+ All Categories
Home > Documents > MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019...

MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019...

Date post: 04-Mar-2021
Category:
Upload: others
View: 1 times
Download: 0 times
Share this document with a friend
66
2021 Benefit and Contribution Launch 06 October 2020 MORE THAN A MEMBER. MORE WITH BANKMED. MORE COVER
Transcript
Page 1: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

2021 Benefit and Contribution Launch

06 October 2020

MORE THAN A MEMBER. MORE WITH BANKMED.

MORE COVER

Page 2: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Agenda

01 Bankmed Value Proposition

02 Industry Matters

03 Bankmed Financials

04 2021 Contribution Increases

05 Plan Structure

06 2021 Benefit Enhancements

07 2019 Health Quality Assessment Results

08 Communications Overview

09 Client Management

10 Q and A

Page 3: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

3

Value Proposition

Page 4: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Partnership in Health and Wellness

Exclusivity and Responsiveness(Closed Scheme)

38% Better Value in 2020 (NMG)

Better Quality (HQA)

Financial Stability(GCR)

Technology and Innovationas Enablers

Commitment to Best-of-Class Member Experience

Page 5: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Our financial stability allows us to

maintain value for our members

Our partnership spans over

more than 100 years- and we are

still going strong

VS

2018 Annual Financial Statements

2019: 40.5%

2018 Council for Medical Schemes Annual Report;The average for restricted schemes in 2018 was 41.9%

Industry average

38.7% 34.5%

Solvency ratio

Page 6: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Non-healthcare costs 2018

VS

2019: 4.8%

Industry average

4.9% 8.2%Non-healthcare

expenses are the costs associated with running

the Scheme e.g. administration and general

administration expenses

Your money is

spent on you

Page 7: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Industry Matters

Page 8: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

General Industry Update

1

2

3

4

5

Bankmed continues to stay close to industry developments

Member of the Health Funders Association (HFA)

Participating proactively to influence howthe healthcare landscape changes

COVID-19 dominating industry deliberations

Bankmed has been diligent in its own response to COVID-19

Page 9: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed’s Response to COVID-19

Page 10: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Details of Bankmed’s response is available on the Scheme’s websiteThe Scheme’s response includes the following:

Tests paid for from insured benefits

COVID-19 Isolation Hotel benefit

Relaxation of networks, specifically

for COVID-19

In-and-out of hospital cost of treatment paid from insured benefits

Pulse Oximeter and additional consultations for

high risk members

Virtual and Telephonic

consultations

Page 11: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

4 342

610251

419

697

87

173

136

131

BANKMED CONFIRMED CASES | 6 846 | 29 September 2020COVID-19 cases by Province

*We have extended the definition of confirmed positive members to also include admissions coded with U07.1 but not confirmed through pathology testing yet

COVID-19 clinical tracker

Tests conducted

Positive members

COVID admitted members

Recoveries Deaths

SA

Bankmed 90443 036 6 846 1106 548

4 152 480 671 669 604 478 16 586-

13.2%Proportion admitted

95.6% Recovery rate(DH: 94.3%)

90.0% National recovery rate

1.6% Case fatality rate

(DH: 2.2%)

2.5% Nationalcase fatality rate

Page 12: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed COVID-19 experience

As at 29 September

1 014admissions

78Ventilator

admissions in ICU

Source: Internal analysis

Distribution by age and chronicity Admissions for COVID-19 positive members

150 ICU

admissions

Admission costs

Completed Admissions Total cost Average

CostAverage Length

of stayDeath rate

Other Wards 651 R 28 236 682 R 43 374 6.6 4.8%

High Care 158 R 17 737 330 R 112 262 9.7 5.9%

ICU 71 R 21 199 023 R 298 578 16.6 34.8%

Ventilation 79 R 33 867 578 R 428 704 18.8 68.8%

Total 959 R 101 040 613 R 105 360 8.9 12.5%

904Members admitted

210 278

1086

2115

693227

528

526

3992340

1000

2000

3000

0-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80+Age Band

Distribution of positive members by age and chronicity

Y N

97% 97% 98% 98% 96% 93% 85% 76% 77%

3%6%

10% 8%

8% 14% 15%

0%

20%

40%

60%

80%

100%

120%

0-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80+

Distribution of positive members by current status

Deceased Active Recovered

Page 13: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Utilisation of Virtual and Telephonic Consultations

