Automation gave the Norwegian Directorate of Health (Helfo) better and faster case management

By identifying repeatable processes and structuring sufficient base data, Computas has assisted the Norwegian Directorate of Health (Helfo) in streamlining their services. The result is full automation, reduced workload, and a more correct case management.

Helfo is the external agency for the Norwegian Directorate of Health. Its mission is to protect the rights of healthcare actors and private citizens, as well as provide information and guidance concerning healthcare services.

Helfo administers annually around NOK 34 billion. This includes settlements from the National Insurance Scheme for healthcare providers, suppliers and service providers, as well as individual reimbursement of private citizens’ expenses.

From old solutions to structured platform

The project for the automation of Helfo’s services began in 2012 with the development of the eSaks platform, which is part of the Health Reimbursement Reform. The reform involved transferring the administration of the National Insurance Act, Chapter 5 on benefits for healthcare services from NAV to the Norwegian Directorate of Health. The Norwegian Directorate of Health and Helfo replaced parts of NAV’s systems, and reimbursement payments were to be channeled through the Norwegian Agency for Public and Financial Management.  The objective was to gain better control of financial transactions by digitizing the processes for individual benefits. With just over 200,000 treatment requirements per year, it was important for Helfo that an automation of the processes would also reduce the workload.

Efficient and agile processes

The solution that was developed provided an important basis for structured case management based on modern technology on which it would be possible to build further. A new system that fit the structure and tasks of the organization and facilitated automation and improvements along the way was created. Also, it was important that the system was in accordance with regulations for privacy, archiving and economy.

– Computas has skillfully met the needs and structure internally in Helfo. The system has incorporated the new internal work processes, and made them more efficient. Increased structured import of data and streamlined case management have been very timesaving for the users. In addition to improved efficiency, the solution has led to more correct case management, says Thomas Ulven, Senior Advisor, the Norwegian Directorate of Health.

The solution has provided a simpler user interface and better decision support for Helfo users. Because the case processing is based on structured data, standard texts and predetermined coding systems, the outcome will be more correct, standardized and documentable. The foundation that was laid in eSaks made it possible in 2017 to establish processes and regulatory tools to fully automate the case processing of applications for blue prescription medicines (pharmaceuticals reimbursed by the National Insurance Scheme). Today, 15-20% of the applications are processed and closed without the involvement of archivists or caseworkers.

– Automation and modernization of this type of solution is an area where Computas has broad experience. A close and good dialogue with Helfo from the start has been important in order to understand which components were needed to develop a best possible solution, says Pål Vermund Knudsen, Account Manager at Computas.

The road ahead

Now that the platform and foundation are in place, Computas continues to contribute with technical and functional expertise, and provides advice on how solutions can be made in the best possible way and which measures make it even easier to automate.

Technology is changing rapidly, and developing solutions that can be continuously improved has been absolutely essential. We are presently working on an upgraded solution that will simplify application processes for general practitioners in the blue prescription scheme (pharmaceuticals reimbursement scheme).  This solution will go into production next year.

– Computas has, along the way, challenged us to create systems for structuring data and modeling, and this has been an important reason why we have succeeded in automating case management, Ulven concludes.

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