How Agility is providing solutions in health insurance

Since its inception in 1995, Ability has grown globally in Asia Pacific, Africa, the Middle East and recently, entered the UK market. Providing solutions for risk management programs in the financial and insurance sectors, Agility helps its clients adapt to the challenges posed by the health insurance market, while using the latest technologies and applying Best Practice guidelines and algorithms.

Neels Barendrecht, CEO of Agility Risk Solutions in Asia and the UK, said that Agility has always focused on owning its own technology, and this philosophy remains today.

Following the incorporation of its maintenance and technology management company in South Africa, the company began exporting its technology to other parts of the world in the early 2000s. The first participating countries since 2003 were Hong Kong, Malaysia and Australia and Dubai in 2011.

Barendrecht explained, “We create solutions for our customers. It can be an A to Z solution, it can be sustainable if they have specific needs, it can be a way to refine and develop intelligence over time. There are a number of ways we support our insurance and financing clients. .”

Although the company’s roots, as well as many of its businesses, are in the medical field, it has also entered into solutions for risks in group life, disability cover and critical areas to ensure that the continuum of health care is properly addressed, monitored and integrated. . “Our main goal is to manage human resources and productivity. This is achieved by providing quality care and health care to employers, and ensuring the right care at the right level for consumers,” said Barendrecht.

Not your “off-the-shelf” software

Although the company was founded in the 90s, Barendrecht emphasized that it is not affected by the legacy system. “Our latest software is built on Artificial Intelligence and is Rule Based. It was developed and developed over the last decade to allow better management of big data at a much larger scale of data. This is the legacy that the Agility process is looking after from the old methods. workflows: Ensuring that small datasets are managed efficiently and quickly in large datasets.”

This is a big difference. Chantal Viljoen, director of technology at Agility Risk Solutions, echoed Barendrecht’s statement that the company does not rely on legacy or decentralized systems. He said the company’s solution is integrated, but modular. “This is to support different maturity levels in different markets. We use AI technology to improve Best Practice guidelines, as well as medical regulations and other laws that are used for all purposes.”

“Our enterprise-based design allows us to have ‘one truth’, thereby ensuring that it is not a legacy of health, life or other insurance. Instead, it works across insurance classes and products with ease. This is very important if you want to ensure that all groups are integrated with products, and ensure that people are well cared for and not just linked to the health of the insured. It also greatly contributes to the speed of the market.”

Further, demonstrating that Agility’s offering is not just your standard off-the-shelf software, Viljoen said the intelligence generated by the system enables its clients to invest in information-based products. “We focus on the customer market, we analyze its problems, and take care of the content of the technology included in the program. This includes medical, statistical, risk assessment and other types of IP that have been developed and developed over the past 27 years”.

Using AI

According to Barendrecht, AI has become an overused word in the industry, used carelessly. “It’s similar to the word ‘integration’. Everyone uses the word integration when they’re just transferring data between systems. It’s not really ‘integration’. Integration is when all your functions and modules are on the same platform and architecture.” The same applies to AI. , he continued, “A lot of people mention AI as part of their solution, but when you get down to it, that’s not what’s happening. It’s almost a marketing buzzword, not a real meaning.”

The real take on AI is when it’s used to “manage risk in a different way,” Barendrecht said. Agility does this by using AI as the first line of entry to better predict accidents, and using machine learning to manage claims.

According to Viljoen, the insurance market places great emphasis on fraud, waste and abuse (FWA). However, this backfires and creates other problems, which damage the relationships between all parties involved in the process.

The Agility solution focuses on proactively managing these FWA risks. “We will not refund any money or fraud afterwards. We position AI as the front line of claims and as the first line of entry. This helps us better predict risks, and their outcomes, while avoiding FWA by carefully following medical, accounting and benefits regulations. This means that the FWA claim is prematurely rejected. “

Stress in the health insurance market

Turning to the healthcare market in particular, the COVID-19 pandemic has created challenges that may persist for some time. Dr Jacques Snyman, chief medical officer at Agility said that first of all, people are very concerned about their health and their health needs due to COVID-19.

