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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

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Folio Financial a Finalist for Investment News 2019 Innovation Award for Digital Wealth Platform and How It Transforms Online Investing for Advisors and Their Clients

Vlad Poptamas

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Folio Financial announced today that it was a finalist for the Investment News 2019 Innovation Award for its Digital Wealth Platform (DWP), in the first year the award has been given to firms. This award recognizes firms that demonstrate original approaches to the opportunities and challenges facing the financial advice profession, as well as innovations that improve how financial advisors take care of their clients, run their businesses and improve client outcomes.

DWP is a next-generation platform offering the essential building blocks for financial advisors to deliver intelligent and personalized digital investment experiences to all types of investors, at a lower cost. DWP provides a unified solution to manage and extend a firm’s digital wealth management strategy. Whether a firm’s growth strategy includes a standalone robo advisor to reach a broader range of retail investors or an infusion of digital automation to improve advisor productivity, with DWP, firms can:

  • Maintain Complete Ownership of the Client Relationship – No more outsourcing digital advice business to third-party robo providers. DWP puts total ownership of the client relationship back into the firm’s hands.
  • Deliver Personalized, Automated Investment Advice – Fully automate the creation and management of custom-tailored, diversified portfolios developed from the ground up to support client goals—allowing firms to deliver greater levels of personalization throughout every step of the investment journey.
  • Ensure Consistency of Advice Across Channels – DWP is fueled by each firm’s unique advice methodology, investment strategies, capital market assumptions and preferred investment products to ensure consistency of advice across channels.
  • Manage Multiple, Complex Investment Programs from One Solution – Fully automate the creation and management of desired investment strategies—from model-based portfolios and managed ETF and/or fund programs to more personalized multi-manager strategies or bespoke, equity-based portfolio creation.
  • Streamline Operations – Complete automation of key touchpoints and operational tasks. From real-time, paperless onboarding, secure money movement and automated portfolio management to streamlined workflows, branded client communications and more, all designed to create a seamless, digital investment experience.

“We are honored that Investment News recognized Folio’s innovation, as well as the many ways our Digital Wealth Platform helps advisors serve their clients and grow their business,” said David Hagen, Folio’s Vice President of Digital Wealth. “DWP is a continuation of Folio’s long history of delivering cutting-edge and scalable brokerage and custody technology to RIAs. Folio was one of the first to offer advisors completely paperless, streamlined account opening, bank-link creation and funding – and to also provide advisors with online trade confirmations, statements, performance reporting, tax documents and proxy voting services.”

Modular in design, DWP is available as a white-labeled, customizable solution or through a robust suite of APIs that offer advisors complete control of the client experience.

 

SOURCE Folio Financial

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Fintech growing strong in Delaware

Vlad Poptamas

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Delaware Governor John Carney, speaking to the state's foundation in financial services at the release event for "Delaware in a Fintech Future," a collaborative analysis about the state's leadership in the evolving sector.
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Delaware in a Fintech Future, a report highlighting Delaware’s role in the rapidly changing financial services industry, was released today. The report, researched and authored by the Delaware Prosperity Partnership, First State Fintech Lab and the University of Delaware’s Institute for Public Administration, details the latest developments and fast-moving technological innovation in financial services.

With brand power that includes JPMorgan Chase, Capital One, M&T Bank, WSFS Bank, and Citibank, the talent pool in banking and financial services has grown exponentially and accounts for 9% of all jobs in Delaware, the highest share of any U.S. state.

And now, in addition to being a destination location for traditional banking, fintech companies from around the world are choosing Delaware.  Examples include Irvine, California-based Acorns, which opened a satellite operation at The Mill in Wilmington, DelawareDelaware-based Fair Square Financial, which recently expanded and moved into a 22,000 square-foot facility in Wilmington, Delaware; and Marlette Funding, which is expanding and creating 200+ new jobs and making a $7.5M capital investment in New Castle County, Delaware.

Defining the fintech sector can be complicated, according to John Taylor, Director of Economic Research at the Delaware Prosperity Partnership.

“Some are referring to fintech as a standalone new industry,” Taylor said. “Certainly, the term is relatively new, but a closer look suggest that all financial services companies are becoming fintech companies, including the well-established incumbents as well as early-stage startups.”

No matter how broad or narrow the definition, Delaware is becoming the location-of-choice for financial and business services.

Fast Facts:

  • Delaware has the highest relative concentration of financial services jobs of any U.S. state. Among U.S. counties, New Castle County ranks third.
  • Since 2009, nearly 200 fintech patents were assigned to Delaware-based individuals and companies, ranking first in the United States on a per capita basis, and fifth in absolute terms.
  • Finance accounts for more than one-fifth of our state’s GDP, the largest contribution of any sector.
  • Delaware has been a magnet for out-of-state direct investment by financial services firms in recent years, with $725 million invested since 2010. Wilmington is the leading destination in our region for this investment.

“We should think of fintech as the next wave of innovation in banking,” says Taylor. “Advances in machine learning and data analytics are enabling new ways for consumers to access financial services.”

 

SOURCE Delaware Prosperity Partnership

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Uplandme, Inc. raises seven figures for a new property trading game

Vlad Poptamas

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Upland Logo Screenshots
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Uplandme, Inc. has closed a financing round, which was led by Finlab EOS VC Fund and with the participation of several angel investors. FinLab EOS VC Fund is a venture capital fund backed by both Block.one, the publisher of the blockchain protocol EOSIO, and FinLab AG, one of Europe’s largest company builders and investors focused on financial services technologies.

The funds will be used to support the initial development and launch of Upland, a digital property trading game that blurs the boundaries between real and virtual worlds. Players buy, sell, and trade properties based on real-world addresses. An in-game currency called UPX will power the economy of Upland. Players will be able to complete property collections, use location-based features and trade their properties on a marketplace.

“We invested into Uplandme, Inc. because we like the genuine idea of a virtual property market powered by the EOS Blockchain and the very experienced and passionate team behind it,” said Stefan Schuetze, Managing Director of FinLab EOS VC Fund. “Blockchain and specifically EOSIO allows the creation of completely new game mechanics that were not possible before.”

We are excited to work with Uplandme, Inc. as we believe they present a very unique and differentiated concept and that gaming and digital collectable companies, such as Uplandme, Inc., are a great application of Blockchain technologies, in particular EOSIO,” commented Paul Grotowski, COO of EOS VC.

“We have chosen the EOSIO blockchain software because it offers the best foundation to create a strong casual gaming experience where players engage quickly and can continuously enjoy the game without the hassle and need to understand today’s complicated world of Blockchain. We are excited to work with Finlab and EOS VC to leverage their EOSIO background and financial expertise which are very important for us as we build out Upland,” said Dirk Lueth, Co-founder of Uplandme, Inc.

 

SOURCE Uplandme, Inc.

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