurity centre in Canada to develop the technology solutions Canadians and people all over the world need to protect their personal and financial information when they use their devices. This will make Canada a world leader in cybersecurity and help us tackle the cost of cybercrime in Canada—an estimated $3 billion a year.”   
– The Honourable Navdeep Bains, Minister of Innovation, Science and Industry

“Ensuring payments are both convenient and secure has always been a top priority for Mastercard. We have a proud history of innovation in Canada, and we appreciate the support from the Canadian government as we deliver on a commitment to lead in digital security. Our new Intelligence and Cyber Centre in Vancouver will help meet the growing demand for technology solutions to reduce the cost of cyberattacks, enable today’s connected devices to become tomorrow’s secure payment devices, and address the growing vulnerabilities associated with the Internet of Things. These innovations will benefit consumers and businesses in Canada and around the world.”
– Sasha Krstic, President of Mastercard in Canada

Quick facts

  • Mastercard is a technology company in the global payments industry. Mastercard Technologies Canada, formerly NuData Security Inc., is a financial technology company and a subsidiary of Mastercard Incorporated. This expansion is the latest in a series of investments by Mastercard in Canada, reinforcing the company’s commitment to supporting Canadian innovation and technology talent.
  • The new centre will build on NuData Security and complement Mastercard’s Canadian headquarters in Toronto. This project aligns with the Government of Canada’s National Cyber Security Strategy—a roadmap for Canada’s path forward on cybersecurity—and with the recommendations of the Economic Strategy Table on Digital Industries.
  • The investment in Mastercard’s global cybersecurity centre in Vancouver is made through the Strategic Innovation Fund, a program designed to attract and support high-quality business investments across all sectors of the economy.
  • In addition to creating and maintaining a total of 380 jobs, this project will enable the creation of 100 student co-op positions.
  • In addition to the Strategic Innovation Fund, there are hundreds of programs and services to help businesses innovate, create jobs and grow Canada’s economy. With its simple, story-based user interface, the Innovation Canada platform can match businesses with the most fitting programs and services in about two minutes.

 

SOURCE Innovation, Science and Economic Development Canada

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