“This is for two reasons. First, it focused on people’s attention to health problems – such as diabetes, heart disease and others – as they have been affected by COVID-19. We are also seeing a significant post-COVID impact on chronic diseases, which include chronic diseases. This adds additional cost to healthcare providers, providers and hospitals. “

Another factor affecting the market, although not caused by the epidemic, is the rise in consumer expectations. Consumers are becoming accustomed to accessing many services 100% online from their mobile devices, which raises concerns that consumer expectations may be unattainable.

Both Snyman and Barendrecht agreed that this is a multifaceted issue that brings both positives and negatives.

According to Snyman, the emergence of Telemedicine, for example, can be very beneficial. “Telemedicine makes it easier to get advice from doctors, which makes it easier to get advice before meeting a doctor. While this may reduce costs, it also means that the service is vulnerable to abuse. “

It can also create unexpected expectations with patients, Snyman continued. There is the behavior of “seeking health” and “buying medicine”, both of which are not always healthy, and can make the dialogue between patients and doctors very difficult.

Overall, Snyman said that if the digitization of medicine is improved, it will be a good thing.

The cost of driving technology

Technology can be a double-edged sword when it comes to the health insurance market. “We are becoming more aware of the evolution of disease. The prevalence and incidence of certain diseases is increasing worldwide. Diabetes is a good example. The fact that diabetes has increased by 49% from 1990 to 2019. The factors that affect the cost of medicine are the same because of the good molecules and the possibility of prolonging life. However, not treating diabetes to meet its goals can be costly. Every 1% increase in HbA1c level increases the risk of cardiovascular death by 25%. This increases the cost of care by 4.4% per year for patients with type 2 diabetes mellitus. ” Snyman said.

This has implications for other diseases. It is often the case that a treatment, condition or disease puts the patient at risk for another. An example would be the suppression of the immune system used in the treatment of autoimmune diseases, which may increase the patient’s risk of disease. Also, Snyman said that as our immune system improves, we live longer, thereby “inducing” disease and aging. “In that sense, medical technology is driving money, because we want to live longer.”

These companies are willing to use medical technology, Snyman continued, but this also puts a burden on the insurance industry. As a result, consumers need to start using insurance at a young age to pay for the benefits they receive as they grow older. Unfortunately, the opposite is true in many markets, especially where employers have stopped providing health care.

Finding answers

He was asked how an organization with its roots in the South African healthcare market has made a significant contribution to international markets. The answer lies within the unique nature of the South African healthcare industry. Agility has developed a unique solution within this challenging environment and has also helped market players around the world with unique and customized solutions.

Barendrecht says that the South African market is probably the most profitable for inpatients and outpatients. “What we call medical plans, what you might call health insurance, health plans or health funds in other countries of the world, involves physiotherapy, psychology and occupational therapy. You will not find this offered anywhere else in the world from health insurance.”

What it does, Barendrecht said, is make the cover more expensive. However, it helps to ensure that the patient’s health is properly managed from primary, to secondary and tertiary care. Elsewhere in the world, health insurance is mostly for hospitalization, only covering the patient once they are already sick. This means that the intervention that can be done from preventive measures is very small and is usually not paid by the person in his pocket.

“This is why we are so rich. We have a lot available to us that other parts of the world don’t have. As a result, the global market is eager to understand how to improve that care.”

“It is the deep understanding of health risk management throughout the care cycle that has enabled Agility to find successful solutions. It is perhaps the thing that South Africans are best known for – finding solutions. South Africa is a very dynamic country. High quality private health care, where the population is increasing and , sometimes, public health care delivery systems. If you learn between the private and public healthcare sector, as we have done, you can create unique solutions and create critical thinking. And this is what we take to other parts of the world to help our clients create effective solutions heart, because that’s what we’ve done. And that’s what we’ve done from the beginning.”

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