Med­scheme

Africa Outlook - - Healthcare -

Med­scheme has con­sis­tently de­liv­ered in­no­va­tive med­i­cal aid ad­min­is­tra­tion and health risk man­age­ment so­lu­tions for more than four decades. We form close part­ner­ships with our clients that in­clude lead­ing med­i­cal aids and large cor­po­rate com­pa­nies in South Africa, Africa and in­ter­na­tion­ally; driven by our vi­sion of ‘Cre­at­ing a World of Sus­tain­able Health­care’.

To­day, Med­scheme is South Africa’s largest health risk man­age­ment ser­vices provider and sec­ond largest med­i­cal aid ad­min­is­tra­tor. We reach more than three mil­lion peo­ple through our net­work of branches con­ve­niently lo­cated through­out South Africa, as well as Botswana, Namibia, Swaziland, Zim­babwe and Mau­ri­tius.

Our proven com­bi­na­tion of client-cen­tric­ity and ex­per­tise is founded on ex­cel­lence in cor­po­rate gov­er­nance and world-class in­for­ma­tion tech­nol­ogy. These at­tributes po­si­tion Med­scheme as the ideal busi­ness part­ner for cor­po­rate clients and med­i­cal aids that seek to of­fer qual­ity health risk man­age­ment and af­ford­able health in­sur­ance to their mem­bers and em­ploy­ees.

Med­scheme of­fers a com­pre­hen­sive range of fully out­sourced qual­ity so­lu­tions, in­clud­ing man­aged health­care, med­i­cal aid ad­min­is­tra­tion and health risk man­age­ment. Med­scheme’s of­fer­ings cater to med­i­cal aids as well as large cor­po­rate clients.

Our clients in­clude AECI Med­i­cal Aid So­ci­ety, Bar­loworld Med­i­cal Scheme, Boni­tas, Fed­health, Govern­ment Em­ploy­ees Med­i­cal Scheme (GEMS), Hori­zon Med­i­cal Scheme, Hosmed Med­i­cal Scheme, MBMed Med­i­cal Aid Fund, Med­shield, Namibia Health Plan, Ned­group Med­i­cal Aid Scheme, Old Mu­tual Staff Med­i­cal Aid, Fund Parmed Med­i­cal Aid Scheme, SABC Med­i­cal Scheme, SAMWUMED, Sa­solmed and the South African Po­lice Ser­vice (POLMED).

In 2017, Med­scheme was awarded the Ti­ta­nium Award for Ser­vice Ex­cel­lence in Ad­min­is­tra­tion and the Ti­ta­nium Award for Ser­vice Ex­cel­lence to mem­bers of Closed Med­i­cal Schemes.

Other Med­scheme awards in­clude Africa best em­ployer brand awards for Hu­man Cap­i­tal Strat­egy, tal­ent man­age­ment and pro­mot­ing health in the work­place; as well as Think money awards for the best over­all, best for ser­vice, best pay­outs and best for cover.

Over the past eight years, we also re­ceived the fol­low­ing awards:

• Hello Peter awards for achiev­ing the high­est

com­pli­ments and low­est com­plaints ra­tios • Ask Afrika awards pre­sented us with the

best ser­vice award

• Di­a­mond Ar­row Award for Ex­cel­lence for

two con­sec­u­tive years

• IRMSA awards for Health Care Risk cat­e­gory

Cus­tomer ex­pe­ri­ence is not only driven by a strong fo­cus on ef­fi­cient pay­out of claims, it is un­der­pinned by con­ve­nient touch points. These touch points in­clude in­stant mes­sag­ing, web ser­vices, email com­mu­ni­ca­tion and a net­work of walk-in cen­tres spread across South Africa as well as the cus­tomer con­tact cen­tre which is manned by highly com­pe­tent agents.

Med­scheme is sound man­age­ment of fraud, waste and abuse, through its data an­a­lyt­i­cal ca­pa­bil­i­ties, Med­scheme is en­abled to not only pro­vide strong end to end health ad­min­is­tra­tion and man­aged care but also to deal with fraud ef­fi­ciently.

