Interview with Neo Khauoe, Principal Officer, POLMED

Interview with Neo Khauoe, Principal Officer, POLMED

Neo Khauoe Principal Officer, POLMED

The South African Police Service Medical Scheme (“POLMED”/” Scheme”) is one of the medical schemes established in 1964 by laws for security services. POLMED is established in terms of the South African Police Service Act, 1995 (Act 68 of 1995) (“SAPS Act”) as amended.

Please unpack the history of Polmed and the services the company offers

In 2000, POLMED registered with the Council for Medical Schemes (“CMS”) as a closed medical scheme under the Medical Schemes Act (Act 131 of 1998). Only employees of the SAPS appointed under the SAPS Act, their dependents and continuation members are eligible to be members of POLMED.

POLMED, in line with the definition of “business of a medical scheme in the Medical Schemes Act”, raises its revenue through premiums collected from its members. POLMED, in return for premiums, must provide relevant health care or pay on behalf of a member for relevant health services in line with POLMED’s approved Scheme rules.

POLMED’s Board of Trustees (BOT) approved a medium to a longterm strategic objective to change the Scheme’s business model from a fully-fledged insurance scheme to one where aspects of a Health Maintenance Organisation (“HMO”) will be included. The primary feature of HMO and an insurance health model is that the HMO insources and focuses more on primary and preventative measures to ensure members remain as healthy as possible for as long as possible and prevent costly hospital admissions.

POLMED’s members have access to wellness programmes where primary and preventative measures are accessed via annual health risk assessments including the full immunisation schedule as defined by the National Department of Health.

A new Member Engagement and Experience division has been created in POLMED to focus on educating members in selfmanaging their specifically identified diseases based on the members’ claims profiles and geographic distribution.

POLMED’s website assists members with most administrative and logistical information such as a provider search tool where members can search for a network provider closest to their residence. This is one of the ways POLMED harnesses technology to improve access to health.

What are the company's flagship programmes?

POLMED has two benefit options, namely the Aquarium and Marine plans.

The Marine plan is the largest of the two plans, attracting 61% of the 178 809 Principal members that are registered on POLMED.

The Marine plan is POLMED’s flagship programme where members enjoy benefits in excess of the minimum requirements as stipulated in the Prescribed Minimum Benefits, for example:

• Chronic medication to chronic diseases

• Specialised medication (biologicals)

• Continuous glucose monitoring devices

• Open hospital network (members are not restricted to accessing certain hospitals)

• Cochlear implants

• Home-based care

• Motorised wheelchairs

• Extensive specialised dentistry

• Ex Gratia benefits AD

As principal officer what are your key responsibilities?

I am the accounting officer of the Scheme and therefore, accountable for the following:

• All statutory and administrative functions of the Scheme to ensure the carrying out of all duties as required for the proper execution of the business of the medical Scheme.

• The supervision of the officers employed by the Scheme.

• The collection of and accounting for all monies received and payments authorised by and made on behalf of the Scheme.

• To keep full and proper records of all monies received and expenses incurred by, and of all assets, liabilities and financial transactions of the Scheme.

• Ensure that annual financial statements are prepared and are in compliance with all applicable statutory requirements.

• To effectively manage the investments, other assets and liabilities of the Scheme to take all reasonable steps to protect the confidentiality of medical records concerning a beneficiary’s state of health.

With More than 25 years of experience, What, in your opinion, have been the biggest changes in the healthcare industry?

The biggest change that has had the most profound impact on patient outcomes is the introduction of new technology across all clinical specialities. Diseases that were deemed fatal a few years ago are now being treated like any other chronic disease. Here I am referring to HIV treatment.

Diabetes mellitus is considered to be one of the most prevalent diseases in the 21st century with approximately 422 million sufferers worldwide. Management of the disease has changed dramatically over the last two decades. Artificial pancreas that detects abnormal sugar levels and automatically adjusts Insulin secretion are implanted in Type I diabetics patients with excellent results.

Continuous glucose monitoring devices that measure one`s glucose level without requiring finger pricks are readily available even though they are currently not as affordable for the majority of members.

An implantable cardioverter defibrillator (ICD) is a small battery-powered device placed in the chest to detect and stop an irregular heartbeat and deliver electric shocks when needed to restore regular heart rhythm.

There is an enormous amount of resources being pumped into research to treat cancer and auto-immune diseases. Amongst the research being conducted in the implementation of nanotechnology and genetic modification with excellent results. However, it must be pointed out that this new technology and advances come at a cost that is in most cases not affordable to most patients.

What have been your most memorable milestones as principal officer at POLMED?

In 2015, when I joined POLMED the Scheme was battling with stakeholder relations at all levels. POLMED as a result had tumultuous Annual General Meetings (AGMs). Despite good solvency and the fact that I was the new Principal Officer, and the Board of Trustees was new, the regulator attempted several times to place POLMED under the control of a curator. With studious patience and effort, performance over the years has drastically improved, growth in member funds despite lower-than-inflation member contributions increasing annually. POLMED has also strengthened its provider network and draws on this support to treat POLMED members.

