CASSI reduces medical authorization reviews from days to seconds and annual costs by 10% with Microsoft Azure Data and AI Platform

Caixa de Assistência dos Funcionários do Banco do Brasil (CASSI) faced significant challenges to optimize its authorization processes for medical procedures.The need to reduce review times and free the technical team to focus on highly complex cases prompted the organization to seek innovative technological solutions. The partnership with Microsoft provided a transformation that resulted in significant savings in cost and improvements in efficiency.

Challenges and objectives

Before the implementation of Microsoft Azure, CASSI was handling authorization processes manually, which took a long time to review and respond to applicants. As reported by Arcilia Machado, CASSI's Technical Regulation Manager, “the goal was to optimize the procedure authorization workflow to streamline the reviews and allow our technical team to focus on highly complex cases.”

A three-pronged transformation

Overcoming these challenges would require a three-pronged action plan:

Authorization automation: The need to automate manual reviews for authorizing medical procedures to streamline that process and free up the technical team for more complex cases.

Systems integration: Integrate different systems and platforms to create a continuous flow of data between the review system and the post-review processing system.

AI modeling and implementation: Develop AI models that could emulate medical decisions and integrate these models into CASSI's operational flow.

Exploring Microsoft Azure data services

To meet these challenges, CASSI chose to implement Microsoft tools, which were crucial to the organization's digital transformation. The solutions chosen were: Microsoft Azure Databricks, used for processing and analyzing large volumes of data; Microsoft Azure Data Factory, for orchestrating and moving data between different systems; in addition to Microsoft Azure Data Lake and Microsoft SQL Server for storage and transaction of historical data.

Endrigo Castro, CASSI's Analytics Manager, pointed out that, “Microsoft tools were the main engines we had in place to make everything work.”

Solution implementation process

The implementation of Microsoft solutions followed a schedule that was thoroughly outlined and involved several steps, from benchmarking and model development to review of process flows, integration between systems,and go-live. Endrigo explains that the process took about eight months, from conception to going live.

Multiple divisions at CASSI, including regulation, risks, operation, and technology, were involved in the integration of solutions.The main challenge was to ensure that the AI concepts made sense to the business areas to ensure they were confident the solution could go live.

Results and benefits of adopting Microsoft Azure

The implementation of Microsoft solutions resulted in several tangible benefits for CASSI:

Reduced review time: The time to review medical requests has been reduced from three days to seconds, allowing an almost immediate response.

Process automation: Approximately 10% of authorizations (about 12,000 per month) were automated, no longer requiring human intervention, which increased the efficiency of the medical team.

Cost reduction: There has been estimated savings of R$4 million a year, mainly due to the reduction of medical labor cost.

Optimization of resources: The technical team was able to focus on more complex cases, improving the quality of care and the management of internal resources.

Next steps and expansion towards AI with support from Microsoft

With the success of the implementation, CASSI has plans to expand the use of Microsoft technologies to other processes. Some of the next projects include the use of AI for processing reimbursement requests, the development of a GenAI-based virtual assistant for internal support, such as help interpret documentation involving rules and regulations and providing guidance to CASSI’s beneficiaries.

Arcilia points out that the institution intends to expand the solution to more activities within their process.

Conclusion

CASSI's partnership with Microsoft demonstrates how the adoption of advanced technologies can transform traditional processes, resulting in greater efficiency, cost reduction, and improved quality of care. Microsoft Azure Databricks, Microsoft Azure Data Factory, and Microsoft Azure Data Lake have proven to be instrumental in achieving these results, enabling CASSI to successfully address the challenges of modernizing, and integrating its processes. The continued expansion of these solutions is bound to bring forth even more advances, positioning CASSI as an innovative organization as well as other entities associated to Banco do Brasil.