Thank you for Subscribing to Apac CIO Outlook Weekly Brief
Medilink Network: Delivering Simplified and Standardized Health Insurance
Given the skyrocketing costs of best-in-class care and medicine, it’s a no brainer that healthcare insurance today has become a monumental boon for patients worldwide. However, year after year, as the healthcare insurance industry garners more popularity, the complexities in its transaction and claims have also grown quite tremendously. For instance each year, millions of transactions are processed in healthcare insurance, among which the simultaneous transactions during peak periods are supposedly known to reach thousands in number. These peak periods might coincide with the most critical and inconvenient times, such as a disease outbreak, flood, or earthquake. Frequently, during peak demand periods, it has been commonly observed that authorizations are delayed due to the shortage of trained personnel at the healthcare operation centers.
The inadequacy of healthcare personnel is one of the major drivers of complications in the healthcare landscape today. While modern healthcare has traversed to new heights with groundbreaking end-results and rapid innovation within the field, it still functions very much like a complex administrative wagon. It constitutes a consortium that requires consistent coordination between various stakeholders such as insurers, hospitals, clinics, doctors and practitioners, pharma companies, and other members, each representing vital components of a single value chain.
If left unchecked, this critical chain runs a serious risk of enduring intense stress, especially under adverse natural factors that are beyond control, such as increase in population, longevity, and the earlier incidence of disease. However, it is often observed that in most cases, the primary gap in the supply and demand of healthcare services is usually due to structural reasons such as the long gestation period that is required to train and equip health workers.
Driven by the zeal to standardize these irregularities in modern healthcare services, Medilink; a reliable partner for the health ecosystem has turned toward machine learning models, pioneering the usage of artificial intelligence for fraud monitoring and claims processing. Through its unique technology, Medilink enables its healthcare clients to channel more resources toward patient care while the company takes care of their back-office services related to health benefits and administration. “We believe that an efficient machine learning model must encapsulate the ideas and expertise of different stakeholders that are involved within the workflow, and that is what we are offering to our healthcare customers,” says Esther Go, President and CEO of Medilink.
Beating 16 other entries in the race for 2017’s ‘Best Innovation for Services and Solutions’, Medilink’s machine learning solution proved its mettle by bringing forth an integral solution for healthcare that is build keeping in mind the feedback and improvement at the core of its innovation. The solution takes the synthesis of human judgment and machine learning to enhance the performance of the entire healthcare community to the next level.
Serving as the bridge between the demand and supply of health services, Medilink specializes in providing reliable technology solutions that significantly minimize insurance and reimbursement related administrative paperwork and ensures that healthcare payments are prompt and accurate. The company provides a range of technology solutions for eligibility verification, authorization, claims processing, electronic payments and fraud monitoring. Medilink authorizes and then pays for member transactions at hospitals and doctors’ clinics on behalf of insurers through electronic means.
We believe that an efficient machine learning model must encapsulate the ideas and expertise of different stakeholders that are involved within the workflow and that is what we are offering to our healthcare customers
Furthermore, Medilink is currently working on simplifying and standardizing the voice operations within its machine learning systems that eliminates the requirement of service agents to have a medical background to perform their jobs.. With this new development, the service agents can simply enter transaction parameters into the system without restrictions. Non-voice operations such as email or chat are also pre-screened by bots, with frequently asked questions resolved instantaneously without further human intervention. At each insurer’s discretion, service options may be configured as either human decision support which allows a human to make the final decision after pre-evaluating the transaction b, or by perform fully automated stand-in processing in place of a human.
The Story of Health Insurance
The advent of automation and digital processes within the global healthcare insurance landscape was soon followed by the inevitable rise of blind spots within insurance pipelines. As a result, today, high volumes of simultaneous transactions originating from diverse locations have become the very source of fraudulent misconduct, creating new realms of challenges for insurers in processing healthcare insurance claims.
The executives of one of the leading health insurers in America found themselves stuck with a similar complication when they noticed that the increase in member utilization was disproportionate to the growth of their member bases. More alarmingly, auditors were identifying more fraudulent cases arising from internal control issues or provider fraud. Adding further concerns was a severe lack of trained medical, allied personnel who could review the transactions. Also, the manual screening of each transaction resulted in long wait times for members, making it difficult for their customer service department as well. Amidst this chaos stepped in Medilink, with advanced expertise in big data analytics and IT services and managed to pull the healthcare organization out of the swamp.
