Automating Recurrent Capitation Payments

I developed a platform for the management of monthly capitation payments to hospitals for a health management organization.
The system was designed to do do the following:

  1. Receive a list of health insurance enrollees and the hospitals to which they are attached.
  2. Compute total payment to be made to each hospital as well as any backlogs of payments due to the each hospital.
  3. Provide a three step approval process for the payments.
  4. Track the success of each authorized payment.
  5. Automatically generate and transmit a payment alert by SMS and payment advice via email to all payees.
  6. Automatically generate and email a transaction report to the relevant users.
  7. Provide a dashboard view of al relevant indices.

THE CHALLENGE
While the calculation of the amount payable to each hospital is simple and can be done manually, the task to compute that for 5000 hospitals, withhold payments for hospitals whose bank information is not available, integrate any backlogs when banking information becomes available had proven to be a herculean task for the accounting department.
They required over two weeks to compute payments and another two weeks to complete payments after approval. They were unable to complete the process and send payment advises to the recipients before the cycle had to repeat in the next month. The options were either to increase workforce with more skilled staff or automate the process from end to end. In many cases, errors occurred and some hospitals were credited with funds meant for another provider.

The software I designed was a web-based solution which required only a file with the data uploaded. It was able to compute payments in 10seconds, down from the previous two weeks and without errors. The total transaction time on the system was down to 48Hrs from over 4 weeks. Most of the 48HRS are required for the approval processes to complete while a few more hours are required to complete email sending due to email sending limits.

The software was first written in PHP with a MySQL database. It was later ported to MEAN Stack (Mongo, Express, Angular & Nodejs).

I am particularly proud of this solution because it exposed all the benefits of automation (Increased efficiency and reduced costs). With it, the company was able to save money on new hires and skilled hires. It also made it easy to increase the number of lives and hospitals managed without any increase in cost or loss of efficiency. This solution encouraged the company to allow my team and I automate all internal processes.

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