Refund Process in Value-Based and Data-Driven Healthcare
Costs in healthcare grow. According to a 2020 BSS study, volume of new treatment models was over CHF 160mio in CH. Value-based and data-driven contracts play a role in that. Out of these contracts, refund obligations can occur. It is analyzed how they’re executed today and if this can be improved.
Severin Kleiber, 2022
Bachelor Thesis, Lyfegen HealthTech AG
Betreuende Dozierende: Jacqueline Haverals
Keywords: Value-Based Healthcare, Refund Process
As an outcome of value-based and data-driven contracts in healthcare, some refund obligations from a pharmaceutical- back to an insurance company can occur. Those contracts are handled on a platform that enables creation, maintenance, and processing of those contracts. The platform considers an extension of its services to also offer the processing of the refund payment component - which is handled outside the platform today. The platform therefore aims for transparency on how this process works today and whether there may be improvement opportunities.
To get the relevant transparency on how this process works today, semi-structured interviews with employees of the platform’s clients, who handle the process today, have been conducted. Based on the findings on how the process works today and what might be improved, three solution options have been developed. Those solutions have been assessed based ion seven criteria that include the development effort for Lyfegen, the off the shelf availability, the option to offer internationally, the change impact on clients, the efficiency gain, the faster payment execution, and the risk reduction.
Main findings out of the interview were that still a significant portion of the work is handled manually and include excel spreadsheets. This directly translates into an opportunity to design the process more efficiently and at the same time to address the risk of human errors when handling manual work. Also, it became transparent that payment terms are still rather long which could be improved by an automatization as well. All three solutions have been assessed on their feasibility based on the seven criteria. While all have advantages and disadvantages, none has been identified to be the clear path to go as it largely depends on how the different criteria are weighted. It has been recommended to open the round for interviews with other departments to get a broader confirmation of the demand. Also, it is recommended to approach respective key stakeholders informally to assess general feasibility and timeline of the proposed solutions.
Studiengang: Business Administration International Management (Bachelor)
Fachbereich der Arbeit: