Solution to address these challenges

ZANEC, as a specialist provider of innovative services and solutions, understands the importance of Innovation and Technology in addressing these challenges. ZANEC has years of experience in building technology tools to monitor medical professional liability claim data and mine the information to identify root causes and apply broader context that targets patient safety and risk mitigation.

Enabling a Comprehensive Medical Professional Liability (MPL) Solution

We enable the comprehensive Medical Professional Liability (MPL) solution based on Service Oriented Architecture (SOA) by designing and implementing an integrated environment for Underwriting, Claims and Patient Safety and establish an Analytical and Risk Intelligence. This integrated solution will facilitate collaboration with the stakeholders and enhance the ability to acquire data and context more deeply and broadly across your partner communities. Enterprise Architecture underpinning the MPL solution will enable Data from the Enterprise Applications to be seamlessly accessible to the Analytics and Risk Intelligence tools. Risk Intelligence tools provide the transformation of data, trending and benchmarking for meaningful insights and actions on a more predictable basis.

Medical Professional Liability (MPL) Platform

Medical Professional Liability (MPL) Platform allows us to create flexible Enterprise Applications targeting Underwriting, Claims, and Patient Safety solutions and collaborate efficiently with both the internal and the external entities and adopt changes quickly at the lowest cost. Key capabilities of the platform are

  • Case Management Services - Supports the coordination of multiple processes, policies, and work objects all in the context of one project and its related tasks
  • Business Process Management (BPM) Services - Information model to build flexible, scalable solutions in quick time
  • Business Rules Services - Comprehensive collection of rule types (Declarative, Decision Tree, Process, Data rules) to enable every step in the process
  • Integration Services - Insurance technology adapters that accelerate integration both internal systems and external systems
  • MDM Services – 'A single version of Truth' provides accurate master data on, say, Physicians and Provider organizations. The SOA based solution provides the master data as a service for applications that need to have the master data and who have an authorized access to the data, based on HIPAA compliance requirements.
  • Single Sign On (SSO) Services – SOA based services that are called by applications for determining the access privileges and based on the available privileges, access to applications are provided by the SSO Services. The SSO Services also provide the ability to provide appropriate access ('Provisioner') to applications based on request and on approval by a competent authority ('Approver').

Medical Professional Liability (MPL) Framework

MPL Framework is a set of business rules that is built on the MPL to deliver the business processes of underwriting, claims and patient safety along with the capability to continuously and consistently engage the customer.

Underwriting Services

Our Underwriting solution helps classification and tracking of insured clinicians and/or organizations'. It supports a changing risk environment and allows for increased risk evaluation capabilities, processing intensive applications such as new business acquisition, customer support and services. Some of the key benefits are

  • Increased process efficiency (E.g. straight through application processing))
  • Analytics for underwriting risk evaluation as well as other internal/external stakeholders
  • Improved customer service and support for physicians and organizations
  • Support for Patient Safety processes (E.g. Office Practice Evaluation) and other internal program needs
Claims Services

Optimized claims-processing environment from notice of loss through to claim closure helps manage all aspects of medical professional and general liability events, claims, and suits. Solution provides support for key capabilities such as Claims Intake and assignment, Financial Management (Billing and Payment), Investigation & Settlement, Claims Vendor Management, Clinical Coding and medical expert management. Some of the key benefits are:

  • Creating a single, transactional view of a claim enables a complete audit trail and allows claims leaders to identify opportunities for increased efficiency and effectiveness
  • Track case financials, clinical information, and medical experts;
  • Combining historical claims outcomes with reserve histories allows for more accurate reserve setting and improved litigation and claims handling strategies
  • Utilizing advanced mining techniques for identifying evidence based Indicators based on Clinical trials for Claims (Defensibility of Claims)
Coding Services

A workflow enabled Coding Solution for the clinical coding team that captures clinical elements embedded in the professional liability cases based on the organization's coding taxonomy including the industry standard reference sources such AHRQ, VA. The solution captures specific clinical information in a stored data structure and allows for future analysis. It provides an online taxonomy structure that allows the team to add/edit/delete new codes based on their taxonomy governance standards and allows access to this information across the Analytics and Risk Intelligence solutions.

Patient Safety Services

Patient safety initiatives involve providing healthcare providers with inputs and solutions that aim to improve patient care and decrease the probabilities of medical malpractice litigation. Integrated tool sets bring efficiency in patient safety processes that promote outstanding patient care and reduce claims. Some of the key benefits are:

  • Analyze asserted malpractice cases to capture vulnerabilities as they occur
  • Ability to triangulate key clinical data (e.g., responsible services, procedures, medications) with contributing factors such as communication and clinical judgment provides areas of liability & financial loss to determine practice areas that need improvement and focus efforts
  • Continuous identification of relevant models, processes, education, and training programs that address key risk areas
  • Measure the impact of introduced patient safety processes
Clinician Relationship Management

These services are vital cogs in the wheel for continuously and consistently engage with the Clinicians. The collaboration for the Clinicians of the provider organization that avail the MPL Underwriting services include

    • Share risk intelligence information
    • Propagate patient safety initiatives such as Training and Certifications for the Physicians, Nurses and midwives
    • Publish comparative benchmark results on the areas of vulnerabilities between one Provider organization Vs the others

Further, the same platform is used to collaborate within the employees of the three core business functions (UW, Claims and Patient Safety) and with the support organizations (IT, HR)

Analytics, Risk Intelligence and Advanced report writing

Our advanced analytics design ultimately provides data driven intelligence to optimise your patient safety strategy by integrating Claims data, Root Cause Analysis data and EMR data to identify root causes of vulnerabilities and apply a broader context that targets Patient Safety, Claims, Underwriting and Care providers. Some of the transformations for meaningful use are, but not limited to:

  • Practice areas that need improvement
  • Areas of liability & financial loss
  • More accurate reserve setting , improved litigation and claims handling strategies
  • Evidence based Indicators based on Clinical trials for Claims (Defensibility of Claims)
  • Risk Evaluation for underwriting
  • Prompt clinicians on deviations from evidence based clinical guidelines and compliance requirements (Clinical decision support systems)