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Real ‘Friends of GEMS’

08 July 2008 Government Employees Medical Scheme (GEMS)

Since its inception the Government Employees Medical Scheme (GEMS) has adopted a progressive, forward thinking strategy, which prioritises members and their healthcare providers.

According to Dr Eugene Watson (pictured), Principal Officer of GEMS the Scheme’s focus on making the medical scheme experience of every member a pleasurable and memorable one has paid attractive dividends. GEMS is now the largest restricted medical scheme in the country with over 260 000 public service employees and 700 000 beneficiaries benefiting from its services.

“Healthcare providers caring for our members are of key importance in ensuring the rendering of cost-effective, quality care to our members. We have commenced forging multi-faceted partnerships between healthcare professionals, beneficiaries and the Scheme, cognisant always of the fact that it is the health professionals who deliver care to members. This partnership is integral to our long term vision that includes relevant information sharing, healthy discussion, formalising relationships and the development of mutually beneficial alternative reimbursement models. This of-course includes incentivising good performance,” comments Dr Watson.

Since 2006 GEMS has initiated a number of member-focused initiatives that, it believes, will further add to the ‘ease of use’ of the scheme. These include the postal delivery of chronic medication, the sending of claims alerts via SMS and ‘Friends of GEMS’, the healthcare service provider registry which enables members to find a healthcare service provider in their area by sending a single SMS.

To date the response to “Friends of GEMS” has been significant with the programme receiving the buy-in of over 8 400 healthcare providers such as GP’s, dentists, physiotherapists and psychologists. Many more professionals are now expressing their willingness to see GEMS members at agreed rates without any additional surcharges.

Practicing healthcare providers are enthusiastic about partnering with GEMS and playing a significant role in identifying cost effective solutions to the benefit of the sector more broadly. Mrs Dolly Ernst, practice manager of the Kilnerpark Anaesthetic Clinic Trust, a 24-year old Pretoria based day clinic with more than 80 doctors, dentists and other healthcare professionals from varying disciplines working from there at different times expressed total delight on the part of her colleagues with the “Friends of GEMS” programme.

Kilnerpark Anaesthetic Clinic Trust, with its fourteen beds and two theatres was one of the first organisations to join “Friends of GEMS”. “Friends of Gems is doing very, very well for us!” says Mrs Ernst. “We have now registered for all the GEMS options and it certainly brings in business for us while eliminating much of the endless paperwork drudgery. We see at least two to three GEMS patients here every week. In these difficult times when doctors are leaving our country ‘Friends of GEMS’ is a truly positive initiative that rewards doctors for practicing medicine responsibly. There is a great deal of commonality between GEMS and us as it is our mission to provide total patient satisfaction at affordable rates at all times. From what we have seen from GEMS to date they truly put their members and healthcare providers first,” comments Ms Ernst.

Preggie Naidoo, Managing Director of the Iso Leso Optometric network is equally enthusiastic about ‘Friends of GEMS’ and the benefits that it holds for the ISO Leso Optometric network and its more than 100 members. “Friends of GEMS undoubtedly bring in patients for the optometrists in our network. Best of all it eliminates unnecessary and time-consuming paper work for all concerned. There is trust and mutual respect in the relationship that we have with GEMS and its members and our association is not sullied by concerns about payment. In the process the patient as well as the optometrist feel valued,” says Naidoo.

‘Friends of GEMS’ is not limited to serving the needs of networks and provider groupings. Individual relationships with healthcare service providers that are not necessarily part of formal networks are growing in leaps and bounds. Lydia Needham of M-Kem Medicine City in Bellville, Cape Town, is one such provider, who has only good things to say about ‘Friends of GEMS’.

“We fill between 120 and 150 scripts on behalf of GEMS members each week. We have never experienced any difficulties as queries are resolved really quickly and payment happens bi-weekly like clockwork. In terms of cash flow and productivity this means a great deal to a small, independent business such as ours. We have some wonderful relationships in place within GEMS which serves us as well as our clients really well.”

It seems at this early stage that ‘Friends of GEMS’ is succeeding in making real friends for GEMS.

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