Managed Care Services
Managed Healthcare brings critical value-add to our members by integrating healthcare with technology through our patient-centred model. With over 40 years' in the healthcare industry enables us to deliver:
The best in-class administrative and managed-care services for our clients and their members with a value-added service offering aimed at ensuring streamlined, efficient, and cost-saving processes in Hospital Benefit Management, Pharmacy Benefit Management, Disease Risk Management and Oncology Management.
This outcomes-based approach is provided to members through a preventative-care approach focused on member-centricity.
A comprehensive managed-care service offering is enabled by an agile, innovative IT platform using technology to integrate managed care with patient-centric care.
Our managed-care programmes endeavour to improve quality of life and reduce morbidity and mortality.
Chronic Medicine Management
The Key elements of our Pharmacy Benefit Management programme include:
- A focus on cost (utilisation and price) savings through the use of formulas, generic reference pricing and exclusion lists, as well as treatment algorithms/plans (developed with clinical integrity/expertise/experience and independent of any vested interests) that can be used to customise options.
- A focus on implementing funding rules that do not compromise access to appropriate diagnosis and treatment, hence not compromising quality of care.
- In order to facilitate care for the beneficiary, our intelligent IT platform identifies beneficiaries claiming chronic medicines off their acute benefit while providing real-time messages, which are sent to the pharmacy to prompt registration on the programme.
- The ability to appropriately evaluate and manage exceptions and exceptional or complex cases through the support of an established medical adviser support infrastructure.
The member-centricity of the programme has been ensured by promoting a single entry point for members to contact us. Our highly skilled clinical team, supported by a medical adviser, focuses on high-cost and high-risk incidences. Our interventions include ensuring the provision of appropriate care at the appropriate facility by the appropriate service provider, thus ensuring the cost of utilisation in the hospital environment is managed.
Disease Risk Management
Our Disease Risk Management programme focuses on prevention interventions to improve quality of life and reduce morbidity and mortality.
- Oncology Risk Management
- Provider Management
- Member Profiling
- Clinical Support Initiatives and Programmes
- Management Information Services
The HIV/AIDS Management Programme allows early identification of the HIV disease, ensuring optimal and sound clinical interventions to those affected by or infected with HIV/AIDS. The programme also promotes control of the disease by making treatment available and accessible while ensuring that affected members fully understand their medical aid HIV benefits. The key aim of the programme is to reduce morbidity and mortality and improve the quality of life for all patients while ensuring ongoing education, counselling and advice on nutrition in strict confidence.
By joining this programme, members gain:
- Access to benefits that cover the cost of HIV/AIDS-related treatments, including antiretroviral medicines and blood tests.
- Access to qualified, specialised well-care managers who provide counselling, advice and support.
- Access to dedicated and confidential helpline.
- Other wellness healthcare programs.
We make extensive use of the latest technology to integrate managed care with patient care. As various platforms share the same underlying databases, 3Sixty Health can provide sophisticated data management and powerful reporting tools to identify unfavourable practice profiles for both providers and members.