Background

Medscheme is developing a new, innovative Hospital Benefit Management (HBM) model. Once fully implemented, the new model will significantly improve efficiency for all stakeholders, reducing administrative burden and speeding up turnaround times.

One of the ways in which this will be achieved is through systematic application of pre-determined funding protocols, which are currently being developed collaboratively with healthcare professionals. It is important to note that although the funding protocols are designed around an evidence-based clinical approach, they are solely for funding purposes and do not aim to replace any clinical guidelines. Furthermore, funding protocols will only be implemented once they have been reviewed and endorsed by the relevant Specialist Society and Key Opinion Leaders. We will inform the relevant healthcare providers as and when this happens.

The funding protocols will be implemented in a phased approach, starting with the ‘manual’ implementation of selected funding protocols. This is to ensure that proper testing and user experience is undertaken by the relevant stakeholders, and will assist healthcare providers (healthcare professionals and hospitals alike) to familiarise themselves with our new process.