PRODUCTS & SERVICES
Medscheme International provides the full spectrum of quality health administration, health risk management and business process outsourcing products and services including:
- Capacity to process medical fund and health insurance membership and claims
- Real-time interfacing and processing of transactions together with communication to members and healthcare providers.
- Dedicated client contact centres
- Fund management
- Electronic customer care services
- Special investigations (benefit exploitation, over-servicing and fraud)
- Evaluation of technologies, pharmaceuticals and clinical practice, cost and quality
- Actuarial and health informatics and analysis
- Hospital authorisation, case management and Disease Management Programme
- Intelligent data management and analysis
- Health risk management protocol formulation and review
Medscheme’s offering includes strategic support services and operational services.
Strategic Support Services includes:
- Regular and ad hoc clinical risk reports and analysis.
- “Value” and operational reporting.
- Patient risk management information.
- Doctor behaviour and performance monitoring.
- Hospital cost projections and performance monitoring.
- Clinical outcomes models.
- Oversight of health risk management reports for all medical schemes.
- An annual actuarial review if contracted by a scheme.
- Monitoring scheme financials and risks.
- Consulting services.
Operational processes and systemsare equipped to apply the clinical funding policies for both in-hospital and ambulatory care.
The range of services covers:
- Hospital risk management
- Chronic medicine risk management
- Dental, optometry and pathology risk management
- Healthcare professional risk management (network contract management) programmes to improve quality and cost of healthcare delivery and implementation of innovative reimbursement models
- Beneficiary (clinical) risk management (including facilitation of disease-specific management)
