AfroCentric Group Integrated Annual Report 2017

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INTEGRATED REPORT 2017
OPPORTUNITIES AND CHALLENGES
Medscheme has the ability to influence
behaviour and make structural changes to
the system that smaller administrators are not
able to emulate.
The weakness of the Rand is driving the cost of medicines and
equipment upwards and medical fraud impedes the
sustainability of private healthcare, as fraudulent claims lead to
healthcare cost increases across the industry. Medscheme is
vigorously addressing fraud, waste and abuse. We have
expanded the Medscheme Forensic Medical Scheme
Department and further rolled out IFM fraud modules.
The amalgamation of Bonitas and LMS Medical Fund (“Liberty”)
added approximately 125 000 lives under our care. The growth
of the scheme allows this volume to be more effectively
leveraged in terms of negotiating rates from healthcare
professionals and, in particular, hospitals.
The challenging environment requires us to integrate the
healthcare value chain and find innovative solutions to address
the rising costs without compromising quality. Consolidation
has placed us in a perfect position to expand our market share,
and we have introduced innovative solutions such as the ICCM
and Hospital Benefit Management Model (Acute Care Model)
which have been instrumental in addressing the costs.
We are engaging Sanlam to re-engineer the Sanlam Reality
loyalty programme to be more competitive for Medscheme
members. Our partnership with Sanlam is pivotal, both to a
cohesive and integrated financial services offering that
integrates with medical scheme products, and to exploring
solutions for the low-income market.
The NHI poses a risk to our member retention within our current
funder base. Through our expertise, we are exploring methods
of facilitating the design of solutions for both the providers of
healthcare and the government.
Skilled resources are highly sought after in the industry. It is
vital for us to continue attracting and retaining critical and
scarce skills.
OUTLOOK
Medscheme will continue focusing on quality, innovation,
fraud management and operational efficiency. We aim to
implement the IFM Facilities and Pharmaceutical forensic
modules which will enable us to recover at least R100 million by
December 2017.
The business is also optimistic about the implementation of:
• the ICCM for Bonitas as part of the diabetes management
roll-out;
• the Nexus IT Programme system enhancements;
• a new hospital benefit utilisation model to address the high
incidence of unnecessary admissions due to provider fraud,
waste and abuse; and
• at least two Robotic Process Automation models into
the operational business.
Visit the Medscheme website,