DixAmico: Leveraging BPM technology to stay ahead of the competition

Highlights

Challenge: With over 800.000 clients and 840 employees, DixAmico is Brazil’s second largest health plan provider. The company is committed to using technology to benefit its customers and outpace competitors. Due to the high cost of healthcare and increased competition, DixAmico views reducing operating costs as critical to increasing profits. DixAmico sought to reduce the cost and turnaround time of new member enrollments.

Solution: Dix Amico chose BEA’s AquaLogic Business Process Management Suite (ALBPM) to reduce the costs of its new member enrollment process. ALBPM simplified the automation process by interfacing with legacy insurance broker, legacy medical, CRM, and ERP systems. By implementing business rules and standardizing the enrollment process, the BPM solution provides a highly scalable environment.

Results: With an average of 5,500 contracts and 15,600 members processed per month, the automated enrollment process allows DixAmico to comply with it 12 day application turnaround guarantee with less than 1 employee for every 1,000 members.

Customer Brief

With over 850,000 enrolled members, DixAmico is the second largest health insurance provider in Brazil. DixAmico is the union of two companies, Dix and Amico. These companies have been in the health industry for over 40 years. The company’s two main offices are in Sao Paulo and Rio de Janeiro. By leveraging its strength in technology, DixAmico provides an extremely high level of service to its members with less than 1 employee for every 1,000 members.

Business Challenge

Brazil is home to over 1,800 insurance companies. Of Brazil’s 180 million citizens, approximately 37 million are insured. Between 1998 and 2006, the number of insured people in Brazil did not increase beyond 37 million. The lack of market growth created a high level of competition between the health plan providers. In order to maintain its market share and profitability, DixAmico uses technology to provide a higher level of service than competitors at a lower cost to consumers.

DixAmico uses numerous innovative technologies. Through the use of fingerprint identification at hospitals, DixAmico confirms the identity of its members when they receive treatment. Furthermore, DixAmico tracks their client’s medical history and automatically provides it to the medical providers. Fingerprint identification reduces the costs associated with fraud and provides a unique offering to the organization’s members.

DixAmico uses a network of independent brokers for new member enrollment. Through a web based form using a proprietary insurance broker application, the broker enters the client’s personal and health plan information. DixAmico receives anywhere between 8,000 and 20,000 of these applications each month. Dix Amico’s staff manually reviews each application for accuracy. The company’s underwriters then review the applications and determine the applicant’s eligibility. Lastly, DixAmico’s staff enters the client’s information into the organization’s ERP and CRM systems. This manually intensive process was prone to errors and required numerous employees. Additionally, once an application was in process, it was nearly impossible to track that application. Nearly 5% of new applications contained data entry errors. DixAmico needed a product that would reduce the staff requirements for new application processing while providing application monitoring and built in error detection.

DixAmico guarantees its clients and brokers application turnaround time in less than twelve days. This guarantee puts considerable strain on the organization’s resources during periods of expansion. DixAmico had two choices when dealing with this situation. Either they needed to hire more employees to handle the increased workload or the company needed to make its current employees more efficient at their work by automating routine and administrative tasks.

For every dollar DixAmico receives from its members, seventy cents goes to healthcare providers. Due to this fact, the organization focuses very closely on controlling internal costs. Any new system at DixAmico must show real economic value in a short period of time.

Solution

Using AquaLogic Business Process Management Suite (ALBPM), DixAmico implemented a new member enrollment process. Brokers enter the customer information into their proprietary system. The information is then automatically sent to DixAmico. At this point the application can be routed down three paths.

1. If the potential customer has any serious diseases or is over the age of 55 the application is automatically sent to an underwriter for review. The underwriter then contacts the customer directly and makes the decision as to whether the DixAmico will insure the customer.
2. The second path the application can take is back to the broker. ALBPM automatically checks the form for incorrect or missing data and will send the form back to the broker if any errors appear.
3. Lastly, the application is routed directly to DixAmico’s operations. This process helps reduce the amount of manual processes and error checking normally required when enrolling new customers.

Once an application passes the underwriting and error checking stages, ALBPM automatically updates the customer’s information in DixAmico’s ERP, CRM and medical history systems. Furthermore, a notification is sent to a customer service representative. The customer service representative then calls the customer directly and welcomes the customer to the new plan. With this process in place, DixAmico will be able to meet its twelve day enrollment guarantee.

In addition to automating processes, the AquaLogic Business Process Management Suite allows DixAmico to manage and optimize its internal process. If there is a bottleneck in a workflow or a particular issue with a specific enrollment application, DixAmico’s management can easily locate the issue and implement a solution. Additionally, DixAmico’s management can implement and track the effects of any changes to their business operations by clearly understanding the individual roles and processes within their organization.

“DixAmico uses its knowledge of innovative technology to provide its members with a higher level of service than any other competitor. We provide a guarantee to our customers and brokers that enrollment into one of our plans will take less than 12 days. AquaLogic Business Process Management Suite allows us to live up to our guarantee even during periods of extreme growth,” commented Mauro Bastos, Chief Information Officer at DixAmico.

Results

With 850 employees, DixAmico provides its services with less than 1 employee for every 1,000 members. Only through the innovative use of technologies like ALBPM, can DixAmico maintain its high level of service and diverse product offerings. With the new member enrollment process, DixAmico’s average application turnaround time is nine days. This is in contrast to the 15 days turnaround time with the existing manual system. Additionally, data entry errors dropped to less than 5%. This is due to the ability of the ALBPM system to track individual applications at all stages within the enrollment process. Quicker turnaround times and the ability to track applications allow DixAmico to maintain a strong relationship with its brokers and customers.

By tracking key performance indicators with ALBPM, DixAmico can quickly identify and manage inefficiencies within their business. ALBPM allows DixAmico to track the flow of applications in real time. Thus, if there is a bottleneck at the underwriter level, management can immediately take the steps necessary to rectify the situation before it becomes a problem. Active management of internal processes allows DixAmico to live up to its twelve day application turnaround guarantee.

ALBPM provides the IT framework for DixAmico to grow its business. “By thinking in processes, DixAmico achieves a better understanding of its business as well as allows proven processes to be reused throughout the company during expansion and growth periods,” commented Mauro Bastos. During acquisitions, ALBPM can be used to integrate DixAmico’s current processes with the acquired company’s legacy systems. The ability to reuse processes provides DixAmico with both time and cost savings. ALBPM supports DixAmico’s strategic growth objectives by facilitating integration of legacy systems with highly refined business processes.

About BEA

BEA Systems, Inc. (NASDAQ: BEAS) is a world leader in enterprise infrastructure software, providing standards-based platforms to accelerate the secure flow of information and services. BEA product lines — WebLogic®, Tuxedo®, JRockit®, and the new AquaLogic™ family of Service Infrastructure — help customers reduce IT complexity and successfully deploy Service-Oriented Architectures to improve business agility and efficiency. For more information please visit www.bea.com.