As pre­vi­ously men­tioned, with thanks to the in­fla­tion costs cur­rently be­ing ex­pe­ri­enced by the in­dus­try, cost con­tain­ment has be­come a ma­jor point of in­ter­est.

Van Em­me­nis con­tin­ues: “Dur­ing the 2016 fi­nan­cial year, the Scheme ex­pe­ri­enced an in­crease in the util­i­sa­tion of health­care ser­vices, par­tic­u­larly hospi­tal ad­mis­sions and re­lated ben­e­fits. To­wards the end of the year we em­barked on a hospi­tal ne­go­ti­a­tions strat­egy, re­sult­ing in sav­ings of R242 mil­lion the fol­low­ing year and all without com­pro­mis­ing mem­bers’ access to qual­ity health­care.

“We will con­tinue to ne­go­ti­ate ro­bustly in this man­ner, con­tain­ing costs wher­ever pos­si­ble and ne­go­ti­at­ing the best pos­si­ble rates for mem­bers.

“This year we will be car­ry­ing out a sec­ondary ini­tia­tive in or­der to iden­tify hos­pi­tals on our net­work that are not cost-ef­fec­tive and work to­wards

To­wards the end of the year we em­barked on a hospi­tal ne­go­ti­a­tions strat­egy, re­sult­ing in sav­ings of R42 mil­lion the fol­low­ing year and all without com­pro­mis­ing mem­bers’ access to qual­ity health­care

im­prov­ing their ef­fi­ciency. Dur­ing the next few years ahead, we will likely seek to iden­tify other op­tions that will en­sure we grow and re­tain our ex­ist­ing mem­ber­ship base, this will in­clude the pos­si­bil­ity of amal­ga­ma­tions as well as the de­vel­op­ment of new dis­tri­bu­tion mod­els and chan­nels.”

The Scheme’s man­aged care pro­grammes also play a vi­tal role in both the de­vel­op­ment of Boni­tas and in en­sur­ing that it can com­pete in the mar­ket.

“With the in­crease in preva­lence of life­style dis­eases and the ris­ing cost of treat­ment, there has been a trend to­wards preven­tion and man­aged-care pro­to­cols,” af­firms van Em­me­nis. “At Boni­tas we cover a range of ar­eas in­clud­ing can­cer, di­a­betes, men­tal health and HIV/AIDS through spe­cialised man­aged care pro­grammes.

“These pro­grammes in­clude vi­tal tools that will en­able our mem­bers to achieve the best pos­si­ble clin­i­cal

At Boni­tas we cover a range of ar­eas in­clud­ing can­cer, di­a­betes, men­tal health and HIV/AIDS through spe­cialised man­aged care pro­grammes

out­comes through qual­ity care and on­go­ing well­ness sup­port. They of­fer access to clin­i­cal sup­port as well as ed­u­ca­tional ma­te­rial to em­power mem­bers to take con­trol of their health.”

Key im­prove­ments

In 2017, Boni­tas was bol­stered by the in­tro­duc­tion of the Boni­tas Di­a­betes Man­age­ment Pro­gramme, the suc­cess of which was un­der­pinned by the Scheme’s abil­ity to iden­tify po­ten­tial di­a­betic pa­tients and en­rol them on the pro­gramme while also ac­tively man­ag­ing them through sup­port, test­ing and ed­u­ca­tion.

Van Em­me­nis con­tin­ues: “This year we have in­tro­duced a man­aged care pro­gramme that fo­cuses on men­tal health, while also ex­plor­ing the avail­able op­tions to in­tro­duce al­ter­na­tive re­im­burse­ment mod­els for pro­ce­dures such as knee and hip surgery.

