Reintroducing HCAI

With such a focus on accident benefits claims costs, Ontario’s automobile insurance industry appears ready to embrace the Health Claims for Auto Insurance (HCAI) system. For those who work within the auto insurance claims field, HCAI offers not only a paperless, streamlined and efficient auto insurance claims handling process, but also a system to capture current, quality health claims data.

Coordinating claims information between multiple stakeholders via a paper-based system can be slow and prone to error. Enter HCAI, the electronic bridge between health care facilities and insurers. Health care facilities submit completed Ontario Claims Forms (OCFs) to insurers electronically through HCAI. Adjusters review the submitted forms and record their decisions electronically.

The system, which was first launched in 2007, entered a period of remediation in 2008 in an effort to increase performance. After many improvements and continuous testing, HCAI is ready for a 2010 reintroduction. This time the rollout involves a pilot phase allowing for an incremental increase in the number of users. Aware of earlier problems, the pilot phase has been the subject of much internal and third-party scrutiny. As the performance meter on the new HCAI information website, www.hcaiinfo.ca, reveals: HCAI is working well.

With multiple users and stakeholders working within the same electronic system, HCAI has been subject to multiple levels of governance. “The board appreciated the level due diligence and governance that was put in place for the HCAI remediation program in 2009,” Andrew Szende, chair of HCAI processing, observed. “The approach involved a very transparent process based on evidence, which provided the board with confidence that risks were being appropriately managed.”

Complete transparency

Third party oversight and internal transparency have been crucial to the operational capacity and functionality of the remediated HCAI system. “All decisions and recommendations have been made with complete transparency and only after third parties have independently evaluated the available evidence,” Chris Kiah, president and CEO of Allstate Canada, and chair of the information technology oversight committee at Insurance Bureau of Canada (IBC), said. With a robust governance structure in place, including involvement from the Financial Services Commission of Ontario (FSCO), IBC’s board of directors, and various working groups and internal committees, HCAI’s reintroduction involved much more than a hardware upgrade.

Transparent communication, multi-layered governance and evidence-based analysis and projections have fuelled the system’s remediation. Third parties have tried, tested and approved HCAI’s system processes and technologies. System architecture has changed. Privacy and business operational procedures are in step with the improvements made to HCAI’s overall performance. Based on evidence and data from the previous rollout, HCAI is prepared for 2010’s usage patterns and volumes. Analysis has determined the hardware necessary for reintroduction, while concurrently predicting future hardware requirements. Since communication is key to the remediation process, there is discussion with current users to determine their views on system functionality.

User feedback

User acceptance testing (UAT) was an important remediation milestone. A quality assurance group, led by Alexandra Ivanova, certified software quality analyst, conducted and evaluated independent tests to review HCAI’s performance and functionality. The results of a UAT survey indicated that 100 per cent of the participants found “HCAI met their needs to help them perform their jobs.”

Extensive performance testing conducted by several third parties allowed Anthony Gartrell, Hewlett Packard consultant, to conclude “the evidence indicates that the HCAI system scales well beyond the projected high volume transaction levels and shows sufficient scalability to address future capacity and increases in user and transactional volumes.” When the pilot began, Gore Mutual Insurance Company was one of the first companies to re-adopt HCAI. “The HCAI system is very intuitive to adjusters and fits well with Gore’s paperless strategy of increasing workflow efficiencies for the adjusters,” Joe Ferrito, program manager, accident benefit losses at Gore Mutual, said.

A combination of due diligence, research and user surveys shows that the HCAI system works.

Although technology products typically face challenges as they mature, pilot participants’ HCAI experience has been positive. “System response times have been excellent and we have in excess of 100 users on the system at any one time,” Steve Bedard, claim process manager, State Farm Mutual Insurance, said. “As the health providers are being added, we are seeing a larger percentage of our work flowing through HCAI without delay. HCAI provides us the ability to proactively see our pending work and aids in our ability to remain compliant with all SABS time lines.”

Adapting to change has its challenges. With HCAI, the primary difference for users is the system’s improved accuracy and the speed at which transactions occur — everything else remains the same.

To further improve users’ experience, communication channels were enhanced. The HCAI information website provides access to accurate, relevant information and tools to help understand and use HCAI. Following months of redevelopment, www.hcaiinfo.ca was completely transformed and relaunched in September 2009. Not only is the improved website designed to supply information to HCAI users based on their specific roles, but the website also delivers on-demand training tools such as e-learning videos aimed exclusively at adjusters.

“The recently upgraded HCAI information website is a great learning tool for insurers to gain efficiency in the training and development of staff preparing to use HCAI,” Gavin Mascarenhas, claims unit manager for The Dominion of Canada General Insurance Company, said. The Dominion was a participant in HCAI’s pilot phase and had its Ontario claims operation fully integrated with HCAI. “The learning objectives were well thought out and constructive. It’s like having a teacher walk you through the adjudication process at your desk,” Mascarenhas added. HCAI’s information website has received rave reviews and its success signifies that the industry is evolving: data collection, information coordination and above all, cost efficiency.

Signing on to HCAI for the first time will require trust in the remediated system. Health care providers and adjusters will have help available along the way through HCAI’s information website. “HCAI is essential to ensuring the sustainability of Ontario’s no-fault insurance program,” Don Forgeron, president and CEO, IBC, said. “As a result of HCAI, health care facilities and insurers must adopt standard practices.” Streamlining the claims process, eliminating waste and improving the quality of data are the hallmarks of the HCAI system.

Allison Brand joined Insurance Bureau of Canada (IBC) as senior business advisor in 2006 and has since been instrumental in preparing the insurance community for the rollout of the HCAI system.