Consultation Type January to June 2020

July 2020 August 2020 September 2020

Virtual Consultations 135 96 45 22

Telephonic Consultations 4 069 2 755 1 271 673

Utilisation of Isolation Hotel Benefit

June 2020 July 2020 August 2020 September 2020

Number ofMembers

13 15 5 0

Number of Days 105 116 24 0

Pulse Oximeter Uptake

August 2020

September2020

Number of Approved Pulse Oximeters

424 59

Page 14: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

1

2

3

4

5

Bankmed is an active participant in these discussions

Final report on the Health Market Inquiry (HMI) released in September 2019: But focus shifted to COVID-19

COVID-19 also generated many views about the National Health Insurance (NHI): • Will implementation be accelerated?• Has COVID-19 made it impossible to prioritise NHI?

Bankmed’s view: COVID-19 has imposed many lessons that are useful for solutions that we really need in the future, and we intend to stay engaged and contribute to the desired solution, in the best interest of our members

Other Industry Developments

Variety of other industry conversations underway, relating to legislation and regulations in the healthcare industry

Page 15: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed Financials

Page 16: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

1

3

4

5

Bankmed’s Invested Reserves

The Two Key Financial Ratios

The Financial Mechanics of Bankmed

Reserve Management

Summary

Financials

Members Savings Accounts2

6

Page 17: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

1

2

3

4

5

YTD July: R3.65bn reserves invested

Two additional multi-asset managers introduced in March 2019, in order to further diversify investment manager skill

Four multi-asset managers: INVESTEC, PRUDENTIAL, ALLAN GRAY and ABAX, andone Money Market manager: TAQUANTA

Overall benchmark, related to medical inflation, amounts to CPI + 3.5% over a rolling 3-year period

Due to ongoing economic conditions, the benchmarkhas not been attained over the last 5 years

Bankmed’s Investments

17

6Bankmed’s Investment Committee closely monitors the performance of the individual investment managers, and the overall investment strategy of the Scheme

Page 18: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Applies to the Core Saver, Comprehensive and Plus Plans only

Consists of contributions paid by members which are allocated to a members savings account and held there to settle certain healthcare costs that aren’t paid from Insured Benefits

Although the member pays monthly contributions in this the regard, Bankmed offers the total annual benefit for utilisation as at 1 January

Bankmed’s practice in this regard creates a risk of creating member debt to the Scheme, in the form of savings claw-backs

The interest is calculated on a monthly basis , but credited to the members savings accounts once annually

Members Savings Accounts

Bankmed allocates 50% of the interest rate earned on the Scheme’s money market portfolio to the members, although there is no obligation to pay members any interest

50%

Page 19: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

The Financial Mechanics of Bankmed

GROSS CONTRIBUTIONS RECEIVED (including savings)

NET CONTRIBUTIONS INCOME

RELEVANT HEALTHCARE CLAIMS EXPENDITURE

INSURED HEALTHCARE CLAIMS (Non Savings)

RISK TRANSFER ARRANGMENT PREMIUMS

MANAGED CARE EXPENDITURE

Hospital CostsDoctors

Medication etc.

Premiums to provider who then commits to cover certain healthcare

expenditure for the year

Fees paid to service providers who conduct managed care initiatives in

order to contain healthcare costs

LESS: SAVINGS CONTRIBUTIONSWhat comes into the Scheme?

What is paid from the Scheme on

Medical Costs?

Page 20: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

GROSS HEALTHCARE RESULT

INVESTMENT INCOME

OPERATING DEFICIT

NET RESULT

NON-HEALTHCARE EXPENDITURE

• Administration Fees• Scheme Management Costs

20

The Financial Mechanics of Bankmed (cont.)

What is paid by the Scheme on Administration

Costs (Delivery Costs)?

Reservesat work

Value to members

Page 21: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Accumulated Reserves / Annual Contributions

• Key indicator of financial health, with statutory minimum of 25%

• Balance between sufficient reserves and using excess reserves to the benefit of members

The Two Key Financial Ratios

Operating Deficit / Annual Contributions

• Incur operating losses to the benefit of members which investment income must cover

Reserve Ratio

Operating Ratio

Page 22: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Reserve Management Strategy

To maintain the required level of

reserves to ensure long term financial

sustainability of the Scheme

Bankmed’s required reserve ratio is

between 35%-40%

The upper end of required reserve

ratio was maintained in 2019, at 40.5%

(38.7%: 2018)

The actuarially forecasted reserve ratio as at the end of 2020 is 46.6%,

due to the unusually low claims

experience resulting from the COVID-19

lock-down measures.

