Mobigator: Transforming the Insurance Industry with Innovations
Clifford Tse, MDFounded in 1994, the Mobigator team, a group of scientists and engineers, was interested in applying science and technology to meaningful challenges. They identified health insurance as an area that would benefit significantly from technology application including process automation, data science, to high-performance computation. Over the past two decades, by analyzing the pain points of health insurance and applying cross-disciplinary expertise, Mobigator developed and continued to provide many innovative solutions and carved a niche in the insurance market.
The firm’s flagship trio platforms – Mega, Mega-I, and Mega-X – assist insurance companies to manage their core operations ranging from plan construction, policy underwriting to claim processing and settlement. Mega’s electronic imaging document management system (EIDMS) scans, indexes and archives paper documents to enable paperless operations. Its adjudication engine handles routine claims automatically while its payment engine handles direct settlement to claimants. The resulting operation is paperless and efficient.
"From strategic planning, resource management to operation audit, mobigator’s insurance solutions are built to provide flexibility to satisfy a wide range of organizational workflow requirements"
Following the success of Mega, Mobigator developed Mega-I to enable insurers to interact electronically with their business partners, including providers, brokers and agents, and third-party administrators (TPA). With Mega-I, a care provider can check patients’ benefit eligibility, and submit and manage claims online. Insurers, on the other hand, can view activities of their provider networks or analyze portfolio performances of their TPA’s in real-time, enabling insurers to respond to potential liabilities and to assist their members’ needs without waiting for claims to be filed first.
At the heels of 2 successful launches, Mobigator offered Mega-X to improve customer service and user experience.
We want to create a win-win situation for all stakeholders. Our solutions help insurers to provide more comprehensive individualized plans, patients to improve their health, providers to implement health management, and health authorities to develop more effective public policies
Mega-X allows policyholders or members to check their policies and benefits, as well as submit claims and track their status. Using online claim forms, any missing or unclear information is immediately flagged to the claimant. As claims are submitted with more accurate and complete information, the processing cost for the insurers is significantly reduced while patients have a more positive experience without endless back and forth.
As a suite of trio platforms, the Mega, Mega-I, and Mega-X trio greatly improves insurance companies’ efficiency and can catapult a traditionally labor-intensive operation into a scalable streamlined and automated operation. A small TPA approached Mobigator with the request to revamp its manual and non-scalable operation. Mobigator deployed the Mega trio to fully transform the company’s operation into a lean and efficient one. Within two years, leveraging a centralized platform of the Mega trio, the small TPA was able to expand from Hong Kong-based business to include Singapore, Vietnam, Thailand, Philippines, and China, increasing its business seven folds with less than 20 percent headcount increase.
Industry-Wide Solution
In the last few years, Mobigator has been extending its solution further upstream to capture the claims and medication information at the point of care. With Clinical Management System (CMS) for clinics and Hospital Management System (HMS) for hospitals, the two systems capture precise claim information during healthcare delivery, which not only eliminates redundant claim submission paperwork for clinics and hospitals but also improves the quality of claim data received by the insurers.
As the inefficiencies and challenges at each institution have been addressed, the next viable step required is establishing standards across the vertical. For instance, in the 1990’s several financial institutions collaborated to develop the Financial Information Exchange (FIX) protocol for exchanging information among them. FIX subsequently became the standard adopted for global financial transactions. Similarly, the Internet Protocol allowed the telecom companies to interconnect to form a global network. In each case, a few pioneers created an industry-wide solution that helped revamp and uplift the industry. Mobigator, being one of the pioneers that developed many innovative solutions for the global standardization of finance and telecom in the 1990’s, now aims to do the same for the insurance sector.
Recently, Mobigator introduced the Insurance Process Gateway (IPG), which is a secured platform to streamline the end-to-end data flow among the health insurance stakeholders. Using IPG, care providers can connect electronically with insurers for the processing of letter of guarantee, claim submission, processing, and settlement. Once integrated with IPG, a provider can connect with any insurers and vice versa. For providers, IPG not only saves them paperwork and administrative cost but most importantly enhances their cashflow because IPG reduces the “clearing” cycle from months or weeks to days.
“With IPG, we are building a standard and open platform to connect insurers and providers, and eventually the patients, which greatly improve the efficiency of the entire insurance industry,” says Clifford Tse, Managing Director of Mobigator.
