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

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

Page 1: CONSULTING...03 Cost containment and analytics consulting Modern healthcare organisations and insurers are under constant pressure to reduce claims costs while improving patient satisfaction

Serviceproviders,insurers,governmentsand other funders are faced with healthcare cost challenges while under constant pressure to deliver innovative solutions to make healthcare more sustainable. Atthesametimetheywanttodeliver 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.Unlikeotherconsultancies 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

CONSULTINGHealthcare 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

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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: • Costcontainmentandanalytics Lead consultant: Gabrie Cillié

• Technologyimplementation Lead consultant: Vijay Pillay

• Actuarial Lead consultant: Alex Browlee

• Providernetworkmanagement Lead consultant: Jenni Noble

• Emergingmarkethealthplanconsulting 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.ThecombinedActuarialandHealthIntelligence Units provide a unique level of skills in analysis and research not typically found in a consultancy.

Alex Brownlee GeneralManager:ActuarialServices

AlexqualifiedasanactuarywiththeInstitute andFacultyofActuaries(UnitedKingdom)in2002, and has been working full-time in the healthcare funding industry since 2005.

Hehasovertheyearsgivenactuarialadvice to a wide range of clients including commercial andemployerfunders,inSouthAfricaandinternationally.HisexperienceabroadincludescountriesneighbouringSouthAfricaandalso 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 asSouthEastAsia.

Heisinvolvedinvariousactuarialhealthcare committees,bothinSouthAfricaandabroad. Alexhasbeenaspeakeratanumberofconferences.

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 SouthAfrica,NamibiaandSwaziland,withsizesranging 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 theHealthIntelligenceUnit(researchand measurement, including actuarial, analytical

CONSULTING - CONSULTING OVERVIEW | ACTUARIAL CONSULTING

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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 CilliéHeadofBusinessDevelopment

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

HestartedhiscareeratMetropolitanHealth inSouthAfricaaftercompletingaBComm (Mathematics)degreeatStellenboschUniversity.Aftergainingexperienceinthehealthcareindustry,hemovedtotheCorporateValuationsunitoftheMetropolitan Group where he was predominantly involved with life insurance embedded value related activities. Following this he spent a number ofyearsinMarketingandBusinessDevelopment of the Metropolitan Retail division as product actuary.HejoinedMedschemeinJanuary 2012andcurrentlyheadsuptheBusiness 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)

HeliosITSolutionsoffersacomprehensiverangeofICT-relatedservicestosupporthealthcareorganization, including two systems specialising in healthcarefunding(NexusandSchema6).Wehavealigned our IT structure with business requirements to support our clients with the following services:• Networkingspecialists• Java/J2eedesignanddevelopment(using variousframeworksandtools),Javaapplication serveradministration,Javamiddlewareand service development• Microsoft.NetDevelopmentinC#with .Netframework• Sharepointdevelopment• Oracleforms,OraclePL/Sqlanddatabase design and development• Databaseadministration• Datawarehousingandbusiness Objectsdevelopment• Serveradministrationandsupport

Vijay PillayManagingDirector:HeliosITSolutions

VijayachievedhisBComdegreethroughUNISAandlaterstudiedtowardhisMBAbeforebeginninghiscareeratSpoornet.HelateracceptedaseniorpositioninNedcor’sITdepartmentbeforemoving toFirstNationalBank(FNB),whereasChiefInformation Officer, he was responsible for the full end-to-endITsolutionsofthebank’sHomeLoansbusinessunit.HealsoservedasamemberofFNB’sAdvisoryBoard.In2011,VijaywasrecruitedbyMedschemeandacceptedapositionastheGroup’sChiefInformationOfficer(CIO).MorerecentlyhewasappointedManagingDirectorofHeliosIT Solutions(Pty)Limited,asubsidiaryofthe AfroCentricHealthGroup,wherehisfocusis toestablishandgrowtheICTbusinessasan independent company.

CONSULTING - COST CONTAINMENT AND ANALYTICS CONSULTING | TECHNOLOGY IMPLEMENTATION CONSULTING

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05 Provider networks consulting

Settingup,managingandmonitoringaprovidernetwork 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)GeneralManager:ProviderNetworkDepartment

JennyhashadextensiveexperienceinSouthAfrica’sprivatehealthcaresectorfromaprovider,funderandpatientperspective.AtMediKreditherinvolvement was in the formulating of group strategy, and then developing, designing and implementing the business processes to support that strategy. Herinvolvementhasbeendiverse,includingthedevelopment, implementation and management of healthcare programmes, databases and systems, the development and analysis of intelligent reporting, the development and implementation of pharmacy provider networks and claims processing for the USmarket.Shehasalsobeeninvolvedinpublic-privatepartnershipinitiativeswiththeSouthAfricanDepartmentofHealth.

Approach and experience

We have a long history of setting up bespoke agreements and negotiating provider rates that encourage quality care and affordable rates.

We focus on helping clients balance the three pillars of an excellent provider network:• Cost• Quality• Accessibility

Our very experienced negotiation team has decades of combined experience in fee negotiations with doctors,specialists/consultants,providers,hospitals, radiologists, pathologists and other healthcare provid-ers. The result is unparalleled access to quality affordable healthcare for your members and policyholders.

For example we helped one of the largest multinational insurance companies to set up a provider network in a country within one month. The new network provided improved access for patients and reduced hospitalisation costs through progressive contracting by 20%.

06 Emerging market health plan consulting

We help financial services clients to add health insurance to their product basket. We deliver an end-to-end product that enables companies to develop internal capacity and infrastructure to earn new revenue through this additional product line. We also consult on individual elements in the projecttoimplementahealthinsuranceplanandwe can draw on one of the largest healthcare fundingdatasetsinAfricatoaidbenefitdesign.

Tim RameteseManagingDirector:MedschemeAfrica

HavingstudiedLabourLawandTaxattheUniversityofPretoria,TimbeganhiscareerintheEmployeeBenefitsDepartmentofthePublicServiceCommission.AftermovingtoNationalSorghumBreweries, hejoinedPretoriaMedicalBrokerswhichwas subsequently acquired by Thebe Investments, wherehewasrapidlypromotedtoExecutive Directorofthehealthcaredivision.HethenmovedtotheSouthAfricanPoliceMedicalscheme (POLMED)whereheacceptedapositionasthemedicalscheme’sChiefOperatingOfficer.

TimjoinedMedschemein2006asGeneralManager intheBonitasBusinessUnitandwaslaterpromotedtoDeputyManagingDirectorofMedschemeHealth. In 2010 Tim assumed responsibility for Medscheme Africawhere,asManagingDirector,heisaccountablefordrivingMedscheme’sdiversificationandexpansion strategiesintotherestofAfrica.

CONSULTING - PROVIDER NETWORKS | EMERGING MARKET HEALTH PLAN CONSULTING

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CONSULTING

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CONSULTING

www.medscheme.com

Office Line: +27 11 671 2000E-mail:[email protected]: 37 Conrad Road, Florida North, Roodepoort, 1709Postaladdress: PO Box 1101, Florida Glen, 1708

Medscheme Holdings (Pty) Limited Reg No 1970 | 015014 | 07

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