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INTEGRATED REPORT 2017
Medscheme has established a multidisciplinary team which is
responsible for coordinating care by:
• assessing patients properly;
• developing and executing personal care plans and
empowering self-management;
• identifying participants and defining their roles;
• communicating properly;
• ensuring continuous follow-up; and
• capturing relevant information and evaluating outcomes.
To empower scheme members to become active partners
and inform their behaviour, the Group is focusing on improving
patient autonomy and easing access to medical records with
the assistance of the web-based personal health record (“PHR”)
system. The PHR system, introduced in early 2017, enables
clients to access their medical records and biometric results
with greater ease. We are looking to introduce a mobile
application version of the PHR system, which will provide
reminders, in the third quarter of 2017. Predictive analytics has
also provided the Group with relevant information to classify
patients as: healthy, patients with stable chronic conditions,
emerging risks, and high-risk patients.
The majority of NCDs and some communicable diseases
can be prevented through early detection, lifestyle changes,
adhering to treatment regimens, diligent screening and follow-
ups with healthcare practitioners. Together with Sanlam, the
Group is looking to incorporate a reward system to encourage
scheme members to be active partners.
It is vital that patients with chronic diseases consult healthcare
practitioners on the best lifestyle behaviour to manage their
conditions. In June 2017, we released an enhanced version
of the electronic health record system which offers improved
user-experience and interoperability with doctors’ systems.
This improved coordination helps us avoid duplicating
investigations and treatments, and improves patient outcomes.
Medscheme’s Evolving Managed Healthcare Strategy informed by cost drivers
Year 0 cost (indicative)
INDICATIVE COSTS
R7 000 plpm**
R2 000 plpm**
R700 plpm**
R100
plpm**
* A Resource Utilisation Band or RUB is a collection of Johns Hopkins Adjusted Clinical Group® (“ACG®”) System Measures with similar concurrent relative
resource use. ACGs are grouped into six RUB classes: 0 – No or Only Invalid Dx, 1 – Healthy Users, 2 – Low, 3 – Moderate, 4 – High, 5 – Very High.
** Per life per month.
High
risk
individuals
RUB*4 and 5
Emerging risk
individuals
RUB* 2, 3 and 4
Diseased individuals
RUB* 2 and 3
Individuals with risk factors or acute
episodes and healthy individuals
RUB 0 and 1
RISK SEVERITY