Medscheme
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