Medscheme mauritius health outsourcing


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Medscheme mauritius health outsourcing

  1. 1. Medscheme International Presentation Mauritius2/6/2012 1
  2. 2. Medscheme Our vision“Creating a world of sustainable healthcare”
  3. 3. Proven 40-year track record of leadership in Southern Africa. Largest managed care provider and third largest healthcare administrator in Southern Africa. Introduction Medscheme €140 million annual turnover. 40% South Africa market share. More than 3,000,000 lives under management. Client base includes 32 leading medical schemes in public and private sectors. 22 offices across Africa and Mauritius. Highly capable and experienced management team.Our values 2 800 employees.“Integrity” International BPO operation in Mauritius
  4. 4. Medscheme Mauritius Established in Mauritius in 1982 Medscheme acquired 30% stake in 2001; 100% stake in Oct 2010 International BPO Only health insurance TPA in local market: •32% market share (63,000 members) International BPO facility established in 2007 (VHI): •Medical coding (ICD9 and ICD10) •Data capture & claims processing •Health care Administration (Mauritius since 1982) 146 employees, 2 shifts Current capacity for 450 seats over 3 shifts (but scalable) Proprietary health insurance system (Schema 6) – “system in a box”Our values Work on client systems via Citrix“Integrity”
  5. 5. Medscheme Mauritius and Medscheme International is a 100% subsidiary of Medscheme holdings (south Africa) A member of JSE listed Afro centric group. Our vision“Creating a world Medscheme Holdings of sustainable healthcare” Medscheme Medscheme Mauritius International Mauritian domestic market International BPO contracts
  6. 6. Medscheme operational Divisions Our vision“Creating a world of sustainable healthcare” Our Values“Empowerment”
  7. 7. André Meyer - Chief Executive Officer Leadership André joined Alexander Forbes Financial Services in 1987 as a Retirement Fund Consultant and subsequently transferred to Durban, where he headed the local MISSION Negotiated Benefits Unit for the company. STATEMENT He was appointed Divisional Director in 1991 and in 1997 was transferred to the Health Care Consultants Division as Deputy Managing Director later becoming joint Managing Director responsible for the Health Management Solutions and the We create access to Communications Division of Alexander Forbes. He also represented Alexander Forbes on the Board of FIHRST Management Services. sustainable, In April 2003, André was appointed as Medscheme’s CEO and, supported by the affordable, quality Executive and management teams steered the Group through the successful turnaround strategy and acquisition process. healthcare through the application of Lee Callakoppen - Executive Director: Human Capital innovation and Lee obtained a degree in Information Science from the Rand Afrikaans University in expertise, delivered 1997 and qualified as an Industrial Sociologist in 1999 after completing his honours. He then furthered his education in Business Management and is currently pursuing as an efficient, an LLB degree. seamless experience He began his career in operational management in the retail sector and later moved into Human Capital, holding positions in various industries ranging from retail to telecoms to media. Lee held the position of HR Executive for the Primedia Content Division before joining Medscheme in 2007. As Executive Director, Human Capital, he is responsible for the continued Our Values implementation of Lethimvula Healthcare’s strategy to become an employer of choice.“Accountability”
  8. 8. Anthony Pedersen – Managing Director: Medscheme International Anthony is a qualified Chartered Accountant having completed a Bachelor of Commerce and an Honours Bachelor of Accounting Science. He completed his Leadership training at Arthur Andersen and is a member of both the South African Institute of Chartered Accountants and the New Zealand Institute of Chartered MISSION Accountants. After a short time as Head of Internal Audit in the retail sector, Anthony joined STATEMENT Sovereign Health in May 1999 as General Manager of Finance and was subsequently appointed as Financial Director in 2001. Sovereign Health was acquired by the Momentum Group in 2005 at which time he became Chief We create access to Financial Officer of Momentum’s Group Benefit business cluster. In January 2007, Anthony relocated to Mauritius to establish a health insurance sustainable, business for Momentum. In this capacity, Anthony gained significant operational experience in the administration of health insurance plans and risk management. affordable, quality In October 2010 he joined Medscheme as Managing Director of both the Groups Mauritian operation (Administrators and Consultants Ltd) as well as the groups healthcare through International business based in Mauritius. In his current role, Anthony is responsible for driving the group’s strategy to the application of diversify the business into new markets. innovation and Head of International Business – Asia, Australasia & USA expertise, delivered Holds a MA, MBA degree with specialization in Finance, from university of Madras and national institute of management studies. Also a Certified Financial as an efficient, Planner with industry experience of over 9 years. Prabhu has rich Marketing & business development, project management, strategic planning experience seamless experience coupled with investments and corporate finance deep knowledge and understanding. He is also a member of prestigious professional associations, CII (UK)and CFA institute member. Currently he is pursuing his law degree from University of London (Exterior). At Medscheme he is responsible for international business development and Our Values market research for the following regions Asia, Australasia, United States. He is designated to champion and support new market entry and group strategy of Medscheme. His core international business activity is health care & insurance“Accountability” KPO new business acquisition and business retention. Prabhu is also executive management committee member for Medscheme international.
