Recognition for industry game-changer on three different continents
When deviating from industry norms is a good thing
If you invest in superior knowledge-driven systems, put in the effort and dig deep, you can make a meaningful difference, revolutionise industries such as healthcare and financial services, and substantially enhance consumer satisfaction, while contributing positively to the bottom line of your clients.
This is the view of Wilma Liebenberg, the chief executive officer, of Knowledge Objects, an award winning developer of knowledge-driven systems within the healthcare, insurance and financial services industries. According to Liebenberg, Knowledge Objects cut its teeth in the South African healthcare management sector, where the company has become known for breaking new ground through its cutting edge, one-of-a-kind technology.
“It is the way Knowledge Objects uses its technological capability and systems that have delivered the greatest impact, however, and our ground breaking methodologies and intelligent systems have resulted in these now being deployed on three continents, namely Australia, Asia and Africa,” asserts Liebenberg.
The state of technology in the SA healthcare management environment
According to Liebenberg, South Africa’s private healthcare sectors standardisation of clinical and funder coding, communication protocols and technical infrastructure, are among the most advanced in the world. This consequently makes rapid advances in risk management automation and artificially intelligent big data systems possible.
“Within South Africa, Knowledge Objects has access to world class evidence based treatment guidelines, coupled with the availability of granular data from advanced systems in real time to ensure that health and financial risk management strategies are effectively executed.
“Given our intelligent systems and the rules-based, fully automated technology on offer, issues such as racial profiling should never have become a problem within the healthcare funding industry. More importantly, members of medical schemes can take comfort in the knowledge that world class, evidenced-based decision making processes are available to ensure that they can count on the best, most effective care.
“Having said this, there are still some out-dated legacy systems in use within the local healthcare management sector. As a result, processes are in some respects still quite manual and require more modern technologies and programming languages so that the industry can enter the space of rules-driven artificial intelligence to improve automation and decision making.
“This was an enormous industry challenge, which Knowledge Objects has taken on and have successfully overcome so that our clients can benefit from the investment, foresight and capabilities of the team,” notes Liebenberg.
Deviating from industry norms for the greater good
The Knowledge Objects systems and programmes, all of which have been developed locally, enables the company to take a holistic view of claiming patterns, disease profiles, medication utilisation, the individual health status of members, compliance with disease management programmes and other areas necessary for effective risk management.
“This in itself is not unusual in the South African healthcare landscape. However, Knowledge Objects’ approach is an important deviation from the industry norm, where data trawling and auditing of outliers is traditionally performed retrospectively and in many instances even manually.
In contrast the focus of Knowledge Objects is on proactive management, with 100% of our claims adjudication analysis being conducted proactively rather than reactively. In addition, we make use of retrospective data science algorithms and artificial intelligence capability to continuously analyse big data and detect trends,” explains Liebenberg.
“These complementary systems further enhance the real-time proactive decision making rules engine, while engagement with healthcare service providers and members enhances the medical care provided. The purpose is not only to deter or detect mistakes or fraud but more importantly to confirm that quality care is being provided at all times to further support the health of patients.
“For example, when it comes to claims management, our approach is based on providing the maximum amount of information to ensure claims submitted are accurate and factual. The advanced artificial intelligence software used by Knowledge Objects, pre-emptively flags inappropriate claims, and identifies suspicious activity and risk patterns.
“Our intelligent technology solutions ensure that incorrect prescription submissions, bundling or unbundling of treatment codes, ‘code farming’ and over-servicing are detected using an embedded rules engine for real-time protocol application to prevent incorrect payments being made,” Liebenberg explains.
“Claims adjudication identifies potential coding and billing issues, including, for example, outpatient coding errors, to distinguish inappropriate or potentially fraudulent claims. Essentially, the system detects and prevents fraudulent or ‘phantom’ claims through communication with members on all transactional line-level records. Also, claims are adjudicated against comprehensive best practice clinical, fraud and coding rules, which are backed by experts from all medical disciplines.”
“This means there is no need for spy cameras or private investigators, which we have recently heard allegations of, and no duplication of administrative processes. All rejection messages are a reflection of the actual protocols and clinical rules triggered per line transaction,” she notes.
Award winning technology
Knowledge Objects was recently acknowledged by the 2019 Technology Top 100 Business Innovation Award (TT100) hosted by the Department of Science and Innovation and the Da Vinci Institute, securing gold for Best Innovation Concept. The judges acknowledged Knowledge Objects for excellence in contributing to the Fourth Industrial Revolution through the use and application of leading and world-renowned artificial intelligence (and Internet of Things [IoT]) software.
Commenting on the award, Liebenberg said, “It recognises Knowledge Objects’ solid achievements in systems innovation, education and coaching, development of networking opportunities, as well as in research and knowledge dissemination, especially in the global health, life and general insurance systems industries.”