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AfroCentric INTEGRATED ANNUAL REPORT 2016
67
Operational reviews
The Group’s growth, its BEE status
and its regular industry award winning
competencies, have attracted significant
market interest, evidenced earlier this year
by Group subsidiary, Medscheme, appointed
as administrators to Polmed and more recently,
being approved administrators of the LMS
Medical Fund with 110 000 lives (previously Liberty
Medical Scheme), awaiting merger approval with
Bonitas Medical Fund.
Website
Page reference
Cost consciousness
Client service
Transformation
Diversifying revenue sources
Growth
Conducting business in an ethical manner
Group Annual Financial Statements
Enhance shareholder value
OPPORTUNITIES AND CHALLENGES
Medscheme operates in a challenging environment. The
complexity of healthcare makes it difficult to balance cost
against quality. Skilled resources are in demand across the
industry. Attracting and retaining critical and scarce skils in
an ongoing concern. The weakness of the Rand is driving
up the cost of medicines and equipment; and medical fraud
impends the sustainability of private healthcare as fraudulent
claims leads to healthcare costs increases across the industry.
The current economic climate combined with hyperinflation
in medical costs is consequentially the membership base
across all claims, reducing claims in a healthcare market
undergoing consolidation, size does matter. Medscheme
has the ability to influence behaviour and make structural
changes to the system that smaller administrators can not
emulate.
Helios holds the distribution licence for the FICO Insurance
Fraud Manager South Africa. This provides Medscheme
with the capability to combat fraud, waste and abuse within
schemes and to generate revenue by selling the tool on to
other administrators and to client schemes.
Medscheme has yet to fully optimise the Sanlam investment
in AfroCentric Group and is exploring the brand and product
extensions the partnership offers.
PERFORMANCE OVERVIEW AND OUTLOOK
The performance highlight was the introduction of the
Polmed medical scheme on 1 January 2016. This increased
the number of beneficiaries under Medscheme’s care by
nearly 500 000, making it the second largest closed scheme
under management.
Numerous innovative initiatives were fine-tuned and
incorporated into the value proposition, such as the
introduction of LiveChat for members. Other highlights
include the enhancement of disease management and an
increased focus on measuring quality of healthcare.
Medscheme also developed a model that predicts emerging
risk with accuracy and segments the population. This
enables Medscheme to engage with those most in need of
immediate high-cost disease care or wellness interventions
to avert future illness, and to deliver the right care at the
right cost to each cohort. This model achieved international
recognition and was purchased by
Johns Hopkins
University
in the United States for distribution to the American market.
The relationship with government is established through the
GEMS contract, and is further strengthened by the successful
Polmed tender.
The year ahead will focus on quality, innovation and
operational efficiency, in a continued quest to ensure that
high-quality healthcare is made affordable and accessible to
all Medscheme beneficiaries.