PROFESSIONAL SKILLS FOR BUSINESS ANALYSIS – Assignment Case Study The national health insurance…


The national health insurance system “Medigood” that pays for patients' visits to family doctors has provided a new category of service that family doctors can be paid a bonus for using. This is for a phone or telehealth medical specialist consultation for a qualifying patient. To qualify patients need to be any one of:
– over 65
– indigenous
– suffering chronic disease.

A consultation can occur when a family doctor with a patient links up for a consultation with a medical specialist using a telephone or telehealth equipment. Medigood will make a payment to both the family doctor and the specialist.

Currently the family doctor or office administrator needs to identify a qualifying patient and then try to find a suitable medical specialist who is available. The office administrators monitor scheduled appointments to see if there are qualified patients and then try to schedule link with specialists. Patients sometimes do not arrive on time or at all, doctors and specialists are often running late and overall it is too difficult; especially for busy doctors with many other patients waiting to see them.

Medigood has already provided Telehealth equipment to all doctors and specialists but to date very few doctors have taken advantage of this. You should do a search of the Internet to understand Telehealth and how it can be used.

Your friend Lee has come up with a new business idea that she wants to sell to doctors and has asked you for help due to your studies in Business Analysis. Lee proposes to develop a software package that will sit on the doctor's computer alongside any other patient management system (PMS) they may have taking advantage of available interfaces. Lee's software will monitor appointments and when it sees there is a qualifying patient with the doctor, or if a qualifying patient has a scheduled appointment, it will alert the doctor that the patient is eligible for a Telehealth consultation and search for an available medical specialist for an on-line telehealth consultation. Medical specialists are expected to register with the system which will monitor when they are on-line and potentially available for a Telehealth consultation with a patient and their family doctor. When the doctor and the specialist both accept the telehealth consultation, the Telehealth equipment at either end is activated. Once the consultation is completed, the software will process the claim for payment to the insurance for both the family doctor and medical specialist.