The privatization of the Dutch healthcare insurance system radically changed the process for determining healthcare prices. No longer established by the State, healthcare costs are now decided during annual negotiations between healthcare providers and health insurers. Each insurer maintains its own systems and rules for the payment of reimbursements to patients and pharmacies for drugs and other medical products. They also differ in the specific drugs they will cover or recommend pharmacies to issue depending on availability. That, combined with the difference across individual price level agreements created significant complexity within the healthcare reimbursement system.
Each year, contracts with healthcare companies are renegotiated, Brocacef Group has a very narrow window of time to implement the numerous changes to ensure the correct reimbursement claims are submitted to health insurers. The updates include changes in prices, discounts, reimbursements, drug alternatives, legislation and regulations. The organization determined that its manual approach to reimbursements could no longer scale effectively with the frequency and volume of changes and needed a new solution.
In parallel, Brocacef Group was developing a customer portal, where their 3.5 million patients in the Netherlands could request repeat medication, book a consultation with a pharmacist or locate the pharmacy where to collect their drugs and other medical supplies. With that came another challenge for Brocacef: the risk of wrongly dispensed drugs. When people getting their sometimes life-saving medication—like insulin—depends on you, errors are not an option”, said Casper Otto, Director Technology of Brocacef Group. “It needs to be the right drug to the right person 100% of the time.”
Brocacef sought an automated approach to reimbursements and believed a business rules engine was the best way to manage the growing complexity of the Dutch healthcare market. The new solution needed to provide a rule-based structure that could be easily maintained by the business.
The company conducted a thorough evaluation of the market and was most impressed with Progress® Corticon®. “To my knowledge, there isn’t a better platform for what we’re trying to achieve,” said Otto. “The flexibility with which business analysts were able to model the decision rules was unrivalled. Corticon was able to integrate all rules without requiring any programming.”
Brocacef also wanted a solution that would enable them to automatically perform complex calculations for production prices and drug discounts and quickly test the associated scenarios. The optimal way to ensure we’ve covered all the rules agreed in the contracts with health insurance companies is to create a model of all these rules, test it and then set it live, and Corticon has allowed us to do all that,” explained Otto.
Finally, the biggest benefit Otto saw was the possibility to reduce medication errors. As he explained, “Speed is critical for us, but error mitigation is imperative. We cannot afford to give people the wrong drugs; those kinds of mistakes are too expensive.”
Brocacef has realized significant bottom-line results with Corticon, reducing costs while increasing the company’s profitability and customer satisfaction. Brocacef managed to completely automate the process for invoicing health insurers and create a flexible environment for business analysts to apply changes quickly, easily and without errors.
“Thanks to Corticon, we’re completely in control of the business,” said Otto, as Corticon enables non-IT experts to document and manage business logic outside the application code. “The Corticon rules engine powers our entire process, like the backend logic of an application. We only had to create the specific use cases to allow our business people to easily model the rules and change parameters on a day-to-day basis with maximum flexibility.”
The flexibility also extended to the IT team. As Otto explained, “When you're hard-coding decisions, you’re creating a hard-to-manage system and a bottleneck for yourself as a developer. With Corticon we can retrieve the logic and make the code more versatile, uniform and easy for us to maintain.”
In this way, Brocacef dramatically shortened the time necessary for business analysts to implement changes agreed with the insurers: “With our previous process it took us 1.5 weeks to implement changes in automated decisions. With Corticon we can do it in 1.5 hours,” said Otto. “Errors in the application of the agreements have been reduced to a minimum. Miscalculations and incorrectly applied agreements led to an enormous amount of extra work and so significantly higher costs. Not to mention the annoyance this causes the customers and the reduced confidence this entails.”
About Brocacef Group
Brocacef Group, established in Maarssen and part of the PHOENIX Group, is a group of companies active in the Dutch pharmaceutical and healthcare sector. Alongside distributing drugs and medical products, Brocacef Group also develops and implements pharmacy and healthcare concepts. For more information, please visit: www.brocacef.nl