“Con­nect­ing with our cus­tomers still

This year we have in­tro­duced a man­aged care pro­gramme that fo­cuses on men­tal health, while also ex­plor­ing the avail­able op­tions to in­tro­duce al­ter­na­tive re­im­burse­ment mod­els for pro­ce­dures such as knee and hip surgery

re­mains a key fo­cus area, as we seek to im­prove upon our dig­i­tal ca­pa­bil­i­ties in the hope that it will bet­ter our mem­bers’ ex­pe­ri­ence while also com­mu­ni­cat­ing ef­fec­tively and keep­ing them in­formed and en­gaged.”

The Scheme aims to use best tech­nol­ogy avail­able in or­der to make things more sim­ple and ef­fec­tive for the cus­tomer.

“We have also im­ple­mented an Elec­tronic Health Record which en­ables our mem­bers to track their health­sta­tus, while also mak­ing proac­tive changes to im­prove their gen­eral health and qual­ity of life,” states the Prin­ci­pal Of­fi­cer. “It will also help us mon­i­tor chronic conditions in or­der to stop them from de­vel­op­ing or wors­en­ing.”

Mem­ber re­ten­tion

For or­gan­i­sa­tions such as Boni­tas, tech­nol­ogy and en­hanced in­fra­struc­ture is an area that needs to be closely stud­ied in or­der to make the re­quired reg­u­lar im­prove­ments.

We have also im­ple­mented an Elec­tronic Health Record which en­ables our mem­bers to track their health-sta­tus, while also mak­ing proac­tive changes to im­prove their gen­eral health and qual­ity of life

“Find­ing mean­ing­ful ways to con­nect with our mem­bers, while also em­pow­er­ing them to take care of their health is a crit­i­cal fac­tor in our ser­vices,” con­tin­ues van Em­me­nis. “In ad­di­tion, there is cur­rently an in­creased preva­lence of chronic ill­nesses such as di­a­betes, hy­per­ten­sion and men­tal health and we are closely study­ing ways to im­prove the dis­ease burden and clin­i­cal out­comes for each in­di­vid­ual with these conditions.”

In or­der to keep car­ry­ing out this re­search and im­prov­ing its ser­vice, new mem­bers are a crit­i­cal fac­tor to the sus­tain­abil­ity of any med­i­cal scheme. In Oc­to­ber, 2016 Boni­tas amal­ga­mated with LMS Med­i­cal Scheme (for­merly Lib­erty Med­i­cal Scheme) con­clud­ing the largest trans­ac­tion of its kind in the in­dus­try, with an ex­cel­lent mi­gra­tion rate.

“We are de­lighted that dur­ing the amal­ga­ma­tion more than 90 per­cent of the LMS mem­bers utilised one of the 12 plans that we of­fer, pro­vid­ing us with a much higher re­ten­tion rate than an­tic­i­pated,” ex­plains van Em­me­nis. “The amal­ga­ma­tion of Boni­tas and LMS fol­lowed an in­creas­ing trend within the health­care in­dus­try to cre­ate stronger and more sus­tain­able med­i­cal schemes, with the hope that they would pro­vide en­hanced cover and ben­e­fits for mem­bers.”

Since it came to fruition, Boni­tas has re­ceived nu­mer­ous awards for its ser­vice ex­per­tise and ex­cel­lence, most re­cently demon­strated when it re­ceived the Ask Afrika Or­ange In­dex, Kasi Star Brand Award and the Icon Brands Sur­vey award in the same year.

“Our mem­bers are aware that when things get tough, we are more than ca­pa­ble of han­dling the smaller de­tails to en­sure they re­ceive the best care in the busi­ness,” con­cludes van Em­me­nis. “We con­tinue to ex­plore and im­ple­ment so­lu­tions that will help to cur­tail costs and al­low our mem­bers to de­rive real value for money.”

The amal­ga­ma­tion of Boni­tas and LMS fol­lowed an in­creas­ing trend within the health­care in­dus­try to cre­ate stronger and more sus­tain­able med­i­cal schemes, with the hope that they would pro­vide en­hance cover and ben­e­fits for mem­bers

BONI­TAS MED­I­CAL FUND

BONI­TAS MED­I­CAL FUND

Newspapers in English

Newspapers from UK

© PressReader. All rights reserved.