How tech is changing insurer-healthcare interaction

by David Keelaghan18 May 2018

TELUS Health’s ambition to become a digital leader in health insurance gained credence with its recent acquisition of Symbility Health.

The $16.5 million deal, finalized earlier this month, allows the firm the opportunity to expand its business in the small and mid-sized enterprise (SME) segment. Frantz Leuenberger, VP, Strategy & Product, TELUS Health and Benefit Solutions explains how adding Symbility Health to its lineup made perfect sense. 

“We figured that Symbility Health was a leader in that sector, offering technology that is best suited for the smaller market that is mostly covered by third-party administrators,” he says. “It is similar technology to what we have, but more geared to smaller enterprises.”

According to Leuenberger, technology is at the heart of everything TELUS Health is trying to achieve. Canada’s complex mix of private-public healthcare delivery can be challenging to navigate, which is where technology can make a big difference, he explains.

“We really believe that technology will change the game and our overall strategy is to do that,” he says. “We built the TELUS Health Exchange Platform, which basically is a set of APIs and solutions that connects the stakeholders of the industry to exchange information together to improve healthcare.”

Those stakeholders – insurers and employers, health regions and hospitals, physicians, pharmacies, pharmaceutical companies and consumers – all have a similar need when it comes to transferring sensitive information: the process needs to be secure, as well as fast.  

In that regard, TELUS Health is confident it is effecting positive change in the industry.

“For health insurance, we are mostly a back-end solution,” says Leuenberger. “We connect to the administrative systems of the insurers, we transport the claims, and adjudicate those claims based on the plans that are built and offered by the insurers.”

With more than 22,000 doctors using its electronic medical records solution, not to mention 6,000+ pharmacies using its practice management offering, TELUS is in strong position to really drive innovation in Canadian healthcare.

Its online benefit check platform for example, as Leuenberger outlines. “Basically when a doctor gives a prescription, the system will check for the coverage of a patient, and will search on a database for drugs that fit with the same disease. If there are alternatives that are cheaper, it will let the doctor know, and they can decide whether to switch to that drug.”

The cost of drugs is a major concern for both insurers and patients, so any efforts to reduce these expenses will be welcomed. But aside from dollars and cents, technology can also make a big difference when it comes to time and convenience.

 “With expensive drugs, some require preauthorization from the insurer,” says Leuenberger. “This is mainly manual, where a doctor will have to enter a lot of information to make sure the patient meets the criteria for authorization. That’s very cumbersome, and for the patient they can’t take the drug until the process is completed.”

He adds: “We are working on automating all of that. So from the point of prescription, when preauthorization is required, a doctor or medical practitioner will enter the criteria that is required. Then we submit that preauthorization directly to the insurer so they give an online authorization and the patient can walk into the pharmacy and have the drug prescribed right away.”

 

Related stories:
Empire Life/ Symbility deal reflects challenges for third party administrators
Health benefits software provider foresees major market inroads

 

 

COMMENTS