Innovation brings medical scheme members more benefits for less

The average South African is highly dependent on their smartphone. What used to be a communication medium is now a personal assistant that manages work, social time, family errands and a tool to manage health. Covid-19 has certainly made us rely more not only on smartphones, but technology in general. In fact, it gave our country an opportunity to reflect and evaluate the use of artificial intelligence (AI) and technological innovations as necessary tools for survival in our age.

In the health care industry, we have been propelled to quickly adapt almost all our processes to deal with the pressures of the pandemic on the health-care system. It became evident that technology was needed to fight the pandemic, keep sectors running and help minimise any adverse economic effects as a result of lockdown regulations.

AI in our scheme’s benefits package

Medshield is a pioneer and we believe in the innovative digital ecosystem. A member-centric approach and embracing technology lowers the barriers to affordable, convenient and high-quality private health care while also ensuring members are more empowered to take care of their health.

Technology has allowed us to stand by our members and support them through the challenges of the pandemic. We announced an affordable 5.9% weighted contribution increase for 2021, which translates to a low R84 increase on our entry-level plans and up to R350 increase on our top-end plans. These are the lowest contribution increases in the past 10 years of Medshield’s history.

When we launched Medshield SmartCare, we had a huge uptake in 2019 and beyond, enabling members access to unlimited consultations with nurses and virtual doctor consultations from more than 390 clinic rooms countrywide. The SmartCare WhatsApp Doc service has been our latest innovation in 2020. A real-life doctor answers member questions via WhatsApp — a convenient way of accessing a family practitioner during the Covid-19 lockdown period.

As we look beyond Covid-19, Medshield has launched the Live Assured package, which is about creating certainty and providing assurances and comfort so that members can feel more at ease and not stress about their health-care needs, as Medshield has them covered.

Live Assured promises to deliver even greater access to member-centric quality health care during these uncertain times. Free 24/7 trauma and counselling benefits across various platforms, loyalty programmes and at-home exercise routines for members are some of the added benefits to ensure enhanced member value.

AI in our daily scheme operations

From the onset, we all needed to adapt our operations to allow for WHO regulations on Covid-19 and social distancing. Working from home on a decentralised basis did, however, present some challenges in tracking calls for many medical schemes. For us, having one third of our staff available and the rest working remotely, meant that the abandonment rate on our calls was higher, but we managed to overcome this as evidenced from our customer ratings. In the first four months we saw an average score of 80% in customer ratings and in May, a further increase to 95%. Without technology, our operational performance would have surely suffered.

According to research by Accenture, Applied Intelligence — the combination of data with the power of automation, analytics and AI at scale — can help health-care providers rapidly achieve efficiencies and next-level performance. In response to this trend, we enhanced the Medshield member app to provide additional benefits. Members remain connected and informed via the app, which allows them to view their membership cards, see their benefits, do authorisations, locate a network provider and other essential scheme services.

We have already seen how AI has allowed for better claims management. A digital claims-monitoring tool can identify claims, provide a timely alert, raise late payment charges and automate follow-ups. Pre-authorisation for procedures has also been made possible through AI, which validates the information associated with the request, freeing human resources to focus on higher-value tasks. Lastly, in clinical coding, AI tools help reduce say denials and under-recovery of revenue by adding AI and automation to clinical document review.

AI in the wider health-care industry

Even for the public sector, as our nation ushers in the National Health Insurance (NHI), the use of AI will become ever more important. According to Dr Nicholas Crisp from the department of health, Covid-19 has already helped the government learn new lessons about staffing, health and safety, and health products — all of which will help boost the implementation of the NHI. As such, they have committed to convert the NHI’s digital capabilities to boast a competent digital system that has accurate data from the public and private sector.

The use of AI to accurately diagnose Covid-19 patients has so far been incredible, offering a computer-generated diagnosis with an accuracy level of 98% all within five minutes. The process can go beyond testing to include disease-staging, where a patient is told whether to go into ventilation or go home. The question is: Will AI replace doctors? 

There is an underlying concern that AI and digitisation of health-care processes might replace the need for real human health-care professionals. However, it should be noted that new technologies in health care have become catalysts to our evolution — not our extinction. The need to find trusted sources for relevant, medical information is still huge, and patients and doctors alike want to avoid being entangled with incorrect medical facts and advice especially when they most need accurate input and quality care.

This is where AI and humans can collaborate. Access to a real doctor via an online platform such as our Medshield SmartCare offering allows this, because we know that the human doctor will always be trusted more than a Google search result or chatbot.

Virtual follow-ups are a convenience for both patient and doctor, allowing one to view the full medical history, test results, and allow for better accuracy of follow-up diagnosis at a lower cost for the patient and the scheme. Recently, there are new-generation mobile apps that use smartphone cameras to measure vital signs such as heart rate, mental stress, oxygen saturation, blood pressure and respiration, all from the convenience of your phone.

These mobile apps provide measurements that are of medical-grade accuracy and as they continue to push the boundaries of medical science, we look forward to seeing more of this emerging technology in SA soon and making it available to our Medshield members.

This article was paid for by Medshield.