Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Resolution Health’s solvency strengthened as membership grows

06 March 2018 Mark Arnold, Resolution Health Medical Scheme
Mark Arnold, Principal Officer of Resolution Health Medical Scheme.

Mark Arnold, Principal Officer of Resolution Health Medical Scheme.

Prudent management of resources sees scheme reaching new heights.

Building on the gains of recent years Resolution Health Medical Scheme is poised to enter a new phase of growth and security, having attracted hundreds of new members since November last year in a largely stagnant medical schemes market. All of this was achieved while steadily growing scheme reserves.

“With prudent management and a diversified membership base, we have effectively built on the gains of recent years and sought to ensure that our benefit options are enriched with the most pertinent cover for each targeted segment of the market,” says Mark Arnold, Principal Officer of Resolution Health Medical Scheme.

“There are few schemes that can attest to building reserves at the rate that we have achieved, even in the face of challenging factors within the industry and the economic climate, in recent years. By the end of 2017 our solvency ratio reached just under 16% having more than doubled since 2012. What’s more, we project that this trend will continue in 2018 and expect reserves to end the year at approximately 20%.

Arnold notes that a number of factors have contributed to this impressive turnaround, including strategic interventions to diversify the scheme’s membership base in target industries – most notably in agriculture and related industries, as well as hospitality and mining.

“Having broadened the profile of our membership while keeping firmly in touch with the unique needs of each sector we serve, has allowed Resolution Health to grow sustainably,” he adds.

“Enhancing membership benefits year-on-year while keeping contribution increases to a minimum is an attractive prospect for South African private healthcare consumers, and we have been able to offer our members exceptional value while still growing reserves in line with a Council for Medical Schemes-endorsed business strategy.

“The richness of the benefits Resolution Health offers, particularly in areas that we know are especially relevant for our members, and the additional value afforded through implementation of the most sophisticated technology and managed care systems available, have attracted significant attention in the market.

“By looking at the benefits members use most on each of our options, we avoid loading options with benefits that the target market for that option are unlikely to use. This is one of the measures that enable us to contain contributions, as we align our options to suit every member at each life stage.”

According to Arnold, Resolution Health boasts one of the industry’s lowest claims per beneficiary ratios. “This is made possible through our managed healthcare systems that not only take proactive care of our members’ health but at the same time also succeed in containing costs. The system ensures that members’ benefits are used effectively and correctly by providers to avoid wastage and protect allocated benefits,” he notes.

Resolution Health makes use of advanced technology and an artificial intelligence engine, which have been developed to detect improper claiming practices and provide protection against fraudulent claims so that members’ funds are protected, and contribution increases are kept to an absolute minimum.

“The integrated approach to managed care and risk management that underpins the scheme’s administration makes use of an advanced claims management system that actively checks members’ prescribed treatment and health conditions for contraindications and potential health risk.
Where the system identifies problematic claims, a team of clinical professionals review the details and engage with the member and their treating medical professional to establish the clinical and procedural validity of the prescribed treatment and claim, thereby adding meaningful value with an extra layer of protection for the health and wellbeing of members.

“At the centre of all these layers of integrated protection – financial, clinical, technological and administrative – is the health of our members. Through understanding their needs and charting the best possible means of providing relevant healthcare cover within a financially sustainable framework, we foresee vast potential for further growth in the months and years to come,” Arnold concluded.

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