As a health insurer, when you have more than 1,350,000 affiliates, plus 7,000 individual doctors, some 400 clinics, between 600 and 700 pharmacies, in addition to some 250 diagnostic centers including laboratories, radiology and others, the ability to respond is essential. Those are not just a few numbers you work with ARS Firsta company of the Human Insurance Group, but also some of the reasons for its restructuring.
Before him challenge In order to respond to all parties, in 2022 the company announced the creation of two general managements. On the one hand, the general management was created by the executive vice president of ARS Primera, Jaime Caycedo, and by Humano Seguros, chaired by José Zapata.
“The idea arises, let’s say, from the analysis of what we do. Of our activity as such. We in the Human Group have two types of companies different, which are two very different activities”, explained in an introductory way the senior manager of Communication of the company, Albania M. Pérez.
That was the reason for making the decision to separate the companies structurally and have a “completely different attitude”, he adds. On the one hand, they have the activity of surewhich qualifies it as a strict commercial nature, “much more focused on sales”, while risk management has to do precisely with that, “risk management”.
Within his restructuring, Caycedo highlights the money Digitization of your processes. In this sense, he explained that they seek to make it “much easier” for the population to carry out any authorization online without having to go to the office to carry out the process.
“We have moved more to the digital issues, because that is what people are looking for and what they need. In addition, it makes it easier for you and reduces your out-of-pocket expense because you don’t have to go to a place to authorize, ”he said.
He stressed that they have 19 offices and about 34 “stands” at service posts. “In other words, they are face-to-face points where there is a person who responds,” she pointed out. The latter are distributed in medical centers. In addition to the latter, there are about 45 business points, which, as he explains, have an assistance task, “but also solve the administrative problem of the personal contact points,” he highlighted.
Regarding the new organization, explains that, with the separation of Humanos Seguro and ARS Primera, they seek to create their own structure for both. “Before, there was only one structure that provided service for both. Now you have an address that is in charge of customer service”, clarified the director of institutional relations and communications for ARS Primera, Juan Alfredo de la Cruz.
“In order to focus on that, we separate the procedures, and that is how we organize ourselves precisely around the patient and around the provider, as manager of the services that we offer”. They ensure that they focus on serving both the provider and inspector of their services, as well as the patient, who is the final recipient. “What we are doing now is precisely defining risk management models,” they add.
As a result they now have a division that supports the borrower. “That only sees the rates, (is pending) of that direct relationship with the provider, so that that provider in turn can provide a better service. At the end of the day they are the face of us,” he added.
Likewise, they seek to organize themselves in specific areas of service to the provider to make available to doctors, clinics, pharmacies, laboratories“all the necessary means so that they can provide the services to the affiliates in the best way and that they do not have problems in their operation.”
With the above, they seek to deal with the more than 22,000,000 authorizations of services that they performed only in 2022. “There are about 2,000,000 a month.
Daily we execute more than 11,000 queries”, highlights De la Cruz, to which Caycedo adds that “there are hundreds of thousands of monthly calls… (also) there are the personalized contact points, because we also have all the digital channels” that include the chat, the APP and a system called Web Health. Can you imagine the number of transactions? 11,000 consultations generate some 30,000 laboratory tests, another 10,000 radiology tests”, Caycedo exemplifies.
Challenges and strengths
As De la Cruz points out, of “the RD$1,550 they receive (the ARS), 90% is to cover the catalog. The other percentage is for administrative expenses. In this sense, both agree that “we are supporters, and we understand that the country has to work to expand the catalog of coverage”, although they understand that it is one of the challenges facing the system.
“With RD$1,500 it is impossible to have an open catalog, particularly in the service model that we have, because now we have a service model where the affiliatecontrary to the recommendations of the whole world, you can go with a receipt for a headache, ”they indicated.
On the other hand, the group has more 7,000 doctors authorized of which about 6,800 are active. “We are billed monthly by about 1,800 doctors,” they detail. In addition, its network of public hospitals amounts to about 40. “We have done a job of sharpening medical centers nationwide and many public hospitals have not wanted to join,” laments Caycedo.
Even so, they assure that it is a work that is carried out gradually. They give as an example the evolution of the system. “In the last 20 years, even the number of services provided to each member of the system has increased. When we started in 2007, each affiliate was provided with five services a year. Today we already exceed 20, we are reaching 25 services ”, they say.
In conversation with this medium, they also highlighted that, despite the difficulties, the Dominican Republic enjoys one of the best indicators of coverage in the region. “In other words, it is one of the countries with the most affiliates, reaching 98% of the total population,” said De la Cruz. They cited countries like Uruguay and El Salvador where around 70%, despite the fact that education on the subject is from primary care. “Since childhood they are giving the duties and rights of Social Security to children,” they add.
Human group is a multinational insurer with Dominican capital, made up of Primera ARS and Humano Seguros. As such, ARS Primera is the Health Risk Administrator (ARS) of the Human Group, focused on the care and well-being of members of the Dominican Social Security System (SDSS).
The new structure has two companies at the moment; one for all issues related to Social Security (basic health plans), which is ARS Primera and another, which manages private insurance plans: auto, home, life, business and health, which is Humano Seguros. They have an accumulated experience of more than 17 years in the health sector.
They became the first health risk administrator to be established in the Dominican Republic, after the enactment of Law 87-01 that created the Dominican Social Security System.