Guiding members on their wellness journey

Medical aids need to be innovative and nimble with their healthcare offerings

Even before theCovid-19 pandemic, South Africans were strugglingwith risingunemployment anddeclining incomes. Addto thatspiralling utilitycosts,load-sheddingand fuelincreases andthingsare eventighter,financially,foreveryone.

When income is stretched, the decisions on where to spend and savebecome critical, includingwhether to spend hard-earned income on privatehealthcare.

Thisissomethingthatmedical schemes havelong been grapplingwith.

It means,says LeeCallakoppen,principal officeratBonitasMedical Fund,beinginnovativeand nimblewithhealthcareofferings.

“Wehavetriedtokeepthings simpleandeasytounderstand, with plans structuredto meet a diverse rangeof quality healthcare optionsthat are easier onthe pocket,” he says. Bonitas hasa strongpresence inall sectorsof thehealthcare market,witha widerangeof plans that appeal across all demographicsand incomecategories. This allowsfor greater freedomof choiceformembersandpotentialmembers.

Callakoppen saysthe roleof private medical aidshas neededtochange.Inadditiontocollecting member contributions and paying claims, schemes areincreasinglyinvolvedinassistingmembers ontheirwellnessjourney.

“Our core focus is to ensure thatwe actin ourmembers bestinterestsatalltimes it’s multifacetedand coversvarious aspects, including creating valuevia anoutcome-based healthcaremodel aswellas partnering withhealthcare providers to improve clinical outcomes.We thereforeplaya more critical role as a healthcare partner to our members ontheirjourneytowellness.”

Bonitas, hesays, isa medical aidforall SouthAfricans notjustcertainsegmentsorincomegroups.

“We havea responsibilityto be proactivein termsof guiding memberstowards livinga healthier lifestyle. And, to do this, we needto take cognisanceof allsocioeconomicfactors affectingSouth Africans. Issuessuch aspoverty,unemployment, mentalhealth and gender-based violenceare affectedbyhealth careandmust thereforebeconsideredwithin thebroadervaluechain.”

It is for this reason, he says, thattheschemeintroducedEfficiency DiscountedOptions (EDOs).

These plans use network healthcare providersand members payabout 15%less for thesame benefits.EDOs currently covermore than 70,000lives.

“Our model is clear: Ensuring members can find a network GP closeto either their homeorplaceofworkthrough anenhanced providerlocator. The network GP then pre-