Silicon Valley analytics software company FICO announced that Discovery Health in South Africa is using the FICO Decision Management Suite to process as many as 100,000 transactions a day. As South Africa’s largest administrator of medical schemes with more than 3.2 million beneficiaries, Discovery Health uses FICO Blaze Advisor decision rules management system to assist in various processes, from insurance applications to claims processing, in order to accelerate decisions, save costs and improve the customer experience.
Using FICO Blaze Advisor, part of the FICO Decision Management Suite, Discovery Health can instantly and automatically determine the eligibility of an insurance applicant and their dependents, set terms such as the waiting periods to be imposed and determine offers and requirements for acceptance, for example medical evidence, referrals to specialists. Underwriters and other staff can update decision strategies quickly, without the need for IT assistance.
Discovery Health has been using the FICO system since 2012, when it selected FICO Blaze Advisor to replace its previous rules management system and consolidate underwriting decision-making in a single system. Discovery Health wanted to make decisions in real-time across platforms and channels. The manual processing of up to 22,000 paper applications per month across 19 medical schemes required 180 staff.
“We needed a best-in-class decision engine to improve our performance,” said Kris Tokarzewski, Chief Information Officer at Discovery Health. “FICO provided the most powerful decision engine, and it has helped us streamline our business and provide better service to customers.”
Using FICO Blaze Advisor to automate processing for 30 medical conditions, Discovery Health has automated around 40% of the previously manual underwriting effort for paper applications, each of which took two to four days to process. Online channels now have the ability to issue near real-time underwriting decision. In 2013, only 11% of health applications were automatically underwritten; today, 100% of online and paper applications are adjudicated by FICO Blaze Advisor, with a 78% auto-adjudication rate.
“The healthcare and medical aid industries form a complicated ecosystem,” said Derick Cluley, who oversees FICO’s operations in Africa. “Running multiple schemes in multiple languages and multiple countries demands the kind of sophisticated decision management that FICO offers. FICO is proud of the part our technology is playing in driving down the cost of healthcare by driving up efficiencies and scale at South Africa’s largest administrator of medical schemes, medical aid scheme just over 3.2 million beneficiaries.”
Discovery Health is part of Discovery Limited, a South African-founded financial services organisation that offers a range of products including medical aid administration, life insurance, credit cards and investments, underpinned with Vitality rewards. Founded in 1992, Discovery is a shared-value insurance company whose purpose and ambition are achieved through a pioneering business model that incentivises people to be healthier, and enhances and protects their lives. The company currently covers over 5.1 million clients across South Africa, the United Kingdom, the United States, China, Singapore and Australia
FICO powers decisions that help people and businesses around the world prosper. Founded in 1956 and based in Silicon Valley, the company is a pioneer in the use of predictive analytics and data science to improve operational decisions. FICO holds more than 170 US and foreign patents on technologies that increase profitability, customer satisfaction and growth for businesses in financial services, telecommunications, health care, retail and many other industries. Using FICO solutions, businesses in more than 100 countries do everything from protecting 2.6 billion payment cards from fraud, to helping people get credit, to ensuring that millions of airplanes and rental cars are in the right place at the right time.