A world first medical payment system has saved South Africa’s medical aids, private hospitals and doctors more than half a billion rand this year.
It has accelerated hospital check-ins, created the technology to help medical practices more efficiently chase debt and ensure faster payments from medical aids to doctors and hospitals.
In simple terms those savings are enough to pay the salaries of up to 500 doctors a year; or foot the medical aid payments of 61 000 families; or pay for 5 000 life saving heart operations for children or build a well-equipped clinic. It helps medical aids and hospitals keep rates down at a time when inflation is battering costs. It gives doctors a reason to remain in South Africa by reducing payment times for patient bills from medical aids from 68 days to 12 days and allows them to improve the quality of care they give.
Healthbridge, the brain child of Massachusetts Institute of Technology trained engineer, Gerrie van Zyl, has, each year, since it was founded, ramped up innovations in payment solutions for the medical industry. It serves South Africa’s 230 private hospitals, all medical aids and more than 5 500 medical practitioners or 40% of all medical practices.
Every patient that has used private healthcare has had their claim data managed by Healthbridge.
Van Zyl now heads Healthbridge parent, Tradebridge, but Luis da Silva, managing director of Healthbridge says, “”We are eliminating administrative inefficiencies from health care: 30c of every rand spent in the health care sector goes into administration. We need to reduce those costs especially in today’s challenging economic climate.
“We have made remarkable inroads into saving considerable amounts for the private health care sector and are excited by the vision expressed by the new Minister of Health, Barbara Hogan and too the fact that she has a background in finance. We would like to set our sights on developing solutions for the public health care sector that could create similar savings that could lead to enhanced patient care,” da Silva said.
“We are not really affected by economic downturns,” da Silva said, “But regrettably the tougher economic conditions are, the, sicker people get with anything from conditions like ulcers to depression. What we do ensure is that doctors get paid – we have managed to help doctors cut bad debt from 10% to five percent. And patient waiting times in hospital casualty or reception areas is down to five minutes from 25 minutes because of our systems.”
Healthbridge systems also help doctors, radiologist, pathologists, medical aids and hospitals detect fraud – a multi-billion rand annual headache for the healthcare industry.
In information technology terms, Healthbridge pioneered revolutionary real-time transaction switching and processing technology and is the industry leader in South Africa. Major clients include all the major healthcare companies such as Discovery Health, Life Healthcare, Medi-Clinic, Medscheme and Netcare.
Healthbridge turnover had enjoyed an average cumulative growth rate of 35% a year for the last decade.
It developed the world’s first complete set of real-time hospital to medical aid information transfer products. Before Healthbridge Hospital Suite, hospitals would interact manually with medical aids. A clerk would fill out forms requesting a patient’s admittance to hospital and fax them to a medical aid or call for permission; it was a time consuming and often inaccurate process. The Healthbridge Hospital Suite created electronic protocols that allow hospitals and medical aids to instantly communicate, allowing automatic preauthorisation for patient admittance, re-authorisation while the person is in hospital when they may need additional tests or procedures and automatic claim submission when the patient checks out. Final payment by the medical aid is also automatically reconciled into the hospital’s system.
By 2005 Healthbridge Hospital Suite was saving medical aids and hospitals about R130 per admission, today it saves them R200 per admission.
Last year Healhbridge added an innovation called MyPractice which automatically tots up doctors earnings for a day, and then sms’s the doctor his or her turnover and the amount at risk of bad debt each day. MyPractice flags potential bad payers and each morning emails or faxes a to-do-list to the practice administrator with claims that need to be paid. It tells them how fast claims are being submitted and rewards practices with a 10% rebate for claims sent in before the patient has left the practice.
And because so many medical practice administrators hate chasing up debt with phone calls, this year Healthbridge introduced POCit Collections which enables doctors to send an sms to patients who owe money. It gives them a secure internet site to view the bill and pay either with their cellphone via POCit or in a way that suits them. Da Silva says, “A third of medical claims have outstanding balances, so this product helps them chase up and secure faster repayment.
“Globally economic conditions will remain tough for a while. The more savings we can create for the medical industry the higher the possibility they can improve services and keep down costs to consumers. The United Nations recently ranked South Africa’s private medical care system 39th out of 162 nations for technological innovation and achievement – we’d like to see South Africa even higher in the rankings and some of our advances could ensure that.”