Health Risk Management Briefing Session 01 February 2012.
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Transcript of Health Risk Management Briefing Session 01 February 2012.
Health Risk Management Briefing Session
01 February 2012
ROAD ACCIDENT FUND
BRIEFING SESSION – Health Risk Management System
GAUTENG
RFP/RAF/2012/00009
DATE: 01 FEBRUARY 2012
RAF - MENLYN
AGENDA
1. Welcome
2. Introduction of the RAF members
3. Circulation of Attendance Register
4. Presentation By RAF - BAU/Case Management Unit
5. Q & A
6. Closing
RAF OVERVIEW• Established through an act of Parliament in 1996.
• Started operating in 1997.
• National Public entity in accordance with schedule 3A of the PFMA.
• Governance: Parliament through SCOPA; Ministry of Transport; Board of RAF
• Provide compulsory cover to all users of South African roads, both citizens and foreigners, against injuries sustained or death arising from MVA within the borders of South Africa. Provide appropriate cover to all road users within the boarders of South Africa
• Rehabilitate and compensate persons injured in a timely and caring manner
• Promote safe use of all South African Roads
• Social responsibility to re-integrate victims of road accidents to society.
• Pays medical and related services costs; general damages; loss of income; loss of support and funeral expenses.
• RAF pro-actively reaching out to communities by expanding the footprint, enhancing processing capability by improving business processes and systems.
• Values: Ubuntu; Freedom to succeed and Pride in what we do.
Page 5RAF PowerPoint Toolkit and Instruction Guide
FREE STATE KWAZULU NATAL
MPUMALANGA
GAUTENGNORTH WEST
NORTHERN CAPE
WESTERN CAPE
EASTERN CAPE
NORTHERN PROVINCE
LESOTHO
ATLANTIC OCEAN
INDIAN OCEAN
BOTSWANA
ZIMBABWE
MOZAMBIQUE
NAMIBIA
Pietersburg
Mmabatho
UpingtonKimberley
Stellenbosch
Cape Town Port Elizabeth
Grahamstown East London
Umtata
Durban
PietermaritzburgBloemfontein
Pretoria
Johannesburg
Welkom
BACKGROUND
• Current transformation process.• Envisaged nine provincial offices for origination of claims.• All claims to be processed centrally at the Benefit Administration Unit
(envisaged).• Claimed benefits include Medical; General Damages; Funeral; LOE and
LOS.• Medical Unit is responsible for payment of past medical expenses;
rehabilitation services; life care and supplier claims.• 2010/2011 Financial year 195,634 medical claims lodged• 187,168 finalized• 2010/2011 medical claims cost close to 800 million rand• Predicted increase – 8-10 %• Pre authorization of rehabilitation and life care services• Payment to claimants, service providers , attorneys
RAF CASE MANAGEMENT
• Hospital based case managersFirst RAF contact with the injuredManual reports
• Case management Unit BAURetrospective AssessmentRefer to field case managers
• Field case managersHome visitsAssess needs and initiate strategiesNo service provider network
• Undertakings DepartmentPre authorisationPayment for services
Health Risk Management Specifications
A health risk management system to proactively manage all medical, surgical and rehabilitative accident related interventions by applying best practice regimens
• Pre authorisation Hospital admissions Prostheses Assistive devices Medical procedures
• Case management• Clinical audit • Medical peer review• Rehabilitation programmes• Private nursing and specialised wound care• Service provider network arrangements
Specifications contd.....
Interactive solution Software able to run on IBM or HP Operating system- one of Unix, Aix, or Windows Databases– Oracle or MSSQL
Standard operating procedures Pre loaded Health Intelligence Rejection of chronic/pre existing but allow exceptions Exclusion management e.g. drug interactions, allergies Protocols and formularies for cost effective treatments Able to create patient specific rules Flagging and tracking of updates Automated updates – current best practice
Details of the Bid
Documents can be couriered or hand delivered at the reception during:
Mondays - Fridays
Working hours
7h45 a.m. – 16h00 p.m.
Please ensure that register is signed at the reception
Closing date and time should be strictly adhered to:
9 February 2012 at 11h00 a.m. sharp
Details of the Bid
Request for proposals: Appointment of a service provider to provide
Health Risk Management System
• Closing date 9 February 2012.
• All questions / enquiries outside this forum will be via email to: [email protected] not later than 11:00 on 2nd February 2012.
• Questions/ Answers will be published on the RAF website by 3rd February 2012.
Compliance
• Compulsory Documents (Valid original Tax Clearance Certificate)
• Page 5-Checklist of documents to be submitted
• Please ensure that document is signed where required
• Complete proposal should be submitted
Technical Mandatory Requirements
• The service provider must have full local solution support.
(please provide the structure of the support team to the RAF)
NB: Bidders who do not meet functional mandatory requirements will be disqualified and will not be considered for further evaluation on the functional requirements.
Technical / Functional Requirements
The functional / technical criterion that will be utilized to test the capability of service providers
Technical /functionality will be evaluated against the following detailed requirements:
Project plan and methodology Experience Standard operating procedures Security features Training Report generation
NB: Bidders who score LESS than (60% out of 85%) will not be considered for site visits
Site visit
NB:Bidders who score LESS than (80% out of 100%) on functionality including site visit will not be considered for further evaluation on Price and BEE
Evaluation
90/10 principle will be used.
Price and BEE
QUESTIONS
?
THANK YOU