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Integrated Disease Management

Medscheme’s Integrated Disease Management Programme encompasses both the management of high risk members through our Beneficiary Risk Management programme and the management and support of Oncology cases through our Oncology Disease Management programme.

Beneficiary Risk Management (BRM):

This award winning programme was developed using sound actuarial and scientific predictive modelling principles to identify members with multiple chronic conditions and a high chance of hospitalisation.

The identified members are contacted regularly by our health coaches who assist in co-ordinating access to appropriate care whilst ensuring that the member has access to sufficient benefits to manage their chronic condition, as well as educate, encourage and empower the member to make certain lifestyle changes so that they take responsibility for their own health and wellness. We also provide access to a targeted and educational health portal that empowers members with useful information at their fingertips. Pertinent information is also shared with the member’s chosen doctor (on consent) and members are referred to their doctor for follow up consultations as needed. These actions ensure that the doctor is an integral part of managing the member back to health.

Our BRM programme generates financial savings and fuels appropriate health-seeking behaviour which has positive long-term consequences for the member and our administered Schemes. Members on this programme demonstrate a decrease in hospital admissions (emergency and medical admissions), an increase in pharmacy visits (improved compliance), increased compliance with follow-up visits with their doctor and increased use of psychology services. In this way we are not just managing hospital spend by negotiating lower rates, but also curtailing preventable hospital utilisation, which is why this programme has shown demonstrable savings and positive long-term health benefits for members and our administered Schemes.

Oncology Disease Management:

This programme adds value by ensuring that members access funding for appropriate and cost-effective Oncology therapy before, during and after active treatment. The member is also supported with educational material and advice and provided access to the most appropriate treatment while ensuring that medical inflation is contained. Complex or unusual patient-specific requirements are managed on a case-by-case basis with a strong focus on guiding the member through this challenging period.

Contact Medscheme

+27 11 671 2000

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