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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Medical Schemes focus on strong Service Provider Networks

18 June 2014 Professor Jan Meiring, Bestmed

Medical schemes are focussing on improving their offering to members in order to curb issues within the healthcare industry, which include frustration over high contributions, high co-payments, unnecessary spend of member savings and inefficiencies.

Most of the leading schemes are implementing strategies that will not only provide sustainable quality healthcare, but also affordable healthcare. Along with bringing down the average age, coupled with consolidations and acquisitions, implementing strong Service Provider Networks (SPN) has become crucial to achieving these goals.

Bestmed’s Service Provider Network strategy is well into its third year. Professor Jan Meiring, architect responsible for developing Bestmed’s SPN strategy comments, “Our over-arching aim is to provide sustainable quality healthcare services at affordable prices, without discomforting our members.”

Professor Meiring, Executive Manager: Service providers, Contracting & Research at Bestmed stresses the importance of general practitioners (GPs), who he says are the primary healthcare providers as they are at the coalface in the healthcare system. Usually, they work for themselves and play a key role in creating demand for services and directing the healthcare process. As gatekeepers, they refer patients to specialists and are relied on for their council. For this reason, it is vital for medical schemes to create a strong network with GPs, and ensure that they manage the downstream healthcare costs wisely.

“Bestmed’s SPN showed substantial growth during 2013, particularly in the general practitioner and pharmacy sectors. The networks were expanded since January 2014 to include Specialist, Dental, Ancillary (physiotherapists, occupational therapists, dieticians, biokineticists, psychologists, nurses, speech therapists and audiologists), different Service (Oncology, Kidney dialysis, Emergency and Drug and Alcohol Rehabilitation) as well as Supply (Oxygen, Stents & Pacemakers and Orthopaedic prostheses) networks. Some of the networks are Designated Service Providers (DSPs) and other as Preferred Provider (PP) networks.

According to Professor Meiring, Bestmed is also investigating the implementation of new networks during 2014, which include Hearing aids, Wound care and stoma as well as Dental therapists and Clinical technologists, to name a few.

Bestmed has experienced great success in channelling their members to network service providers. To date, the scheme boasts with a mature network of pharmacies after a two year roll out. “R7.80 out of each R10 spent by Bestmed members are in the pharmacy network,” says Professor Meiring.

This is similar to the GP network, where a footprint of 2 421 GPs has entered the network.

To assist members to source the Bestmed network providers, there is a Geo-mapping service on their website, which is available to all members. “Our target this year is ambitious as we aim to bring 1 500 specialists inside the network with a footprint throughout the country. Bestmed members need to be within a 50km radius of available network specialists.

Sustainability

In order to facilitate an easy and smooth relationship with service providers, Bestmed has set up a dedicated provider consultant service, which is a personalised one-on-one service where the service provider department will solve all related multiple, complicated and lengthy queries. Furthermore, direct weekly payment to the providers at network tariffs is also guaranteed. To support the service to the providers, a Provider manual was also introduced, explains Professor Meiring.

Since Bestmed embarked on its service provider strategy three years ago, Tier 1 GPs in their network have benefitted from the strategy with their tariffs increasing by up to 23%.
Tier 1 – 3 means that GPs can earn an additional 6% by contracting in to the scheme and another 16% by quality service to the members. In order to achieve this, GPs are profiled against the norm set up by their peers. This initiative not only looks at utilisation and costs, but takes into account the number of preventative measures and tests done by the GP.

The object is to find the balance between economic frugality and not compromising the member’s health. Peers are profiled, reviewed and managed by the Independent Practitioners Association Forum (IPAF).

Win-win situation

Forming strong networks is an effective way to manage the Scheme’s risk and improve service offering, which then adds value to the service provider, Scheme and members. Through the networks, members will continuously use known trusted suppliers, which builds relationships and instils trust.

According to Professor Meiring, this means that members will not be charged more than Scheme rate by service providers contracted within the network and in turn the members will use their Medical Savings Account (MSA) more effectively.

“Our future objectives and strategy will keep circling around the healthcare provider environment to secure quality sustainable provider services at affordable costs, and the scheme to provide an environment which is a win-win for all, especially the healthcare service providers,” concludes Professor Meiring.

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