The operations at Discovery Health, which is said to be the largest medical scheme in SA, with about 1,9m lives, depend to a large extent on the effectiveness and flexibility of its IT infrastructure. John Robertson, CIO for the Discovery group, says its IT infrastructure was designed to provide real-time services and accessibility to members, doctors and pharmacies alike.

  Robertson says Discovery Health employs its online channel – – to encourage members, doctors, employers and brokers to interact with the company electronically.

  “For instance, we have recently introduced a real-time automated process whereby the hospital pre-authorisation is done when our members are admitted to hospital,” he says. “We use a switching method in conjunction with HealthBridge that makes this possible,” he adds.

  Robertson says that the medical scheme receives 80% of claims electronically. This, he adds, has helped improve accuracy during the data capturing phase, making data kept for members, doctors and pharmacists up to date.

  The other 20% of the claims are received through the mail. They are scanned and the images are stored and linked to the member’s records for use in the call centre environment. Robertson says on average, 25 000 claims documents and about 12 000 pieces of paper are scanned on a daily basis.

  “Our objective is to create a paperless office in our operations as far as is practically possible,” he says. “In our call centre and claims capture operations there is no paper at all. All functions and operations are electronic. This has saved us time, has improved speed and accuracy and helped us provide an excellent service for our members and partners.”

  Robertson says the medical scheme also uses mobile telephony to interact with its members in real time. These facilities include immediate access to Medical Savings Account balances, Vitality points and status, the progress of most recently submitted claims and balances on their DiscoveryCard – Discovery’s Visa credit card.

  "The use of SMS has proven to be an excellent tool in providing a nimble and real-time solution,” says Robertson.

ICT World