Cheiron Health Technologies

InterSystems CACHÉ underpins Cheiron’s administration solution

Healthcare software company Cheiron Health Technologies has brought a customised version of Epic Software’s Tapestry system to market in South Africa, with an initial 195 000 lives under administration.

Tapestry is a fully integrated, proven medical aid administration system that has been customised for local conditions. It enables companies to share demographic data with third-party vendors.

“A key strength of our customised system is that it can process claims in a fee-for-service environment, and offer capitation and managed care capabilities to provider networks such as independent practitioners associations, managed care service provider organisations and health management organisations,” says Eugene de Witt, CEO of Cheiron Health, which is 90% owned by Kwacha Holdings, 10% by Sanlam and 10% by the World Bank through preference shares.

Over 36 months of development went into the system before it went live in January last year. Cheiron services Sizwe Medical Services, which administers Sizwe Medical Fund that has 65 000 principal members and over 190 000 lives on its books. The company also services Moriting Employee Benefits and Lesedi Clinic from a technology perspective.

Through the Tapestry solution Cheiron offers a range of managed care programmes across the spectrum of healthcare management, including:

- High-volume capitation systems
- Fee for service processing
- Hospital utilisation programmes
- Pharmaceutical benefit management programmes (Acute and Chronic medication)

In our quest for full electronic convenience to our service providers Cheiron Health Technologies have developed an interface in the tapestry system making us unique in terms of having a real time live capability for receiving transactions from all providers with a turn around time of under 10 seconds” This functionality has been rolled out to all Pharmacies and we are busy working on giving our Doctor population “real time live” capability. Said de Witt

A Feature that makes our system unique in the South African market is the fact that we have the NDDF file built into the system which removes the need to use a third party vendor to do Drug Utilisation Evaluation and review for our client.

Tapestry, is underpinned by the InterSystems’ CACHÉ post-relational database management system which enables Cheiron to keep up with overall system performance demands, data integrity, ease of system customisation and system availability in general.

“Epic is a patient-centric system that tracks every life on the system, not only principal members. We profile every single member and provider, which, combined with the system’s reporting friendly nature, helps us to root out fraud and abuse. Using the system to ensure that members receive good quality healthcare support is one of our primary drivers and Cheiron Health Technologies is represented on the Board of Healthcare Funders fraud committee,” says De Witt.

Tapestry assesses and adjudicates claims electronically and manually. The fully functional capitation module can accommodate the managed care environment. Case management, referrals and authorisations can be created and managed.

The system is adaptable and fully scaleable and can accommodate any medical aid product development or changes to benefit limits, management thresholds, managed care requirements and exclusions up to dependent level.

“The system is rules-based which means that the Administrator’s rules and benefit structures across one or multiple options can be accommodated in a secure environment,” says De Witt.

The Cheiron system is upgraded to include most recent health trends within the South African market as well as the global market. The company contracts with MGX Business Continuity Solutions for the purpose of disaster recovery.

“Uptime and performance are serious concerns for us, which is why we run the system on HP Unix and CACHÉ and have contracted MGX’s BCS,” says De Witt. “The market is prepared for a new-generation solution, coupled with a growing sense of awareness of what is right for local conditions,” says Henry Adams, country manager of InterSystems in South Africa.