  9. 9. Medscheme International Services International Health Outsourcing Services Our values“Mutual Respect”
  10. 10. Medscheme Health TPA Service Client record management Contribution /premium management Health Administrative service Claims management(assessing) Client services (call center) Retention (out bound call center) Data and information Management offering Fund Management Financial Management Key accounts (pay point client services) Client walk in services Sales and Marketing Commissions Management Provider claims and queries management Fraud control & Audit“Innovation” Business & Market intelligence E- commerce
  11. 11. HEALTH INSURANCE CLAIM PROCESSING Claim processing Data image processing and capture Medscheme International Intelligence claim edit Claim screening and negotiating Claim auditing BPO service HIPAA standards management Revenue cycle Management Data entry & Data conversion Data verification Re –pricing and negotiation Provider contract interpretation Benefits validation High risk claim review Online updating Mailroom service Intelligence queue/data cleansing“quality service” Data mining and reporting Case management
  12. 12. MHRS – Medscheme Health Risk Solution Health Risk & Managed Care Hospital utilization management Managed oncology program Wellness program Counseling of high claimers Expertise Chronic medication management Managed radiology program Managed dental program Managed pathology program Alternative fee structure / re-imbursement Disease management Health risk assessment Specialists and GP networks Technology services and electronic medicine management“Innovation”
  13. 13. Benefit Management Cluster Health Benefit Management Hospital Optical Benefit HIV/AIDS Benefit Management Management Management Oncology Dental Benefit Benefit Management Management“Innovation”
  14. 14. Mauritius Key Facts : Favorable Outsourcing Climate GMT+4 hours Dutch colony; French colony; English colony; independence 1968 Mauritius Facts Constitution based on Westminster Parliamentary model Political stability; multi-party system – elections every 5 years Official language is English, but French & Creole mostly used Population of 1.28 million Freedom of religion; Hindu majority (65%) 29.2% of workforce below 30 years Favorable tax regime (15%flat rate) – 3% for international co’s 34 attractive double taxation agreements Free economy, no currency control“Innovation” Excellent connectivity – SAFE cable Low cost, well qualified workforce
  15. 15. Who can benefit from our services? Medscheme International Third party Administrators Who can benefit ? Insurance Companies Medical Billing Companies Managed care organizations Government organizations Private Practice Hospitals Pharmacies Pharmacy Benefit Management companies“Innovation”
  16. 16. Few names from our Valued client list Medscheme International Our clients“Quality” South Africa
  17. 17. Quality Business Back up Disaster Recovery Site Medscheme International Fully operational offsite data centre & disaster recovery Disaster Recovery site site at La Tour Koenig 2 hour recovery delay Daily data backup stored off-site Tested 3 times per annum Power redundancy UPS Generator power Connectivity redundancy 1 Mb Nomad backup line“Innovation”
  18. 18. Quality Medscheme International Quality Management System - ISO 9001:2008 accreditation Quality @ HIPAA Compliance SAS 70 certified Process Improvement - Six Sigma“Innovation”
  19. 19. Connectivity Leadership MISSION Medscheme STATEMENT Nomad VPN Nomad VPN International backup We create access to backup sustainable, affordable, quality MT line MT line healthcare through the application of innovation and expertise, delivered BT MPLS IS MPLS as an efficient, Client Port Louis organisation seamless experience Our Values“Accountability”
  20. 20. World-class technology and communications Salient facts: Technology •Total data storage capacity 256 TB. •Hardware partners are EMC, CICSO, AVAYA and UNISYS. •95% of software supplied by Oracle, Novell Linux and Microsoft. •Proven SAP integration to clients Proven hardware and and healthcare providers Full implementation of •Data in Disaster Recovery software optimised to deliver international best environment is on average 15 optimum benefits to both practice seconds behind our Production clients and the company. data. •One of the first companies globally to implement Oracle technologies to achieve operational storage efficiencies, using tiered storage on Oracle 11G. •All databases are running the latest version of Oracle 11G Release 2 - another first in the industry.“Innovation”
  21. 21. NEXUS IT – World class Health Technology Hospital Aid for Aids management Provider Nexus IT Medicine management management Disease management“Speed & System Excellence”
  22. 22. Key Financial Information Audited 16 Audited 12 Audited 12 Audited 12 months months months months MEDSCHEME 2010 2009 2008 Irish Health2007 €’000s €’000s €’000s €’000s NUMBERS Insurers Managed Care Revenue 146,699 78,943 88,606 101,204 Road Traffic Profit before taxation Accident Fund 16,227 7,934 6,261 11,932“Profitability &Performance ”
  23. 23. Your outsourcing Benefits Medscheme International Benefit of outsourcing minimize operations cost and maximize revenue. Example : Relief from employee expenses ,benefits and facility expenses. Access to specialized service which are not your core expertise functions On time service delivery Your valuable resource can focus on core competencies Great saving on infrastructure , software and technology cost Your business never sleeps. ( time zone benefit) Your business can handle any volumes because you have Medscheme international – “the Health Expert” can help you to address your growing business needs. Upto 40 % reduction on your business operations cost“Innovation”
  24. 24. Contact us MEDSCHEME Medscheme International 1st floor , Tower A 1Cyber city Ebene , Mauritius Irish Health Request Quote : Insurers Send your detailed project outsourcing requirement to Managed , Care if you wish to talk to our project team kindly reach @ +230 4231666 . Our vision“Creating a world of sustainable healthcare”
  25. 25. MEDSCHEME Irish Health Insurers Managed Care THANK Our vision YOUFund“Creating a world of sustainable healthcare”