How Managed Care Works

Here in this article, we will have a look at how Managed Care works in South Africa.

What is managed care? – How Managed Care Works

Medical Schemes have introduced managed care programs as a way to contain spiralling health care costs and to offer value-added service to members.

So the objective of managed care is, to ensure that members are given the correct treatment or drugs that they need, in the most cost effective manner.

How is managed care applied? – How Managed Care Works

  • Updating hospitalisation pre-authorisation for certain procedures.
  • A scheme case manager reviews In-hospital treatments, who works with your doctor to ensure that you receive the correct level of care and treatment while ensuring that there are no unnecessary costs.
  • Serious and chronic illnesses have coverage by schemes’ disease management programs, offering education to members on how best to manage their conditions.
  • Medicine management programs check that they prescribe the correct and profitable medicine and that there are no contradictions or duplications.
  • Maternity programmes assist members by ensuring that there are necessary check-ups and scans.
  • Dental and optical management

 

Why is there a need for this?

How Managed Care WorksThe treatment of medical conditions often involves some specialists – blood tests, scans, physician, surgeons and so on. So each reliant on the other’s contributing to reaching a successful conclusion.

Jeremy Yatt, the principal officer for Fedhealth, believes that no one is orchestrating these processes which often led to a poor case conclusion.

A more holistic approach to the management of a patient’s health care has become necessary. Yatt explains that, for this reason, Fedhealth have fully embraced a coordinated health care initiative!

 

Coordinated health care – How Managed Care Works

There are three main drivers to coordinated health care initiatives:

  • High-risk beneficiary management – this identifies and manages members who either have or are likely to develop a serious or chronic medical condition.
  • Family practitioners – Fedhealth’s Yatt, says that family practitioners are at the core of their care program. So they have an established network of family practitioners, providing quality primary health care. Also, the programme has realised a 26% decrease in hospital and emergency room admissions!
  • Personal health records – Fedhealth have introduced electronic health care records for members. So in this way, doctors can access the full picture of a patient’s medical history including hospital treatment, blood tests, and the likes.

 

So it is evident that Fedhealth’s managed care program is greatly improving the way that health care is practised. And offers their members a value-added service while having mechanisms in place to manage down costs.

 

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