The budgets for the years thereafter will

be aimed at stabilising the

reserve ratio at approximately 38%

Page 23: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

RatioYear Reserve Ratio

2016 40.1 %

2017 38.8 %

2018 38.7 %

2019 39.2 %

2020 (forecast) 46.6 %

2021 (budgeted) 38.2%

Reserve Management Strategy (cont.)

Page 24: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Summary

1

2

3

4

To keep contribution increases low while maintaining rich benefits, the Scheme needs to run sustainable operating deficits

To run sustainable deficits the Scheme’s reserve levels need to be adequate in order to produce the required investment returns

The required investment returns must be sufficient to cover the planned operating deficits and grow reserves adequately to keep the Reserve Ratio stable

During times when investments areperforming poorly, a Scheme has to generate savings elsewhere by utilising effective managed care initiatives and other cost cutting techniques.

Page 25: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Summary (cont.)

1

2

3

Regardless of low investment returns, Bankmed has performed well enough over the past few years, to maintain stable contribution increases

This has been achieved by savings generated on claims expenditure via effective managed care initiatives and favourable provider tariff negotiations

Overall, Bankmed is well managed and financially sound, which is confirmed by its AA+ credit rating

Page 26: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

2021 Contribution Increases

Page 27: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Average Contribution Increases 2021 Other Medical Schemes

Fedhealth

8.8%

DHMS

0% (6/12)

Bonitas

4.6%

Momentum Health Medical Scheme

3.9%

CAMAF

3.5%

BestMed

4.0%

KeyHealth

5.0%

0% increase for the first 6 months of the year after which a 5,9% increase will be implemented

MedShield

5.9%

Page 28: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

28

Annual Increase Comparisons

8,98,6

10,6

8 7,8

10,2

11

11,9

10,7

7,97,98,3

8,7

7,78,1

9,2

8,2

8,9

10,7

7,9

9,5

8,2

9,9

7,3 7,3

0

3,9

4,6

3,5 3,6

0

2

4

6

8

10

12

14

DHMS Momentum Bonitas CAMAF Bankmed

2016 2017 2018 2019 2020 2021

*

* 0% increase for the first 6 months of the year after which a 5,9% increase will be implemented

Page 29: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Annual limits of many medical categories were increased generally by 4.5%

Plan 2015 Increase

2016 Increase

2017 Increase

2018 Increase

2019 Increase

2020 Increase

2021 Increase

Essential 3% 5% 6.5% 6% 5.5% 5% 2.5%

Basic 6% 5% 6.5% 6.5% 6.5% 6% 2.5%

Core Saver 6% 6% 7.5% 7.5% 7.4% 7% 3.5%

Traditional 7.5% 7.8% 8% 8.25% 7.4% 7% 3.5%

Comprehensive 8.5% 8.5% 8% 8.5% 8.5% 7.8% 3.9%

Plus 9% 9.5% 9% 8.75% 9% 8% 3.9%

Average 7.9% 7.8% 7.9% 8.1% 7.9% 7.3% 3.6%

2021 Bankmed Contribution Increases

Page 30: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Plan structure

Page 31: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

A Plan to suit everyone

Comprehensive range of benefits paid from both insuredand savings out-of-hospital

Wide range of benefits with annual sub-limits for day-to-day expenses. Network Plan

Hospital plan with a savings component for day-to-day expenses

Wide range of primary care benefits (including non PMBs) available via GP Entry Plan Network

Lean, low cost Plan. Benefits limited to PMBs only available via GP Entry Plan Network

Top of range Plan with savings and an ATB(safety net) for when savings are exhausted

Essential

Core Saver

Plus

Comprehensive

Co

ntr

ibu

tio

ns

Benefit range and specific networks

Wellness and Preventive Care

Managed Care ProgrammesWellness-Based Incentive Programme

Bankmed Balance available to all members

Traditional

Basic

Page 32: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Essential and Basic Plan Overview

Plan Benefits Essential Plan Basic Plan

Positioned forEntry level Plan, suited for low healthcare needs.

