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INTEGRATED REPORT 2017
NHI NEEDS
HOW AFROCENTRIC IS POSITIONED TO SUPPORT NHI
Payment integrity
of healthcare claims is a core
objective to secure the success of the pending NHI.
Prompt and accurate payment for healthcare services
rendered by legitimate practitioners and facilities will form
the backbone of the NHI and ensure that all citizens
receive prompt, affordable quality healthcare. Managing
fraud, waste and abuse will be key to safeguarding the
financial sustainability of the NHI nationally.
AfroCentric’s exclusive licensing in
Insurance Fraud Manager
(“IFM”)
predictive analytics software is providing material savings
for its client medical schemes. IFM is licensed through FICO,
the world’s leading software provider of credit scoring analytics.
By continuously scoring healthcare claims and providers using
advanced analytics, AfroCentric is able to proactively monitor
and detect irregular claiming behaviours far earlier than
conventional retrospective methods.
On 22 June 2017, Cabinet approved the latest form of the
NHI White Paper, and, on 29 June 2017 held a public briefing.
THE NEXT PHASE OF NHI
With the release of the Cabinet-approved White Paper, the
second phase of the NHI commences. The building blocks of
the NHI Fund, and its ability to effectively purchase services, will
be put in place during this phase. Accreditation of providers by
Office of Health Standards Compliance (“OHSC”); information
systems (including patient registration and information
exchanges); payment strategies; and technology assessment/
rationing/prioritisation will be the core purchasing building
blocks. The private sector has this as its core expertise, and the
Department of Health has repeatedly stated that it intends to
leverage this capital.
Work on costing and setup of the Fund is set to continue.
Secondly, the following services will be prioritised over the next
two years: maternal health, integrated school health, healthcare
for the elderly and mental health. Solutions for the scaling of
care delivery to these vulnerable populations will be a key focus
area for the private and public sector alike.
To enable the work to be done in this next phase, the interim
structures in the graphic below will be constituted. They will be
the structures within which debate, solutions and planning will
take place across sectors. AfroCentric intends to play a pivotal
role in the work produced by these Committees.
IMPLEMENTATION STRUCTURES
Health
Technology
Assessment
Committee
Benefits
Advisory
Committee
Advisory
Committee on
Consolidation
of Financing
Arrangements
Tertiary
Services
Technical
Implementation
Committee
Governing
Authority on
Training and
Development
Pricing
Advisory
Committee