Interview - Health insurance
Building the IT
insurance is playing an increasingly important role in the provision of
healthcare across the Middle East with a number of countries in the
region making health insurance mandatory. To facilitate this initiative
Saudi Arabia-based Waseel is pioneering the digital connection of
insurance companies with healthcare service providers. Middle East
Health speaks to Riyadh Bajodah, chief operating officer, Waseel.
Middle East Health: Can you please provide a bit of background for
Middle East Health readers who may be unfamiliar with Waseel? What it is
it that Waseel does?
Riyadh Bajodah: Well, first I would like to thank you for this
opportunity to tell you about Waseel and the vision of Waseel. Waseel in
principle can be seen as the prime healthcare insurance data exchange
portal (gateway). Waseel was built to be the market solution that will
serve and enable both players in the healthcare industry, Payers and
Providers (insurance companies, TPA, direct payers, hospitals, clinics
and regulators) to operate smoothly, save time and reduce cost through
the online exchange of health insurance information. Waseel offers three
main services, “eligibility” that will enable providers to make sure
that the patient has a valid [health insurance] card and is entitled to
specified health services. The second service is “approvals submission”.
This service highlights the efficiency of the system. Providers send all
approvals requests directly to the payers system online without the need
for paperwork. They can also send these requests from their own hospital
information system to the payer’s backend system without the need to
access the Internet and track the status of each approval as well. The
third service is “claims submission”. This service saves time and cost
by extracting electronically all the claims data from the provider
system. It analyses, validates and sorts the claims information before
sending them to the payer backend system without the need for paperwork
or data entry.
MEH: Is Waseel still serving only Saudi Arabia or has it now
expanded its operations to other countries in the region?
RB: In the past two years, we have concentrated on expanding our
network of healthcare providers in Saudi Arabian market to be able to
better serve our group of payers. Waseel currently serves the Saudi
market with more than 210 providers around the kingdom and three major
payers. However, Waseel is engaged in a pilot programme with one of the
major payers in the UAE.
MEH: Two years ago Saudi Arabia was just beginning the roll out
of mandatory health insurance for all. What is the current state of the
roll out? How successful has it been, so far?
RB: I believe that the scheme is now applied to all companies with
less than 500 employees [part of the phased roll out to companies,
starting with large companies and then moving onto the smaller ones].
It’s a great development and I think its moving in the right direction.
However, the market needs to be monitored closely to insure proper
implementation and protect insured members’ rights from being
manipulated by some companies (payers or policy holders).
MEH: Waseel looked set to grow substantially when MEH visited two
years ago. How has this rollout impacted your business?
RB: The effect of the rollout on Waseel growth is still not as
expected since we don’t yet have all the payers in our portal. On the
other hand, we are experiencing substantial growth due to our focus on
claims integration and on the added services that we have announced.
MEH: What are these new services?
RB: They are services like Online Unified Approval Claim Forms (UCAF)
and an Electronic Claim Management Tool (WaseelE).
MEH: Has Waseel succeeded in getting the main insurance companies on
board to work with this digital technology? How many? Which ones?
RB: NCCI (National Company for Cooperative Insurance), Med Gulf and
CARS are our insurance partners. They represent around 50% of the
healthcare insurance market in Saudi. On top of that we are in talks
with three more companies in Saudi and the Gulf.
MEH: Can you tell me about some of your biggest projects that have
taken place in the past two years? Which companies are these with?
RB: Our biggest project was linking Med Gulf to our portal. The
project and the nature of the business was a challenge to the Waseel
team. With the Med Gulf team we have managed to launch the first two
services on time and without any sever issues or downtime. We expect to
launch the claims soon along with CARS (our third payer) at the same
time. Another project we have launched is the eligibility printout which
will enable providers not yet using the claims service to smooth the
process of registration by printing the eligibility response on the UCAF
[agreed claims and approval form in Saudi Arabia] and use it as a
claim-supporting document. This does away with the traditional photocopy
of the insurance card. Several more projects such as pharmacy approvals,
dental coded services and others are in the pipeline.
MEH: What are the main challenges Waseel faces and how is it
planning to overcome these?
RB: In my opinion, the readiness of both payers and providers, the
availability of the required data elements, the ability to manage and
enhance the internal system and processes and the real utilisation of
the internal systems are all challenges that Waseel is facing. We have
developed our own integration tool that will give more options to the
users to manage, save, edit and submit their claims and approvals
easily. Also, ongoing training programmes that we offer will insure the
proper utilisation and understanding of our tools and services.
MEH: What does the future hold for Waseel?
RB: We want to become the electronic super highway linking all the
players in the healthcare insurance industry.