Sound administration key to cost containment

THERE are few things more important to a medical scheme’s ability to contain costs than the administrator it chooses, according to Patrick Masobe, Chief Executive Officer of Agility Health, (Pictured below) a leading knowledge-based healthcare solutions provider.

He says, “Every medical scheme is entirely dependent on its administrator when it comes to managing its risk, reputation, and members’ sound healthcare.

“Are the scheme and administrator a good fit, or is the scheme tolerating shortcomings because it believes it will not get better elsewhere? This approach can prove harmful to members and impact the overall sustainability of the scheme.”

He explains that medical schemes belong to their members and their governing bodies have an obligation to protect the sustainability of the scheme, its members, as well as its funds.

“Before signing up an administrator, it is mandatory to establish whether it has a track record in terms of a value-for-money service offering. This means keeping costs and member contributions down. A very good indicator being an administrator’s risk management profile. This is key to keeping costs low and resistant to fluctuations.”

Medical schemes under the administration of Agility Health benefit from Patient Driven Care™ (PDC), a personalised disease management intervention system based on clinical and statistical insights. It uses a risk-rating framework based on clinical input data. Quality intelligence is also gathered throughout the underwriting, authorisation and the claims processes. “It has significantly reduced the number of hospitalisation episodes for patients living with high-risk chronic illnesses, thereby containing claims of such members, while proactively looking after their wellbeing. In a nutshell, members are enjoying better health outcomes and claiming less overall,” Masobe explains.

Agility Health also places considerable emphasis on corporate governance and has consequently put in place mechanisms to ensure outstanding performance in this area. “A truly integrated approach to administration and managed care solutions leads to improved management of schemes, healthcare outcomes, as well as detection and prevention of fraud,” he concludes.