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AFROCENTRIC GROUP
62
OPERATIONAL REVIEWS
MEDSCHEME
SOUTH AFRICA
OVERVIEW
Medscheme is the largest manager of medical schemes in South Africa, managing approximately 3.6 million lives. It now offers the
most advanced and comprehensive fraud, waste and abuse management service available to medical schemes in South Africa.
7 000
FAMILY PRACTITIONERS;
4 500
SPECIALISTS;
2 500
PHARMACIES; AND
2 000
DENTISTS AND
70
ORTHOPAEDIC SURGEONS.
20
OFFICES AND
3 251
EMPLOYEES RESPONSIBLE
FOR
15
LEADING MEDICAL SCHEMES IN
SOUTH AFRICA
OUR
NETWORK
CONSISTS OF
MORE THAN:
Medscheme focuses on
enhancing
its operational systems to
coordinate care
and
build
partnerships
between patients and healthcare providers.
Medscheme is a specialised, integrated health administration
and managed healthcare organisation. It addresses
unsustainable health costs through innovative technology
and managed care solutions in a complex operational and
regulatory environment. Our dedicated and resilient team
secures new contracts and finds new solutions in the
procurement and funding of healthcare. Our awards are
a testimony to their hard work.
Through our Integrated Chronic Care Mode (“ICCM”), we
deliver the highest standards of care to our clients’ members.
We view client relationships as partnerships that provide
beneficiaries with the most cost-efficient and high-quality
clinical care. The healthcare value chain is a continuum, and
each contact point along the chain is an opportunity to improve
health outcomes.
Regular liaisons with family practitioners encourage coordinated
care that treats patients, not diseases. Medscheme ensures
ongoing consultation with hospitals and healthcare providers to
gather clinical data that improves results monitoring. In this way,
we are able to measure the cost-efficiency of interventions and
the quality of healthcare funding.
Schemes are managed in separate business units, and clients’
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
that our dedicated, knowledgeable employees are tailored to
their business. Medscheme collaborates with the other Group
companies to deliver an appropriate package of care services
that may be tailored to the client and the individual scheme
member.
We are thought leaders who pioneer new technologies and
better ways of doing business. Through these, we make a
measurable difference in the healthcare industry, and offer
our customers more flexibility and efficiency.
Medscheme has the necessary infrastructure and IT platforms
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,
member surveys and claim turnaround times.