Stakeholder relationship improvement across all spectra including hosting successful AGMs after many years of challenging times around that area is a testimony of this milestone.

During the State of Disaster, Police were required to be on duty to enforce the lockdown. However, unlike health workers, Police were not prioritised as frontline responders and were not among the first to be vaccinated. POLMED successfully championed vaccination of its members at their respective work areas and succeeded in boosting many of its members’ immune systems by providing multivitamins.

During the COVID-19 pandemic, POLMED members had quarantine and isolation sites for their exclusive use, this eased the infection rate from members to their families.

We also participated in the KZN flood drive, providing relief to 100 members and their families after they were adversely affected by the devasting floods. As part of innovative care, the Scheme implemented weight loss and smoking cessation programmes in 2022. These unique activities are intended to empower and equip members to live healthier lives.

In October 2022, the Scheme hosted a health symposium for its members and stakeholders.

Please share with us what excites you about what you do

I entered the healthcare industry driven by love and compassion for people. I thought nursing would be the perfect opportunity to lend a helping hand. I still cherish my experience of working with the most vulnerable in society and it has given me rich insights into what the majority of our people have to go through in life and how they need to be supported.

This sense of love and compassion continues to drive me every day and makes me love what I do. When I see how our police officers work tirelessly to protect and serve our country and its people, I count it as a privilege and honour to be the accounting officer responsible for putting together the health benefits that will take care of them in times of need.

Furthermore, it is gratifying to head a Scheme with a model whose basic premise is to create value for stakeholders without motivation for profit, and yet we continue to show impressive growth. Starting with 235 940 insured lives in 2000, the Scheme now covers 492 508 lives, an increase of around 100.8%, making it the fourth largest medical Scheme in South Africa. Even in the challenging economic environment, POLMED still offers comprehensive benefits and cost-effective contributions.

Based on an independent actuarial analysis that was performed in 2022 utilising the Signal model tool, the Aquarium plan was identified as the most cost-effective plan in the country, taking into consideration the premiums that members pay versus the benefits that they have access to. POLMED is proud of being one of the medical schemes with the lowest non-healthcare expenses of 3.61% in the country. The Scheme is in a good financial position which is evident based on the relatively low member contribution increases that were approved by the BOT for 2023/2024.

Understanding the risks that the police face and balancing access, cost and affordability are interesting aspects of my role. When I resolve complex medical issues, leaving our members delighted, I become elated too and wish there were 36 hours in a day so that I could deliver even more service to members. Having worked for more than 11 years with POLMED members in different roles is one of the highlights of my career.

How important are ESG principles to Polmed and what are some of the key policies that reflect a commitment to the sustainability of the environment, social issues and good, clean governance?

As a non-profit organisation, POLMED appreciates the role it plays in ensuring a safe environment as part of its social responsibility and sound governance principles in business operations.

As a result, ESG is embedded in the Scheme through our responsible business practices and initiatives, to highlight a few:

• Reducing our paper usage by issuing all trustees with the necessary hardware and software to conduct their duties electronically without the need to print any documents.

• Providing relief services and support to members during natural disasters and flooding.

• Providing internship opportunities to the children of “Fallen Heroes” (SAPS members that passed on while on duty).

• Empowering black-owned enterprises, and specifically black women-owned enterprises within our supply chain.

• Empowering women in the workplace, with almost 70% of the POLMED workforce being female.

• Working closely with SAPS and labour unions (POPCRU and SAPU) to understand the demanding realities of police work and to serve as a community anchor not only for our members’ medical needs but their holistic well-being.

Do you have exciting plans for 2023?

POLMED’s BOT has approved three strategic themes that will be considered and implemented for the medium to long term namely:

• Repositioning of the Scheme as an exempted Security Services Medical Scheme from the Medical Schemes Act and NHI Bill in compliance with Section 199 of the Constitution.

• Migrating from an outsource to insource business operating model (Vertical Integration) -Self Administration, Data Warehouse solution, Wellness Health Centres and Health Maintenance Organisation.

• Investigate introducing an efficiency discount option (EDO) for cost containment.

• Continue to lobby for an increase in employer contribution in line with medical inflation and member growth.

As we continue to implement the new structure, it is exciting to observe the capabilities of the new employees that we have employed. Most of whom are highly qualified, driven, hardworking and curious to change how POLMED members’ quality of life can be improved.

POLMED strives for high performance, ethical behaviour, and a culture of zero tolerance for fraudulent activities. Our values of respect, care, response and collaboration are central to our daily activities.

Lastly, we look forward to an improved and collaborative relationship with our regulator.

Please share a message of inspiration with our readers.

My advice would be that everyone should strive to have a curious mind, be inquisitive, and challenge the status quo. For us to change the goal post and stretch ourselves, we must endeavour for constant innovative improvement. We need curious minds that are determined to bring out change. Polmed