CONSULTING ... 03 Cost containment and analytics consulting Modern healthcare organisations and...

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  • Service providers, insurers, governments and other funders are faced with healthcare cost challenges while under constant pressure to deliver innovative solutions to make healthcare more sustainable. At the same time they want to deliver optimal value for money to beneficiaries.

    Generalist consultancies lack the industry specific understanding needed to help you solve the problems unique to healthcare, while niche consultancies tend to focus on limited aspects of healthcare and do not understand the dynamics and operational landscape that is unique to healthcare funding.

    We work with you in understanding your challenges and needs to implement solutions that help you achieve your objectives. Unlike other consultancies we have a deep understanding of the healthcare industry across various countries, with experienced advisors that have extensive industry experience.

    CONSULTING - VALUE PROPOSITION

    Cost risk management

    Outcomes improvement

    CONSULTING Healthcare is a complex and specialised industry

    KEY BENEFITS

    - We have a history spanning more than 40 years of partnering with blue chip companies to help them face the numerous challenges in providing health- care services and funding.

    - Our team consists of actuaries, accountants, medical doctors, pharmacists and industry experts that have implemented a wide range of innovative solutions spanning the entire range of healthcare funding and risk management needs.

    Sustainable healthcare = cost risk management + outcomes improvement

    2663_Fact_Consultant_03.indd 6 2013/05/13 8:28 PM

  • 01 Consulting overview:

    The intelligent interpretation of large data sets is a cornerstone of our approach. We work with you to understand the challenges you face and then help you put the structures in place to assess and interpret your operational environment with the aim of creating agile long-term solutions.

    We have an extensive toolset to profile healthcare providers, events and cost. We can use this to help you identify solutions to cost drivers and explore revenue generating opportunities.

    Our consulting services cover the following broad lines: • Cost containment and analytics Lead consultant: Gabrie Cillié

    • Technology implementation Lead consultant: Vijay Pillay

    • Actuarial Lead consultant: Alex Browlee

    • Provider network management Lead consultant: Jenni Noble

    • Emerging market health plan consulting Lead consultant: Tim Rametse

    We have a history spanning more than 40 years of partnering with blue chip companies to help them face the numerous challenges.

    Our team consists of actuaries, accountants, medical doctors, pharmacists and industry experts that have implemented a wide range of innovative solutions spanning the entire gamut of healthcare funding and risk management.

    and clinical staff), enabling a depth of consulting expertise. The combined Actuarial and Health Intelligence Units provide a unique level of skills in analysis and research not typically found in a consultancy.

    Alex Brownlee General Manager: Actuarial Services

    Alex qualified as an actuary with the Institute and Faculty of Actuaries (United Kingdom) in 2002, and has been working full-time in the healthcare funding industry since 2005.

    He has over the years given actuarial advice to a wide range of clients including commercial and employer funders, in South Africa and internationally. His experience abroad includes countries neighbouring South Africa and also a multitude of other countries where he has been involved whilst employed at an international healthcare reinsurer. These include Italy, India, Mexico, Dubai and some further less detailed involvement in countries in other regions, such as South East Asia.

    He is involved in various actuarial healthcare committees, both in South Africa and abroad. Alex has been a speaker at a number of conferences.

    Approach and experience

    We have delivered actuarial services to a wide range of medical insurers and medical schemes, with both open and restricted membership, globally. Medscheme currently provides these services to clients in the financial, mining, industrial, motor vehicle, retail and broadcasting industries as well as for the government sector. These funder clients range in size from as small as 3 000 lives to as large as 700 000 lives. In addition, Medscheme currently delivers actuarial services to open enrolment insurance clients in South Africa, Namibia and Swaziland, with sizes ranging from 5 500 lives to almost 300 000 lives.

    02 Actuarial consulting

    Our actuarial consulting team integrates with the research, analytical and operational functions across the business and they are able to consult on risk management solutions both in using traditional actuarial methods as well as through health risk management mechanisms. The healthcare specialisation of this team offers a unique skill and ability. They have particular experience advising on legislated minimum or basic benefits where no benefit limits apply and only clinical funding interventions can be used to manage financial risks.

    The team interacts and works together with the Health Intelligence Unit (research and measurement, including actuarial, analytical

    CONSULTING - CONSULTING OVERVIEW | ACTUARIAL CONSULTING

    2663_Fact_Consultant_03.indd 1 2013/05/13 8:28 PM

  • 03 Cost containment and analytics consulting

    Modern healthcare organisations and insurers are under constant pressure to reduce claims costs while improving patient satisfaction and outcomes. We work with you to analyse their challenges and provide input on possible solutions.

    Gabrie Cillié Head of Business Development

    Gabrie, a qualified actuary, has extensive experience in life and health insurance, having been involved in actuarial valuations, marketing and product development.

    He started his career at Metropolitan Health in South Africa after completing a B Comm (Mathematics) degree at Stellenbosch University. After gaining experience in the healthcare industry, he moved to the Corporate Valuations unit of the Metropolitan Group where he was predominantly involved with life insurance embedded value related activities. Following this he spent a number of years in Marketing and Business Development of the Metropolitan Retail division as product actuary. He joined Medscheme in January 2012 and currently heads up the Business Development unit.

    Approach and experience

    The intelligent interpretation of large data sets is a cornerstone of our approach. We work with you to understand the challenges you face and then help you put the structures in place to assess and interpret your operational environment with the aim of creating agile long-term solutions.

    We have an extensive toolset to profile healthcare providers, events and cost. We can use this to help you identify solutions to cost drivers and explore revenue generating opportunities.

    04 technology implementation consulting (Helios IT)

    Helios IT Solutions offers a comprehensive range of ICT-related services to support healthcare organization, including two systems specialising in healthcare funding (Nexus and Schema6). We have aligned our IT structure with business requirements to support our clients with the following services: • Networking specialists • Java/J2ee design and development (using various frameworks and tools), Java application server administration, Java middleware and service development • Microsoft .Net Development in C# with .Net framework • Sharepoint development • Oracle forms, Oracle PL/Sql and database design and development • Databaseadministration • Data warehousing and business Objects development • Server administration and support

    Vijay Pillay Managing Director: Helios IT Solutions

    Vijay achieved his B Com degree through UNISA and later studied toward his MBA before beginning his career at Spoornet. He later accepted a senior position in Nedcor’s IT department before moving to First National Bank (FNB), where as Chief Information Officer, he was responsible for the full end-to-end IT solutions of the bank’s Home Loans business unit. He also served as a member of FNB’s Advisory Board. In 2011, Vijay was recruited by Medscheme and accepted a position as the Group’s Chief Information Officer (CIO). More recently he was appointed Managing Director of Helios IT Solutions (Pty) Limited, a subsidiary of the AfroCentric Health Group, where his focus is to establish and grow the ICT business as an independent company.

    CONSULTING - COST CONTAINMENT AND ANALYTICS CONSULTING | TECHNOLOGY IMPLEMENTATION CONSULTING

    2663_Fact_Consultant_03.indd 2 2013/05/13 8:28 PM

  • 05 Provider networks consulting

    Setting up, managing and monitoring a provider network requires skilled advisors who can help you plan and implement your network. We help you deliver excellence every step of the way. With our provider networks solution you can reduce setup time and manage costs proactively.

    Dr Jenni Noble (MD) General Manager: Provider Network Department

    Jenny has had extensive experience in South Africa’s private healthcare sector from a provider, funder and patient perspective. At MediKredit her involvement was in the formulating of group strategy, and then developing, designing and implem