Medscheme is South Africa’s largest health risk management services provider and second largest medical aid administrator. It reaches over three million people through its network of branches located throughout South Africa, as well as Botswana, Namibia, Swaziland, Zimbabwe and Mauritius. Its clients include medical aid schemes and large corporates operating throughout southern Africa.
“We administer multiple medical schemes,” says Zaid Ismail, senior manager – Business Applications, Medscheme. “We facilitate the processing of claims from members of the medical schemes to pay out providers and members themselves for reimbursement of claims or medication, hospital visits or doctors and specialists.”
Each scheme has its own set of rules and permutations, each country its own set of regulations and legislative requirements. This creates an administration that is extremely complex and data-heavy.
“We intend to grow both internationally and organically within South Africa,” says Ismail. “We’re focusing on integrating more loyalty and wellness products into our offerings and completely revising our approach to administration. We want to make our administration a lot more efficient. We feel we can reduce the cost of healthcare and provide the industry with more sustainable ways of managing care services.”
The business has two strategies to tackle inefficiency. It wants to create medical protocols to ensure compliance and allow for faster decision-making, and, wherever possible, eliminate manual processes.
“We’re already an extremely IT-dependent business,” explains Ismail. “We have a rules engine that enables the automation of payments, collections, contribution and debt management, and claims processing. As a result we can process up to 140,000 claims each day.”
He says the business is taking a more aggressive approach towards collaboration tools (e.g. application lifecycle management), including the involvement of subject matter experts in real-time decisions: “But any changes here will, of course, impact multiple areas. With the complexity of the healthcare industry, especially around the IT systems, we have to be careful when introducing changes. If we don’t have a high level of usability with our test content, we end up spending three or four times longer getting something through a test cycle and into production. The longer it takes us to get it into production, the longer it takes to benefit from the efficiencies we’re introducing.”
Testing at Medscheme, says Ismail, is tied to business function not IT: “Micro Focus Application testing is independent of IT. The team comprises of a Senior Manager, a Test Manager, three Test Analysts, two Test Automation Analysts, and 10 Testers. Our priority was to find testing software with the features in place to suit the business, and not something that requires a huge amount of re-engineering.”
It is what originally led Ismail to Micro Focus Quality Center, and subsequently Application Lifecycle Management 12 (ALM). “We needed a solution that would scale with us, in terms of both maturity and complexity of process,” he explains. “The year-end usually coincides with new business opportunities and important development projects that all have a go-live date of January 1st,” says Ismail. “Without ALM, achieving this objective would require a significantly larger team to ensure sufficient test coverage for the volume of changes.
“Implementation was organized and methodical. First we bedded down the governance needs, and the related processes using manual oversight via Microsoft SharePoint lists and Microsoft Word documents to capture screenshots of the test outcomes. Once we were comfortable that we had no noteworthy gaps in our traceability practices, we proceeded with full implementation.
“Additionally we use the Service Manager suite of tools to manage the change cycles for system changes. When a change is ready for development, we receive a request in User Acceptance Testing at which point we create a new release in preparation for testing. This ensures we’re ready to start test execution when development is done, rather than only starting with planning at that point. It improves time to market. We also intend to leverage the integration capabilities between ALM and Service Manager to further improve our efficiency and traceability.
The immediate benefit of ALM is to create a huge repository of reusable test scenarios. “Eighty percent of the previous year’s tests can be reused and much of the remainder can be adapted,” comments Ismail. “Compared with starting from scratch this saves us a huge amount of man hours.
Compared with three years ago, these efficiencies have eliminated up to 30,000 man hours from our year-end test cycles. Our repository currently has close to 100,000 scenarios across a broad array of business systems functionality, and continues to grow with every release.” Time saved means more time for more testing. “In the first year we were doing between 9,000 and 12,000 scenarios,” says Ismail.
Time saved means more time for more testing. “In the first year we were doing between 9,000 and 12,000 scenarios,” says Ismail.
“Today, without any direct increase in headcount, we’re doing 40,000 scenarios for the same project, a rise of nearly 350 percent. We’ve gone from 12-15 minutes per scenario to 1-2 minutes with an experienced tester, which equates to an 86 percent reduction in time taken per test. All this made it possible for us to achieve unqualified audit reports for the testing practices for two years in a row. ALM allows us to automate where we need it, which in turn releases team members to provide analytical oversight where it’s needed most.”
What this means for the business, he continues, is reduced risk, better reporting and a clearer audit process.
“Also, because we use subject matter experts from the business, not IT – in new projects, we’re now more efficient in how we use these experts. Previously we may have needed to take them away from the business for four months, that’s now halved. We’ve reduced our impact on operations and it has boosted our credibility with business users. Buy-in has gone through the roof.”
Ismail believes Medscheme is using ALM beyond all original expectations. “We make sure to regularly refresh all test data with recent production data. Checking these results would normally take a senior tester four to six hours. Using Micro Focus Unified Functional Testing we’ve brought this down to 20 minutes. That’s up to 95 percent faster than previously. It’s another massive saving.
“For me, the culture in our team is that innovation is not a question of doing something more creatively. The whole point of innovation is having an understanding of what capability is available and then applying it in a context that was not previously considered. Capability and intent are two very different things. We don’t see this as risky. All we’re doing is applying ALM within a context that challenges the traditional approach to facilitating test cycles between IT and business, and it works very well.
“I believe our approach to User Acceptance Testing is significantly different to the typical industry approach. We’ve married the benefits of automation, with the need for strong analytical oversight from manual testing, and have created a very powerful tool for business to keep IT on the straight and narrow, without introducing technical complexity. This makes it sustainable within the business domain, without compromising the areas of accountability or points of handover between the two parties,” concludes Ismail.