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Tokyo’s Kita City in trial to streamline use of AI in nursing care insurance processing

As part of the efforts to enhance social security benefits, especially against the backdrop of aging population in Japan, Tokyo’s Kita City is partnering Fujitsu to conduct a trial to evaluate application of artificial intelligence (AI) to the municipality’s mission critical systems in nursing care insurance processing.

According to the press release by Fujitsu, the field trial is to evaluate how AI can be used to streamline tasks associated with guidance and supervision of nursing care benefit claims from service providers, which Kita City employees can customarily process by hand.

In March 2015, the Tokyo Metropolitan Government announced the Improvement Plan for Long-Term Care Benefits (3rd Phase) to make nursing care benefits fairer, by appropriately identifying the beneficiaries of nursing care services, ascertaining the services beneficiaries truly need through appropriate care management, and promoting the delivery of appropriate services by providers in accordance with the rules.

Under the Improvement Plan, employees of Kita City will assess and analyse the appropriateness of certification applications from nursing care service providers and nursing care benefit claims. Based on its analysis, the Kita City is also responsible for supervising and providing guidance associated with payments for nursing care benefit claims to the nursing care service providers.

Although there are increase in both the number of people certified as requiring care and in the number of care facilities in Japan to cope with the aging population, there is also growing volume of information and work related to guidance and the analysis of nursing care benefit payment details.

As the analysis of nursing care benefit claims must be conducted in great detail, with reference to laws such as the Long-Term Care Insurance Act, it requires a high level of skill and a great deal of time. The use of AI could potentially reduce the burden on employees and improve the efficiency of the analysis process.

Utilising Fujitsu Human Centric AI Zinrai, the field trial in Kita City aims to improve the efficiency of nursing care benefit payment operations and further enhance the services nursing care service providers offer to residents. The trial has been launched in January and will run until March 2018.

In this field trial, machine learning technology is deployed by systems engineers to create a model to analyse the appropriateness of claim details. Machine learning will be applied to analyse data, such as past nursing care benefit claims from service providers in Kita City's nursing care insurance system.

Kita City aims to use the insights gained from this field trial not only to increase the efficiency of processing nursing care benefit payments that employees previously had to spend time handling, but also to further rationalize nursing care benefit claims.

Credit: Fujitsu

The technology Fujitsu Human Centric AI Zinrai is developed by Fujitsu Hokuriku Systems, combining both customer business expertise and software development technology.

In this project, Fujitsu trains machine learning algorithms on data, including appropriate nursing care benefit claim data and claim data that required guidance and supervision, from past claims by nursing care service providers stored in Kita City's nursing care insurance system. Then, a model is built to automatically analysis nursing care claim data.

The newly built model will be used to analyse the appropriateness of nursing care benefit claim data, and evaluate the results of those analyses against past guidance and supervision records

Going forward, Fujitsu aims to offer the trained model Zinrai as a service to local governments across Japan.

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