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AfroCentric INTEGRATED ANNUAL REPORT 2016
65
Operational reviews
OVERVIEW
Medscheme is the largest manager of medical schemes
with approximately 3.7 million lives under our management.
Medscheme has 19 offices in Southern Africa, with a network
of more than 6 800 family practitioners, 4 100 specialists,
2 100 pharmacies, 2 000 dentists and 30 orthopaedic
surgeons. 3 542 employees look after 16 leading medical
schemes in South Africa and the Southern African
Development Community (“SADC”) region.
Medscheme is committed to service excellence and
collaborates with clients to assist them in delivering the
highest standards of care to their members. We view the
client relationship as a partnership designed to maximise
value to beneficiaries in terms of cost efficiency and delivery
of clinical care. The healthcare value chain is a continuum,
with each contact point along the chain representing an
opportunity to improve health outcomes.
Regular liaison with family practitioners encourages co-
ordination of care and promotes a patient-centred approach
that treats people, not diseases. Medscheme is engaged
in an ongoing consultation process with hospitals and
healthcare providers to extract clinical data that enables
enhanced results monitoring. In this way, we are able to
measure the cost-effectiveness of interventions and the
quality of healthcare funding.
Schemes are managed in separate business units, and client
needs are considered in constructing the business processes
and resources for each unit. The client service team is unique
to each scheme, so clients and their members are always
assured of dedicated, knowledgeable employees taking care
of their business. Medscheme collaborates with the other
Group companies to deliver an appropriate package of care
services that can be tailored to the client and the individual
scheme member.
In a complex industry, Medscheme provides thought
leadership, pioneering new technologies and improved
ways of doing business whereby we can make a measurable
difference in the healthcare industry.
Medscheme has the infrastructure and IT platforms in place
to process high volumes and pays out a significant Rand
value in claims each year. Service quality is assessed using
a range of indicators, such as call response time, query
resolution and claim turnaround times.
STRATEGY
Medscheme’s strategy is to facilitate the most efficient
and effective healthcare that will achieve the best possible
outcomes and the best quality care of beneficiaries at an
affordable cost.
Medscheme is a medical scheme administrator and health risk manager with interests extending into
our neighbouring countries. Medscheme is contributing to the control of unsustainable medical inflation
and improving access to quality of care.
Committed to
service excellence
MEDSCHEME SOUTH AFRICA
ACHIEVED THE
SERVICE
EXCELLENCE
AWARD FOR HEALTH ADMINISTRATION
AND HEALTH RISK MANAGEMENT AT
THE BHF AWARDS
Facilitate
the most
efficient and
effective
healthcare
BHF
MEMBER
OF
THE YEAR