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Intelligent Management of Special Coverage Programs

We consolidated a specialized digital ecosystem for OSPE that automates the management of critical healthcare programs. The module integrates complex business rules to control Diabetes (DBT), Contraceptives (ACO), Chronic Medication, and Infant Formula programs, ensuring treatment continuity through automated renewals and efficient medical auditing fully integrated with the Leannec core system.

Client

Obra Social de Petroleros (OSPE) is one of Argentina’s leading healthcare organizations. Through this module, the institution guarantees personalized and traceable coverage for thousands of members requiring specific medical programs and long-term treatments.

Features

We implemented a differentiated rules engine to automatically validate age, gender, annual quotas, and active plans for each program.

We automated the Contraceptive (ACO) cycle, generating staggered authorizations to cover the affiliate’s annual demand.

We integrated the Diabetes (DBT) workflow with the Leannec core via APIs, managing annual medical forms and specific purchase processes.

We redesigned Chronic Medication management to differentiate between occasional and scheduled requests, optimizing quota control.

We developed a logistics module for Infant Formula programs, managing monthly renewals and coordinating direct home delivery.

We executed automated auditing processes to finalize approved requests under predefined technical criteria.

Services

Evolutionary and Corrective Maintenance: Continuously updated business rules to align with OSPE regulations.

Medical Process Automation: Eliminated manual workload in electronic prescription generation and authorization flows.

Integration Engineering: Synchronized the module with purchasing, dispatch, and regulatory traceability systems before ANMAT.

Coverage Optimization: Implemented prioritization algorithms to determine automatic discounts by product or plan.

Technologies

PHP

Ionic

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