SELFMED MEDICAL SCHEME

SELFMED MEDICAL SCHEME

Facilitating progression through innovation

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Redefining Medical Scheme Healthcare Tanya Bell reveals how Selfmed Medical Scheme is powering development in South Africa’s private healthcare market Writer: Jonathan Dyble | Project Manager: Callam Waller

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rivate healthcare has continued to make significant strides within the South African market.

National statistics show that approximately nine percent of the country’s GDP is attributed to healthcare each year, on par with the likes of Spain and Malta, largely driven by the private sector.

With more than 200 private hospitals across South Africa, private medical schemes serve roughly 18 percent of the South African population, compared to 81 percent opting for public medical treatment.

However, with investment across both sectors being relatively even, private medical schemes indisputably offer the best quality services to patients across the country, reflected by a study from Statistics South Africa showing that 97.3 percent of households were satisfied with their private healthcare service.

There is, however, still room for improvement and great potential within the market – potential that is driving Selfmed Medical Scheme, one of South Africa’s most successful

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medical schemes, to continually pursue excellence.

“We proudly boast over 50 years of providing our members access to the highest quality healthcare, and this combined with excellent personalised service, makes Selfmed one of the most experienced in the industry,” says Tanya Bell, Head of Marketing at the Scheme.

Technological advancements

Selfmed takes an innovative and forward-thinking approach to the betterment of its operations, most readily reflected by its emphasis on the implementation and use of new and advanced technologies.

One of the biggest challenges facing the industry is rising healthcare costs, an issue that is increasingly placing pressures on medical schemes to find sustainable ways of coping with rising financial difficulties.

In addressing this, Selfmed is tactically increasing its research and development activities in the aim of proactively introducing new mechanisms to help better control its finances.

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One such technology that the Scheme has looked to as a result of this is machine learning, an intelligent solution that has the potential to help cut costs, improve memberscheme relationships and enhance the Schemes services, as Bell explains.

“The Scheme is currently applying machine learning to the claims database, enabling us to draw a more accurate picture of any of our members’ specific healthcare needs,” she says. “The implementation of machine learning is a big step and the aim is to mature the technology to such a stage that we can give members individual health information that will help them to lead a better life.

“We hope to change the interaction between the medical aid provider and the customer so that a partnership is developed, rather than the current system where the medical aid is acting

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more like a payment facilitator than a long-term partner in healthcare.”

innovative strategies to complement our service offerings.

“When we analysed the product An expanded portfolio range of the Scheme we realised that This disruptive outlook and willingness there were segments of the market to adapt and evolve has resulted that were not being serviced by in Selfmed launching two new key our products. The need for a more offerings to its portfolio in recent affordable product with benefits that times: SelfNET and SelfNET Essential. provides cover for one-off events Bell reveals: “In line with our instead of continual and recurrent care strategy to progressively offer was identified – and so, the SelfNET innovative, more affordable benefits to and SelfNET Essential options were our members, the SelfNET and SelfNET borne.”

Essential benefit options were added Combined with the Schemes in 2015 and 2016 respectively.

Selfmed 80%, Med Elite, Selfsure and “Due to the Scheme being in Med XXI products, each of which has a process of monitoring market been specifically designed to cater to trends, coupled with the challenging a different life stage, Selfmed ensures operational climate and a competitive that it is able to provide a more market, an immense amount of market personalised service and experience to research is continually required in all of its members. order to stay on top of our game, “This, ultimately, is what we are identify trends, and develop new and focused on,” Bell states.

FOCUS ON Selfmed Medical

Principal Officer - Christo Becker

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Multi award winning Health Funder Risk Managers specialising in Pathology and Radiology expenditure with close to 20 years’ experience in RSA and Southern Africa.

Pathology and Radiology Spend Risk Managers Financial and Clinical pre-paid claims assessing by qualified Medical Technologists and Radiographers Specialist Pathologist and Radiologist consultants Forensic duplicate recoveries on post-paid claims Practice and Member profiling RPL tariff & ICD10 crosswalk Consulting on Benefits to schemes Consulting on Billing Rules Support existing Managed Care programs Monitor billing pattern changes Phone (+27)83 654 5555

Breaking the mould

Whilst the launch of both SelfNET and SelfNET Essential were specifically aimed at increasing Selfmed’s overall scope within the South African healthcare market, the Schemes motivations are also driven by its member retention strategies and improving its existing offerings.

“We have found our approach has proved that in the times that we are living in, it is no longer simply about product, but just as importantly about nurturing the member-relationship experience,” adds Bell. “Our unconventional open-door policy, whereby a member can contact any member of the team, is something that we hold very dear to our service offering.

“The well-known adage that prevention is better than cure holds very true in the context of our business. To this end our managed healthcare programmes play a vital part in not only bolstering the

We regard ourselves as a dedicated team that hold the best interests of Selfmed and its members in high esteem

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sustainability of the entire Scheme from a cost perspective, but also ensuring that our members are guided towards the best possible medical outcomes through our quality care and wellness initiatives.”

It is these key philosophies that have placed Selfmed on the renowned footing that it stands upon today, and it is this ethos that the Scheme will continue to abide by religiously to further establish itself as a fundamental player in driving forward South Africa’s healthcare progression.

Bell Concludes: “We regard ourselves as a dedicated team that hold the best interests of Selfmed and its members in high esteem.

“To this end, moving in to the future we will continue to be proactive in introducing new and innovative strategies that will continue to drive us forward whilst ensuring that our members enjoy best value in respect of their healthcare needs.”

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Southgate Office Park, First Floor South Carl Cronje Drive Southgate Tyger Waterfront Bellville, 7530 South Africa Tel: +27 21 943 2300 marketing@selfmed.co.za www.selfmed.co.za

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