Safety above all

Everyone knows the story of how the COVID-19 pandemic swept across the world at the beginning of 2020. For healthcare providers like NZOZ Bukowa it meant a radical shift in how they deal with patients. Innovations like tele-health had been on their long-term digitalisation plan, as it had been for many healthcare providers – but the pandemic accelerated this. To ensure the safety of patients they needed a partner who could help with a tele-health solution so that non-critical patients could be treated remotely. Enter: Yameo.

Video In Person: Healthcare Edition

Yameo’s own Video In Person platform also has a dedicated healthcare version which is used for tele-health use cases. You can discover more on our dedicated webpage. By 2020 Yameo had already worked with healthcare organisations for over 9 years doing everything from gamification apps to e-claims systems. We knew the relevance of industry trends and topics such as patient data and compliancy regulations. This made it relatively easy for NZOZ Bukowa to adopt the Video In Person platform.

Fast & Scalable became a necessity

The sudden lockdown meant there was a fast need to have a working solution in place. Importantly: an easy to use solution. NZOZ Bukowa did not have the resources to train staff in the use a of new tele-health platform, nor did they expect patients to learn a manual or download software prior to tele-health sessions. This is where Video In Person excelled as the WebRTC technology meant no download was necessary and our User Interface was designed to be easy.

Within 5 days the solution was in place and NZOZ Bukowa began hosting tele-health sessions with patients.

Some supportive features (& patient data is key)

What made the Video In Person for Healthcare solution work? Well, some supportive features which meant quick and easy usage for NZOZ Bukowa. We understand that in such cases particular features can make or break a solution. We had in place features like screen-share, co-browsing, geo-localisation of session participants, video recording and importantly a scheduling feature so assistants could schedule sessions.

Furthermore, to make life easy we setup a dedicated Polish support team for NZOZ Bukowa to share any feedback or issues. Fully branded the solution so their patients would recognise who they were interacting with. Implemented custom data handling policies in line with their regulations, whilst also ensuring compliancy with ISO and HIPPA regulations.

It starts with a vision

In 2011 the National Health Insurance Scheme (NHIS), an initiative within the Ministry of Health in Ghana had a vision – deliver seamless e-claims processing of health insurance claims. Along the way they hoped to become one of the leaders in Africa with such a solution. Fast-forward 11 years later and that vision is now a reality, but more on the results below.

We had our first meeting with representative of the NHIS to learn more about their vision and goals for e-claims processing. The state in 2011 was simple: everything was paper-based. NHIS knew all too well that paper-based was the past and that transitioning to e-claims was the future for their business. Now it was 2011 and Yameo was a company that had been on the market for just 5 years. In-house we had some experience with claims processing systems from our work with Dutch insurers and healthcare providers. However this would be one of our biggest challenges! And we really looked forward to it!

Understanding a new business culture

Until this moment Yameo had experience working with European-based organisations and so working in Ghana was our first big international step at the time. It was filled with interesting challenges, none more than understanding the new business culture. To better understand our new client we sent our Project Manager, Director and top developer to Ghana to meet with representative of the NHIS and immerse themselves into the work ethos, business culture and communication structure. That one week really laid the path forward for over 12 years of cooperation. To learn more about our our Discovery Workshops, read our dedicated page.

Let’s define the scope of e-claims processing!

We setup a 3-day workshop with the NHIS in Ghana to discuss the long list of requirements and how to prioritise them. We started by focusing on the end-users (healthcare providers) who would be creating e-claims to demand payment. They needed to have their own portal to upload claims and get fast feedback about the quality of delivered claims. Defined business rules would need to be written to validate claims, autocorrect if necessary and update prices to determine the payout. This meant:

• Backend system with system data backed-up, replicated and archived on a regular basis
• Web enabled – no download, keeping it easy to use
• Role based privileges for users

Moreover, the NHIS needed its own portal and dashboard to keep control and monitor in real-time the e-claims system and ensure quality. This again was based on privileges and roles to determine the right people had the right access.

Anti-fraud measures

Another important requirement was a built-in functionality to detect fraudulent claims. Since the NHIS is paying out validated claims they need to ensure fraud cases are minimised, yet extinguished. We built a special component based on business rules and updated over the years to include new technologies which was wildly successful in detecting fraudulent claims.

Business Rules Engine

We also had to build from scratch a business rules engine. We had done such development before but on a much smaller scale. To give you an example over one million lines of code were required here –  a real credit to our .NET team at the time for undertaking and successfully developing a business rules engine of this size. It is really to their credit as the solution is still up and running today with exceptional results (see below).

Such a unique client deserves tailored support

The vision NHIS had was to be a leader on the continent in healthcare e-claims processing and this requires a tailored approach to support, hosting and integration.

Integration

To start we needed to integrate the e-claims processing component with existing systems in the NHIS and Ghanaian government. To ensure seamless claims processing and control we worked with their team to make it happen.

Custom SLA

As we said in 2011 Yameo had been on the market for 5 years and working with such a big organisation in Ghana meant a custom approach. We opened a representative office in Accra, the capital and invested in a dedicated contact person for NHIS. Until today we have a dedicated team that supports their project.

Hosting by NHIS

A requirement was that NHIS will host the solution which meant we helped train their staff to manage and maintain the solution.