PMB cover onlyLow contribution Plan with IH and OH benefits

and chronic disease benefits

Wellness and Preventative Care Benefits Rich spectrum, expect for contraception Rich spectrum

Restricted GP Network Yes Yes

Specialist Network Yes Yes

GP Specialist Referral Yes Yes

Hospital NetworkYes Yes

Pathology, Radiology and Medication Restricted formularies

Managed Care Programmes HIV Programme and Oncology Programme: PMB level of cover only

Optometry Benefit No Isoleso Optometry Network

Basic Dentistry No Yes

Page 33: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

33

Core Saver, Traditional, Comprehensive and Plus Plan Overview

Plan Benefits Core Saver Plan Traditional Plan Comprehensive Plan Plus Plan

Positioned for

Young, healthy members with relatively low healthcare needs.

Limited MSA for day-to-day expenses

Plan provides comprehensive medical cover to meet moderate

to high healthcare needs. Network Plan.

Plan suitable for moderate to high healthcare needs for members who want a savings component

Designed for moderate to high healthcare needs for

members who want a savings component and ATB

Wellness and Preventative Care Benefits

Rich spectrum Rich spectrum Rich spectrum Rich spectrum

Medical Savings Account Yes No Yes MSA + ATB

GP Network Yes Yes Yes Yes

Specialist Network Yes Yes Yes Yes

GP Specialist Referral Yes Yes No No

Hospital NetworkNo Yes No No

Managed Care Programmes PMB level of cover Cover for both PMBs and Non-PMBs subject to pre-authorisation

Optometry Benefit Subject to MSA Insured Insured / MSA MSA / ATB

Basic Dentistry Subject to MSA Insured Insured MSA / ATB

Dental Admissions Emergency/PMB cover only R1 950 deductible

Page 34: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

2021 Benefit Enhancements

Page 35: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

The principles behind the annual review include the following:

1

2

3

4

5

To enhance benefits/innovation - these do come at a cost but are necessary to remain competitive and be the medical scheme of choice for the banking industry

To optimise Risk Management in order to keep contribution increases as low as possible

To consider a tiered differentiation in benefits between Plans especially for the “discretionary benefits” where members perceive value and would therefore consider higher premiums justifiable

To lower out of pocket payments

To improve member experience

Page 36: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

2021 Enhancements informed by

Minimal enhancements in favour of lower

contribution increases due to the state of the

economy

COVID-19: Lockdown/Job

insecurity/Isolation

Mental Health issues on an

incline

Member-centric philosophy of

Bankmed

Employer Group requests

Page 37: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

• Mental health disorders are emerging as the number one cost driver in the healthcare sector

• The impact of mental illness is not only felt in the healthcare sector. It is also the largest contributor to global disability and accounts for 10 billion days of work lost on an annual basis

• The most common condition within the mental illness cluster is depression, typically accounting for greater than 50% of all members registered with a mental illness and more than 50% of total spend on mental health disorders

Mental Health Disorders

Page 38: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

• “As many as one in six South Africans suffer from anxiety, depression or substance-use problems (and this does not include more serious conditions such as bipolar mood disorder or schizophrenia), according to statistics released by the South African Depression andAnxiety Group (SADAG)”

• Previously the focus was on four chronic diseases (cardiovascular, diabetes, respiratory and cancer) that contributes to 60% of deaths. The focus currently is on five chronic diseases that contributes to 75% of deaths, the fifth one being Mental Health

• The very concerning incline in Mental Health conditions is certainly• Impacting productivity of the employee base due to absenteeism and presenteeism• Impacting the claiming patterns• Impacting scheme sustainability

Mental Health Disorders

Page 39: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

The Social Impact of Mental Illness on South African patients

• 17% cannot take care of dependents

• 26% are separated or divorced

• 47% lose friends (a key part of their support network)

• 49% experience negative family relationships

• Only 27% of South Africans reporting severe mental illness ever receive treatment. This means that nearly three-quarters of these sufferers are not accessing any form of mental health care at all

• South Africa has one of the highest rates of gender-based violence (GBV)

• 23 South Africans commit suicide every day

Page 40: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

The Social Impact of Mental Illness

Depression has a serious impact on the South African economy. Depression costs SA more than R218bn in lost productivity:

• R28bn is attributable to absenteeism (unscheduled absence from work)

• R190bn is attributable to presenteeism attending work while unwell)

The lifetime prevalence of Depression in SA is 9.7% or 4.5 million. About 20% of South Africans will experience a depressive

disorder at least once in a lifetime. Depression is a treatable condition and between 80% and 90% of people have a good

response to treatment.