"Today, medilink prides itself as a healthtech/ insurtech company that enables payors, providers, and members to implement ict solutions that promote efficiency, transparency, as well as sustainable and profitable growth"
Medilink was able to prevent fraud effectively through intelligent verification and exception-based human intervention while also minimizing processing cost along the way. The healthcare organization estimated saving 12 percent of utilization expenses from avoidance of fraudulent claims. They even managed to improve their customer satisfaction rising from instant response to authorization requests. “Our fraud analytics came to the rescue and enabled the client to lower the cost of healthcare and make healthcare coverage more affordable,” affirms Esther.
Medilink’s expertise enables health facilities to instantly access insurance eligibility of patients, without having to call the insurer or subjecting the patient to a long waiting period or the need for paperwork. Facilitating unparalleled accessibility, Medilink employs machine learning techniques to monitor potential abuse and fraud. Timely interception and disapproval of insurance transactions helps the company ensure that the pooled healthcare funds are directed to the patients that are in need while helping the insurance organization to keep premiums down and therefore making them more affordable to the population.
Medilink brings its clients 20 years of experience in offering both IT solutions and managing healthcare payment gateway operations. The company’s road to success is attributed to several service upgrades undertaken by them over the years. Medilink introduced its first service offering—electronic health benefits eligibility verification and authorization in 1999, which was enabled by re-purposed POS terminals. Four years later, the company launched the next logical service—payments. Esther explains, “We began to pay doctors and hospitals on behalf of insurers and Health Maintenance Organizations (HMOs) based on the authorized transaction, which originated from the terminals. This prompted the need for a healthcare payor enterprise system.” With this development, Medilink launched the enterprise solution in 2007 that allowed insurers to design a policy, underwrite risk, enroll members, and provide customer service, process claims, and bill. Extending further into the customer service arena in 2014, Medilink created self-service portals available for providers such as members, doctors, hospitals, and clinics. In addition to POS terminals, the company’s services were made available through web and mobile applications as well. When the clients experienced high growth in transaction volume, Medilink helped them understand their revenue and utilization drivers through business intelligence services such as analytics, visualization, and forecasting.
“As a unique service included within our portfolio we also perform escrow services for payments from insurers to health facilities and practitioners, enabling us to guarantee payments for authorized transactions,” adds Esther.
As Medilink excels as a prominent service provider offering software-as-a-service to various insurers and health maintenance companies, the company also utilizes its own offerings through a business process outsourcing (BPO) service. Medilink functions as a stand-in processor offering business continuity during peak periods and holidays. As a user of its own solution, the company ensures that features are secure, scalable, and reliable.
Aligned with the best practices in the market, Medilink subjects its operations to external reviews and audits. In 2007, the company secured its ISO9001 quality management certification and has used it as a benchmark to improve its systems and processes continuously. Given Medilink’s dependence on the automated systems and its compliance with data privacy laws, the company was also certified ISO27001 last year. With prospects of securing certification of Business Continuity Management (ISO 22301), Service Management (ISO 20000), Occupational Health and Safety (45001), this year, Medilink is well on track to achieve all the required parameters.
Beyond the Horizon
Currently, as Medilink continues to automate high-volume transactional processes such as pre-authorization, claim processing, and payment settlement, the company wants to free its user base including payers, hospitals, clinics, and doctors from routine, repetitive tasks. By next year, the company plans to launch its proprietary mobile app for members that will incorporate features to allow patients to consult with health practitioners. Medilink plans to continue building features to the app and engage members through gamifying their health-seeking behavior and connecting the health circle that includes patients, family, friends, and health partners.
After establishing a strong presence in Singapore, the company is actively seeking to expand their portfolio in the ASEAN region in the coming days “As we step into other geographies, our core technology and business principles will continue to empower healthcare communities with essential tools and expertise to deliver efficient, accessible, and affordable healthcare,” concludes Esther.