A South African-born financial services technology company has won a Southeast Asian award for its artificial intelligence (AI) system that is designed to make healthcare more affordable and effective, answering to the needs of the future today.

The Singapore Technology Excellence Award in the category Artificial Intelligence – Health was presented to Agility Risk Solutions, which specialises in the development of next generation administration and risk management systems in the Asian-Pacific health and financial services industry through the deployment of AI and rule-based technology.

“It is an honour to accept this prestigious award on behalf of Agility Risk Solutions, for the integrated JARVIS system that is already showing excellent results for healthcare market insurers and policyholder patients in South East Asia, and can be applied in any global health setting,” says Dr Dena van den Bergh, CEO of Knowledge Objects, who, as technology partner to Agility Risk Solutions, accepted the award in an online ceremony.

Providing its source code owned and developed software globally to clients of Agility Risk Solutions, Knowledge Objects specialises in strategic health risk management services and has more than two decades of global experience, including operations in other parts of Africa, Australia and the Middle East, as well as South East Asia.

“This is a proud moment for our team of developers, clinical and technology consultants who have worked so hard to customise and build this unique AI-enabled programme, which is helping to shape the future of healthcare and answers the challenges faced by many healthcare systems around the world. With Singapore regarded as the third most technologically advanced country in the world, the competition was fierce, and we are particularly proud that our solution was found to be the best of the best,” Dr Van den Bergh says.

This latest generation end-to-end administration software platform, JARVIS, applies 67 000 rules, algorithms and protocols embedded in the software, as well as AI machine learning processes to adjudicate healthcare claims in real time. Because the technology is highly flexible and source-code owned, it was easily customised to the Singaporean market’s unique requirements as the company continues to expand its footprint across Asia.

“The system actively checks patients’ treatment and conditions for contraindications and potential health risks through finely attuned clinical protocols to prevent potentially harmful treatment combinations. At the same time, business rules are also applied to eliminate wasteful expenditure and ensure valid claims are paid immediately for optimal patient and client satisfaction,” Dr Van den Bergh adds.

“As the system reduces the administration burden, operational expenses, as well as healthcare costs, are reduced by ensuring funds are efficiently used for clinically valid claims.”

In fact, Agility case studies indicate that operational expenses can be reduced by as much as 50%, while decreased human intervention in pre-authorisation and claims adjudication helps remove the potential for human error interference.

The technology analyses patient specific data to predict whether a person is at risk of a health event such as a heart attack or stroke and alerts clinical case managers to engage with them and direct the resources needed to improve their wellness.

“Using the technology’s powerful capabilities, we are able to implement highly targeted strategies with a specific risk management focus. As an example, our patient-centred programmes help patients to proactively manage their health and, as a direct result, drastically reduce hospital readmissions. For a Singaporean-based health insurer, an independent study showed that these types of interventions can yield a conservatively estimated 20% in claims cost savings,” says Dr Jacques Snyman, medical director for Agility Risk Solutions.

To illustrate how the technology enables better clinical outcomes, Agility interventions have yielded as much as a 50% reduction in hospital re-admissions when compared with insurers who use legacy systems and programmes.

“The integrated and embedded pharmaceutical benefit management application allows for better medicine and therapeutic compliance, resulting in a better managed member profile and reduced acute cost. Due to the integration of the software, Agility’s patients are supported by a single Personal Healthcare Coordinator (PHC) who assists them throughout their full care path, as opposed to dealing with numerous agents at different stages of their journey,” Dr Snyman explains.

“From a patient perspective, this essentially means that patients can often be supported to avoid a catastrophic health event in the near future, which is good news in itself for the individual’s quality of life and their family. At the same time, it also reduces overall health costs through reducing clinical risk,” Dr Van den Bergh adds.

The highly innovative system draws on big data and is constantly improving through machine learning, which detects new patterns and trends to improve clinical risk management on a continual basis, while fraudulent or wasteful claims are proactively detected immediately at line-item level before payment is granted.

With JARVIS, claims and pre-authorisation queries no longer need to be handled via email or phone, as the system automatically engages with providers to clarify any questions for immediate response and resolution.

“There is so much room for improvement in healthcare with the application of leading-edge AI technology. This award signifies that there is hope for making quality patient-centric healthcare affordable to more people across the world,” Dr Van den Bergh concludes.