Page 41: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Mental Health Disease Management Programme

Comprehensive programme that includes both out-of-hospital andin-hospital support. The following are some components of the programme:

• Members on all six plans have access to the mental health programme, however plan benefits will apply with respect to condition cover

• The programme looks at strategies across the spectrum from the healthy to those members requiring comprehensive inpatient care

• The healthy and at risk segments are promoted through regular screening at wellness days and online

• Access to a mental wellbeing module on the website which includes information that promotes mental well-being e.g. advice on mindfulness, meditation exercises

• Access to counselling should someone at risk wishes to speak to a counsellor

• A primary care programme which is GP level of care. This is a crucial component and the mainstay of treatment

Page 42: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Mental Health Disease Management Programme

• The Premier Plus GP Network will play a pivotal role in this programme. This network is already managing Diabetes, Cardiovascular Disease and HIV for Bankmed. Mental Health will be an extension to the Premier Plus Programme

• The GP will enrol member onto programme e.g. Major Depressionmonitor compliance to medication, ensure follow up visits, script renewal etc.

• Coaching and educational material will be provided

• The programme includes a hospital DSP/Network which Bankmed isalready participating in, case management and discharge planning by a care coordinator

• Enrolment on a relapse prevention programme to provide the necessary support on discharge to prevent unnecessary readmissions

• The implementation will be phased in. The employers EAP is included as part of this model

Page 43: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Frail Care

1

2

3

4

Frail care is an existing benefit

Members on the top 3 plans haveaccess to this benefit

The benefit is, however, complex.

2020 benefit: 50% of cost limited to R470 per day

5 2021 benefit: Flat daily rate

Page 44: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Health QualityAssessment (HQA)

Page 45: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Health Quality Assessment

• Benchmarking exercise in the funding industry

• Highlights key quality issues in the SA medical scheme industry

• Drives improvement in the delivery of evidence-based medicine

• 18 schemes participated in 2019 HQA from 9 different Administrators

• Comprised of 115 benefit options

• Represented 7,29 million beneficiaries (81,63% of the medical scheme population)

• 206 Indicators in four categories are evaluated, namely:

1. Prevention and Screening

2. Hospitalisation

3. Maternity and New-born

4. Chronic Disease Management

Page 46: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Definition of Quality

Agency forHealthcare Research and Quality (AHRQ) defines quality as

“the degree to which healthcare services for individuals and populations increase the

likelihood of desired health outcomes and are consistent with current professional

knowledge”.

Page 47: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019Primary Care (Including Screening)

Indicator Bankmed Industry Benchmark CMS

PreventionFlu vaccine coverage > = 65years (%) 28.38% 20% 61% 3.85%

Pneumococcal vaccine coverage ≥ 65 years old (%) 9.60% 3.49% 72.7-77% N/A

Screening

Cervical Cytology coverage (previous 3 years) (%) 41.96% 32.67% 59.3-75.2% 15.99%

Mammogram coverage (ages 50-74 years in previous 2 years) (%)

37.90% 24.07% 72% 32.68%

Bone densitometry coverage for all females aged 65 years or older (%)

9.25% 7.25% N/A N/A

Colorectal cancer screening ≥ 50 years in previous year (FOBT, %)

14.91% 10.79% N/A N/A

Percentage of beneficiaries ≥ 2 years old visiting dentists 32.45% 21.61% NA N/A

Page 48: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019Chronic Disease Management

Indicator Bankmed Industry

Diabetes

HbA1c coverage for Diabetic patients (%) 65.56% 60.31%

Cholesterol related tests coverage for Diabetic patients (%) 60.33% 55.00%

Monitoring Nephropathy for Diabetic patients (%) 71.56% 67.23%

Podiatrist cover (%) 6.65% 3.52%

Statin coverage (%) 62.08% 56.42%

% of Hypoglycaemia related hospital events 0.56% 4.59%

Lower Limb amputations per 1 000 diabetics 2.23 3.16

Page 49: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019Chronic Disease Management

Indicator Bankmed Industry

Ischaemic Heart Disease

Aspirin coverage for IHD beneficiaries (%) 83.04% 69.78%

Cholesterol test coverage for IHD beneficiaries (%) 61.63% 53.25%

Statin Coverage for IHD beneficiaries (%) 82.05% 75.38%

Beta blocker coverage 52.48% 49.96%

Flu coverage of IHD registered beneficiaries 25.09% 18.66%

AsthmaLung function test coverage 15.63% 11.47%

Flu vaccine coverage 16.01% 12.27%

Page 50: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019Chronic Disease Management

