The key to managing the group's financial risk is through analytics, said chief information officer, Marius van der Westhuizen, "but it was only when we adopted QlikView that the true power of analytics came to the fore."
He said that CareCross has always done extensive reporting, including contracted doctors' over- or under-utilisation, to determine the state of key variables and intervene, if possible, to lower costs. "But our reports were paper-based and presented a static and delayed version of the truth."
At the time (2012), the group used SQL Reporting Services for reports. "You couldn't find associations or pull up other views," he added. "Tons of claims would keep flying in and the data was old as soon as it was printed. We needed real-time insights."
Having budgeted for a business intelligence (BI) tool for some years, only to be told it is too expensive, Van der Westhuizen had a chance encounter with QlikView, used by actuaries in their presentation to the business.
"Besides coming in at a very competitive price, I was blown away by what it could do. I formed a team and with QlikView South Africa's help we built an extensive group app within a week, which showed potential for us gaining high-value real-time information at a very detailed level, and saving as well as making us money."
Thus, the group purchased QlikView and started training users and developing the first apps. "We began to see results within three months and bought more licences," he said. Today QlikView is used across all divisions.
On the chairman's instruction, high-level users were issued with iPads to ensure frequent use of QlikView, "basically making it a condition of employment", Van der Westhuizen said.
"At the beginning there was resistance - one senior staff member had never used a PC - but with this kind of executive sponsorship we got it accepted throughout the organisation. We also learned to optimise our delivery and training, allowing usage to grow organically as users 'got it'."
The original app developed during the evaluation period has been extended into three key areas, with significant benefits.
This app focused on physicians' compliance with charging preferred rates has allowed CareCross to micro-manage its performance and mitigate reputational risk, receiving enthusiastic support from the group chairman, Ian Black. In 2013 CareCross proactively identified the top 200 doctors with the highest patient encounter rate. Through the use of QlikView its risk managers saved close to R3 million on the cost of sales by proactively managing the doctor compliance at these 200 targeted doctors.
Another compliance app - the patient treatment adherence model - got the attention of CareCross's medical scheme business development director, who realised it would be possible to sell the information to schemes, showing them how to save money by managing high-risk patients' compliance with treatment and disease management programmes. CareCross Disease management team proactively managed 200 high-risk scheme members during 2013, which resulted in an increase in chronic medication compliance of 10% and direct saving in their major medical expenses (average cost per member per month) by 300% compared to the previous years. The scheme signed a new contract for 2014 to assist them further with managing these high-risk patients.
Lastly, CareCross scripted an interface in QlikView, establishing real-time connections between the group and the doctors and pharmacies on its books that allow it to see and influence medicines being prescribed (to favour brands on its formulary). This data could also be used by manufacturers to qualify leads.
"You can't do this with SQL Reporting Services," Van der Westhuizen said, "but we could retain our SQL database investment and continue programming in it while pulling up analyses in QlikView."
By presenting its data analytics on QlikView to its manufacturing partners, the NuCare Health Operations director could sign up more partners and increase the number of promotion items on the medicine formulary that resulted in an increase to the company's revenue in excess of R1 million per annum.
"QlikView has given us a whole new way of looking at data and finding previously hidden trends and costs," said Van der Westhuizen." We can now find the exceptions and proactively take action much more quickly."
Praise has been fulsome throughout the rest of the group too. Dirk Erasmus, national sales manager of NuCare Health, a division focused on the sale and distribution of medicines to doctors and pharmacies, said: "QlikView is the most transformative platform for business today."
The potential for growth is enormous, said Van der Westhuizen. "We are looking at rolling out our apps to manufacturers and assisting their sales teams to target specific doctors to increase their sales targets. QlikView slots perfectly into our business model. I know we have a great future together."
