Technological breakthroughs are helping health care providers deliver services at par excellence. These have become a driving force behind improvements in health care industry, bringing health care more accessible to people, increasing patient safety, and allowing medical practitioners to work with great ease. Indeed, technology has contributed to the sector’s growth and is expected to shape the industry in the years to come.

In the Philippines, the MediLink Network, Inc. (MediLink) is among the local companies taking the lead to embrace health care technological innovations. Incorporated in 1999 as a joint venture between the Zuellig Group and the Equicom Group, MediLink has evolved to become one of the most successful health tech companies in the country.

Currently, MediLink’s portfolio has more than two million members from the top health maintenance organization (HMOs) and insurance companies in the country. Its electronic network has expanded beyond point of sale (POS) terminals into Web and mobile applications, covering 100% of tertiary hospitals and 92% of secondary hospitals in the country.

Through this, MediLink is able to implement information and communications technology (ICT) solutions that promote efficiency, transparency, and sustainable profitable growth.

“Many health care industry players still have paper-intensive processes such as billing, claims submission and payment reconcilement. Together with our health industry partners, we are collaborating to electronify high-volume transactions,” MediLink told BusinessWorld in an e-mail.

In particular, MediLink’s extensive electronic network allows service providers such as hospitals, clinics and doctors to quickly check its member eligibility. By scanning a QR code, verifying a card or inquiring via an online facility, eligibility can be verified in a couple of seconds.

In cases where insurers or payors require pre-authorization, MediLink provides escrow services to guarantee payments to providers. MediLink assures that these services are rendered according to payor-prescribed-guidelines such as allowable conditions or benefit limits.

MediLink also allows providers to submit claims electronically with a verified approval code, given that these claims are processed in accordance with the member’s health plan. To monitor and prevent fraud, claims are adjudicated using business rules and artificial intelligence (AI) algorithms.

Prior to authorizing electronic payments, MediLink’s decision support system confirms that the claims presented by providers fall within the member’s benefit limits. The payments are then settled with providers on behalf of payors. The electronic proof-of-payment is provided to both payor and provider via their respective online portals to ensure transparency.

In addition, MediLink’s analytics services are also beneficial to its clients to gain insight on utilization from a variety of dimensions. The insights such as member demographics, industry, geography, provider level, type of service, clinical diagnoses and clinical procedures, among others, could be used to identify key utilization cost drivers as a reference to develop targeted utilization management programs.

For several years, MediLink has achieved several milestones and developments. The company was accredited by Philippine Health Insurance Corp, (PhilHealth) to be one of its Health Information Technology Providers (HITP). Today, there are more than 350 PhilHealth-accredited hospitals and clinics that have chosen MediLink as their eClaims service provider.

In line with its aspiration to allow customers utilize electronic platforms — just similar to how automated teller machines (ATM) are used by banks — MediLink was able to materialize the AI-enabled electronic approval for letter of authorization (LOA) issuance and claims adjudication.

The company is also making a name for itself outside the country. Just recently, MediLink won in the Services and Solutions Category in Harnessing Machine Learning to Enable Efficient, Accessible and Affordable Healthcare during the International Innovation Awards 2017.

Also, MediLink President and Chief Executive Officer Esther Go is one of the winners in the Asia Pacific Entrepreneurship Awards 2017 in the Philippines for Healthcare and Pharmaceutical Industry.

Beyond improving efficiency through its wide range of services, MediLink assured that they will continue to explore possibilities at the bleeding edge.

“MediLink is motivated to help our country achieve universal health care coverage by enabling health industry players with technology solutions that make health care efficient, accessible and affordable. Fortunately, the pace of new technology introduction and improvement shows no sign of abating,” MediLink said.

In the next five years, the health tech company is looking at the possibility of extending its footprint in the Asia-Pacific region. “We believe that solutions enabling efficient, accessible and affordable health care are relevant not only to the Philippines, but in other markets as well. Health care, after all, is a universal human need,” MediLink said. — Mark Louis F. Ferrolino

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