Innovating Risk Management
Over the past 20 years, Mobigator created Mega, Mega-I, Mega-X, CMS, HMS, and other solutions to connect different areas of healthcare delivery and insurance management. After addressing the arcane workflow and operational aspects of insurance management, the next step at Mobigator is to get deeper into the crux of the insurance business, i.e., risk management. “Traditionally insurers control their risks at the time of underwriting and claims adjudication in a passive and reactive manner. Our analytical solutions offer insurers the opportunity to understand the risk more precisely and then create plans to mitigate those risks proactively,” explains Tse, who graduated with four degrees from Massachusetts Institute of Technology (MIT) and studied clinical research informatics at Stanford University. To effectively manage and predict risks, Mobigator’s solutions are developed by leveraging the team’s expertise in health informatics, data science, and information technology, utilizing big data, machine learning, and artificial intelligence.
To illustrate how this all ties together, Tse shares a recent case study. Mobigator worked with an insurer who previously did not extend coverage to applicants with diabetes. Mobigator built a risk stratification engine that assessed the risk profile of an applicant over the next five years. With a clear measurement of risk, the insurer developed a care management programme with the providers that factored in applicants’ level of health management. If rejected applicants undergo the care programme and demonstrate their health conditions under control, they become eligible to receive coverage. For existing members, their premiums can also be reduced by showing improvement in their health. The pilot run was so successful that the resulting data is influencing how health authorities are rethinking their approaches to preventive care. In this case, be it the insurers, providers, the patients or even health authorities, all parties benefit from Mobigator's solution. “We want to create a win-win situation for all stakeholders. Our solutions allow insurers to provide more comprehensive individualized plans, patients to improve their health, providers to implement health management, and health authorities to develop more effective public policies,” states Tse. “We regard our technology as enablers for insurers to be the hub that uses spokes to connect with the ecosystem. Ultimately our goal is a healthier and more positive experience for all using future-proof technology.”
In summary, across the globe, healthcare has become an increasingly severe socio-economic challenge. Patients have expectations of a more positive experience, which is further compounded by an aging population that requires expensive treatments for complex acute and chronic illnesses. Fortunately, advancements such as genomics and precision medicine will help. However, they will depend heavily on computations and analytics to shape diagnosis and treatment for better outcomes while balancing cost. As healthcare and health insurance industry become increasingly data-driven, Mobigator, with its proven track record and its deep roots in data science, machine learning and artificial intelligence, is well positioned to deliver the next innovative breakthrough much needed for the industry.
Innovating Risk Management
Over the past 20 years, Mobigator created Mega, Mega-I, Mega-X, CMS, HMS, and other solutions to connect different areas of healthcare delivery and insurance management. After addressing the arcane workflow and operational aspects of insurance management, the next step at Mobigator is to get deeper into the crux of the insurance business, i.e., risk management. “Traditionally insurers control their risks at the time of underwriting and claims adjudication in a passive and reactive manner. Our analytical solutions offer insurers the opportunity to understand the risk more precisely and then create plans to mitigate those risks proactively,” explains Tse, who graduated with four degrees from Massachusetts Institute of Technology (MIT) and studied clinical research informatics at Stanford University. To effectively manage and predict risks, Mobigator’s solutions are developed by leveraging the team’s expertise in health informatics, data science, and information technology, utilizing big data, machine learning, and artificial intelligence.
To illustrate how this all ties together, Tse shares a recent case study. Mobigator worked with an insurer who previously did not extend coverage to applicants with diabetes. Mobigator built a risk stratification engine that assessed the risk profile of an applicant over the next five years. With a clear measurement of risk, the insurer developed a care management programme with the providers that factored in applicants’ level of health management. If rejected applicants undergo the care programme and demonstrate their health conditions under control, they become eligible to receive coverage. For existing members, their premiums can also be reduced by showing improvement in their health. The pilot run was so successful that the resulting data is influencing how health authorities are rethinking their approaches to preventive care. In this case, be it the insurers, providers, the patients or even health authorities, all parties benefit from Mobigator's solution. “We want to create a win-win situation for all stakeholders. Our solutions allow insurers to provide more comprehensive individualized plans, patients to improve their health, providers to implement health management, and health authorities to develop more effective public policies,” states Tse. “We regard our technology as enablers for insurers to be the hub that uses spokes to connect with the ecosystem. Ultimately our goal is a healthier and more positive experience for all using future-proof technology.”
In summary, across the globe, healthcare has become an increasingly severe socio-economic challenge. Patients have expectations of a more positive experience, which is further compounded by an aging population that requires expensive treatments for complex acute and chronic illnesses. Fortunately, advancements such as genomics and precision medicine will help. However, they will depend heavily on computations and analytics to shape diagnosis and treatment for better outcomes while balancing cost. As healthcare and health insurance industry become increasingly data-driven, Mobigator, with its proven track record and its deep roots in data science, machine learning and artificial intelligence, is well positioned to deliver the next innovative breakthrough much needed for the industry.
November 24, 2017
