Naspers Medical Fund has been able to meet new and emerging medical administration legislation ahead of demand through its relationship with MIP, the financial services software specialist.
This has been made possible through buying into MIP`s billing model, allowing Naspers Medical Fund upgrades, customisation, maintenance, support and user training for a fixed monthly, per-member fee.
"Critics from the larger open schemes said that it couldn`t be done," says Janine Louw, principal officer at Naspers Medical Fund. "But self-administration has really paid off for us with the support we get from the MIP team and their understanding of our business. We have been running the system for five years and it has improved with time. It has been a really good move."
Circular 8 is just one change proposed by government; it revises the prescribed minimum benefits (PMB) to define minimum mandatory benefits for all medical schemes. All medical schemes will also contribute to a risk equalisation fund (REF) to compensate schemes with large numbers of high-risk members.
"With the new government changes in the form of the REF it is going to become impossible for administrators to continue charging on the old basis," says Richard Firth, CEO and chairman of MIP. "The model will change as the administrators take more risk and the government begins to decide on the benefit packages. This is an important shift as the scheme or administrator will no longer use actuaries to define a benefit package but will have to offer a basic set of minimum benefits in the future. This will obviously reduce margin and therefore all administrators and schemes will need to review internal costs, the largest being IT, to remain sustainably profitable."
"The past saw a more financial approach to medical administration, but now the registrar requires an additional and critical clinical component," says Stuart Watson, regional manager at MIP in Cape Town. "Our software has that component and due to our model, Naspers Medical Fund has it running at its Cape Town office. Many larger organisations don`t have this yet because they don`t control their own medical administration software as Naspers does, and they don`t have access to rapid customisation skills."
The Naspers Medical Fund administers 4 100 principal members and over 9 200 lives. MIP`s Healthcare Application Software was first deployed at the business in 2001 on Sun Microsystems equipment and replaced a bespoke system. It continues to serve all operations and is a comprehensive system that includes everything from member management, through claims assessment, accounting, statistical and statutory reporting, to client services.
At the time Louw said: "We chose [MIP`s Healthcare Application Software] because of its feature-rich functionality and close fit to our requirements. Other systems we viewed were either as rigid as our old system or too expensive for a small corporate medical fund such as ours. We wanted to get away from the mainframe environment and into the flexibility of open systems. [MIP`s Healthcare Application Software met] both criteria."
The fixed, per-member fee does not place an onerous financial burden on smaller schemes or administrators. It does serve up a smorgasbord of services that include the use of the administration program, related database software, and any changes due either to altered benefits, rules or the need for additional information to improve management control.
"It integrates to payroll, online pharmacy benefits, third-party banking systems, and managed care systems at MSO," says Watson. "Naspers Medical Fund has access to its data for ad hoc reporting and what-if scenarios with third-party tools for interrogating the database and for dealing with the risk equalisation fund. It is supported by MIP at a known monthly fee and is a prime example of a restricted scheme that can administer itself efficiently and cost-effectively to retain control of its future and pass on the cost savings to its members."
Share
Editorial contacts