Medical aid administrator Medscheme has appointed a new CIO and initiated a strategy that will see a different IT solution for each of its three main business units.
The new strategy was established immediately after management changes within Medscheme in April. CEO Andre Meyer took the helm of the company on 1 April and with him came Kevin Wright as chief information officer, replacing Hankie Vogel.
Medscheme has grouped the medical aids that it administers into three main business units: open (commercial) schemes, closed schemes that relate to specific organisations, and state-related schemes. Each requires a different level of administrative support and IT complexity. Legislation relating to medical aids and the scheme`s own rules add to the overall complexity and administration burden.
While Medscheme has followed the industry trend of developing its own software, it has since decided to look outside to obtain certain systems. It is deploying its own Sovereign system to administer certain schemes such as the NMP, Topmed, Meridian and the recently launched Momentum Health. The legacy system, Pulse, is used to administer the less complex medical aids, while the Medware system developed by Neil Harvey & Associates (NHA) has been earmarked for the commercial schemes.
"A decision was taken to keep the Sovereign system and its staff focused on the existing 135 000 Sovereign-administered families, and is expected to grow by between 4 000 to 7 000 members per month," Meyer says.
The Pulse system, which is the oldest, can cope with the state medical schemes that have high processing requirements but tight margins, he says. More than 1.4 million members and dependents are administrated with this system.
The NHA system is able to cope with the more complex environment of the commercial medical schemes, where a considerable amount of product differentiation occurs and each is inclined to have its own set of rules.
"In the long run, we feel that the increased efficiencies we will obtain through the various systems will help contain costs and improve service," Meyer says.
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