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BPO Med has worked successfully with the following
clients and partners:
Healthsource
Australia
 In
an industry first, health insurer Grand
United Health Fund set up a joint venture with The
IQ Business Group, to create a business process
outsourcing (BPO) company aimed at offsetting the increased
pressure faced by health funds to cut costs. Healthsource
Australia commenced operations on 1 July 2003, headed
by Matthew Moore, a specialist in this sector for over
12 years.
 Employing
80 staff members Healthsource manages outsourced business
processes such as claims processing and administration,
initially for Grand United but ultimately for a number
of health insurance funds. Grand United, which was originally
established in Sydney in 1848 as a friendly society,
now covers over 62,000 people. Processing activities
undertaken on behalf of health fund clients include
member maintenance, reconciliation of payments, hospital
contracts, claims processing, financial services and
operations support including records management and
statistical reporting. HealthSource aims to provide
clients with a sustainable improvement in operating
costs of approximately 20 per cent. By providing Health
Insurance clients with a complete processing and technology
solution for back office functions, HealthSource enables
funds to focus on product and benefit management.
Complementing IQ's current health offerings of consulting
and back-office processing through its joint venture
HealthSource, SuperMed went live in July 2003 at Healthsource's
first BPO client, Grand United Friendly Society.
Mr. Patrick Crooks, Director of The IQ Business
Group in Sydney, Australia, said: "With increasing
product and cost focus, health funds need system diversity
and flexibility to tighten benefit management and streamline
back office processes. To remain competitive, health
funds need a flexible system that can cater for product
innovation, member acquisition and quick time to market
and SuperMed provides the solution."
Crooks continued: "So profound is IQ's belief
in the SuperMed system, we installed it in our own private
health insurance processing business - HealthSource
Australia. Ultimately, IQ's primary objective is to
make clients' processes more effective and efficient."
Thebe
Ya Bophelo Healthcare Administrators
 Thebe
Ya Bophelo Healthcare Administrators Established
in 1993, Thebe Ya Bophelo Healthcare Administrators
currently administers approximately 134 000 lives. Thebe
administers the Hosmed Medical Aid Scheme and
the Thebe Med scheme (previously known as Odyssey
Health).
SuperMed was selected to replace the previous administration
system based on its reputation in the industry. Principle
selection criteria were based on reliability and stability
with the added benefit of automated straight through
processes.
Thebe went live with SuperMed in 22 September 2003
after migrating the entire membership base and 11 million
claims. SuperMed was configured with all required business
rules in record time. The manual claims capturers where
taught to react to the business rules in the system
when capturing claims. This resulted in the empowerment
of the users and allowed them to perform the role of
claims assessors as opposed to mere data capturers.
The graphically rich and intuitive interface allowed
for rapid training of all Thebe personnel.
The EDI auto assessor was implemented with great success
and achieved 80% throughput within 9 weeks. This coupled
to the Mediscor interface has resulted in a huge
amount of claims having no human interaction whatsoever.
Since implementing SuperMed, claims throughput has
increased significantly. Assessors (manual) are able
to process almost 50% more claims than in the previous
system. The flexibility of the SuperMed system allowed
Thebe to switch to a weekly payments run, much to the
delight of all service providers and members.
BPO Med migrates healthcare admin
system to CACHÉ database
 InterSystems
Application Partner, BPO Med (previously IQ Health)
has converted its healthcare administration software,
SuperMed, to InterSystems' CACHÉ database. Explaining
the decision to move away from its previous database,
BPO Med CEO Koot du Plessis says: "We needed a reliable
solution. CACHÉ is the most successful database in the
US healthcare market, which bears testimony to its reliability.
We also find it is more affordable than our previous
database because of the reduction in licensing fees."
He adds: "The CACHÉ system is much faster, and more
user-friendly as a development environment for programmers."
He attributes the company's 100% success rate with CACHÉ
to InterSystems' support, assistance and training.
 Henry
Adams, country manager for InterSystems SA, says new
functionality in CACHÉ allows applications to be developed
in less than a quarter of the time it took before, leading
to enhanced productivity and faster time to market for
BPO Med.
The company was formed from the amalgamation of IQ
Health, SuperMed and Healthsource Africa, giving birth
to a new industry leader in healthcare business process
outsourcing (BPO). The company gives industry players
an opportunity to outsource backroom operations that
are not their core business.
"Worldwide, businesses are moving towards BPO in order
to allow businesses to focus on core activities while
a third party delivers backroom operations on a service
level agreement principle" says Du Plessis.
Processing is done on a 24x7 basis, giving clients
a 24-hour turnaround time on work processed. Participating
clients are offered the SuperMed administration system
that runs on the CACHÉ database, free of charge.
Du Plessis says BPO Med's experience stems from the
clearing houses of the late '90s. "These clearing houses
would handle doctors', opticians' and hospital claims,
for example. They would handle the claim from the time
it was received from the service provider, would clean
it up - check the validity of tariff codes, amounts,
the combination of tariff codes, validation of the member,
and what benefits were available - process that and
forward it to the administrator for paying."
Since 1993 thirty-six installations were successfully
implemented, based on the SuperMed technology. IQ Health
was a technology company that delivered business solutions
for its clients. In 2001 the two companies came to an
agreement whereby IQ would use the SuperMed system for
its clients. The companies have completed three implementations
since then, one in July this year for an Australian
client called Grand United.
Adams says BPO Med recently completed an installation
of the CACHÉ -based application at Thebe/Hosmed
and won a contract from a new-generation scheme, Ultimate
Health, to process claims, register members and administer
its provider networks. A third CACHÉ -based installation
is in use at Odyssey Health. Adams concludes: "InterSystems
is privileged to have one of South Africa's leading
suppliers of high-quality health solutions migrate its
entire product set to and standardise on CACHÉ. While
working with its highly skilled team, we were impressed
with the level of technical skill and professionalism
within the organisation." .
About InterSystems
Headquartered in Cambridge, Massachusetts, InterSystems
Corporation (www.InterSystems.com) is a leading
provider of high performance, low-maintenance database
systems for Web applications, with over 4 million users
worldwide. InterSystems' flagship product, CACHÉ, is
a post-relational database that uniquely offers three
integrated data access options: a robust object database,
high-performance SQL, and rich multidimensional access.
CACHÉ enables rapid Web application development, extraordinary
transaction processing speed and realtime queries against
transactional data. InterSystems is the leading database
in healthcare, with CACHÉ in use at the majority of
major hospitals and labs around the world, including
America's 10 best hospitals as rated by U.S. News and
World Report
Contact Christine Bergstedt, InterSystems South Africa,
(011) 324-1800, christineb@intersys.com
Kalpana Parshotam, BPO Med, (011) 259-4000,
Frank Heydenrych, FHC Strategic Communications, (011)
608-1228, frank@fhc.co.za
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