Indicator Bankmed Industry

Cardiac FailureFlu vaccine coverage (%) 25.17% 18.47%

ACE & ARB inhibitor coverage (%) 56.56% 61.73%

Depression

10 day post discharge follow up (%) 13.2% 39.69%

30 day post discharge follow up (%) 30.54% 47.47%

Multiple admissions for Depression 1.81% 0.78%

COPD

Flu coverage for COPD beneficiaries (%) 34.29% 28.77%

Lung Function test coverage for COPD beneficiaries (%) 37.53% 33.52%

COPD beneficiaries admitted once for respiratory condition (%) 31.40% 27.32%

COPD beneficiaries admitted more than once for respiratory condition (%) 10.82% 9.54%

Page 51: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019

Hospitalisation

Indicator Bankmed Industry

Cardiac Procedures

Stents 1.36 1.48

Average length of stay for all cases (days) 5.93 5.45

Readmission for any reason within 30 days 8.04% 10.83%

Page 52: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmed compared to Industry | 2019Maternal and New-born

Indicator Bankmed Industry

Maternal and New-born

Number of Teenage Pregnancy (10-19 years inclusive) cases per 1 000 teenage beneficiaries

2.55 2.52

TSH Coverage in New Borns (≤ 6 weeks old) (%) 90.31% 83.52%

Hepatitis B serology coverage during pregnancy 65.97% 42.70%

HIV Screening during pregnancy 72.31% 46.02%

Haemoglobin (Hb) test coverage during pregnancy 80.38% 77.42%

Caesarean Section rate 73.19% 76.04%

Page 53: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Bankmedcompared to

Industry |2019

Page 54: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

2021 Integrated Communications Overview

Page 55: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Educate

Educate and inform members

Delight

Enhance the member journey and experience

across all channels

Add value

Your partner in health, wellness and

lifestyle design

Our message to our client's and members

Page 56: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Key message 1

Educate

We help create a Smart member through educational and informative campaigns:

A ‘Smart’ member:

• Better understands their benefits and Plan options to make more informed Plan choices

• Knows how to optimise their managed and preventative care programmes to stay healthy

• Is digitally savvy and can access Bankmed platforms i.e. App, website and social media platforms etc.

• Engages on multiple communication channels for convenience and ease of use

• Enhances their wellness and healthy habits through regular engagement in wellness initiative’s, PHAs, etc.

• Understands their health status and derives insights about their health to make informed decisions (data-driven insights)

Page 57: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Key message 2

Delight

We delight our members by enhancing the member journey and experience across all channels:

App

Re-Launch October 2020

Print

Print is on hold unless specifically

required at Employer Group

Clients but online copies are always available

SMS

SMS optimised to replace postal

during COVID-19

Email

Segmented communication

via email to specific audiences i.e. members with

co-morbidities etc.

Social

Launched LinkedIn

March 2020

Website

Re-Launch October 2020

Page 58: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Enhancing the member journey and experience

App | Phase 1: new features

New login screen

Phase 2 coming soon….

Brand and screen enhancements

Medicine Tracker

Benefit and Limit tracker

Provides members with key messages.

New design presents the member with a detailed

description of the benefit, the limits associated with

the benefit, how much has been used,

and which claims have accumulated to the benefit.

Keeps track of all the medicine a member needs to take by adding it to their

Pillbox. Reminds the member of when to take

their medicine and when to renew their script.

Set the appearance of your medicine so it’s easily

recognisable. Each medicine reminder can be set up

precisely according to the instructions set.

Page 59: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Enhancing the member journey and experience

Website | new features

Enhancing the member journey and experience across all channels:

Page 60: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Enhancing the member journey and experience

Linkedin

Get the latest information at your fingertips:

• Health and wellness information

• Industry news

• Topical information such as the COVID-19 pandemic

• Opinion pieces from our Healthcare and Clinical experts

• Member stories

• Participation in medical and health forums

• Benefit and Plan information

Page 61: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Key message 3

Add value

We add value to our members and clients through rich,engaging and relevant content:

• Thought Leadership

• News blog on our website

• Collaboration with Employer Group Clients (Campaign toolkits)

• Access to information around the Global Pandemic and what Bankmed is offering members – COVID-19 webpage

Page 62: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Client Management

Page 64: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Client Management

• Custodian Support

• Roadshow Project Planning

• Marketing the Project

• Preferred channels

• Communications Content and Distribution

• Encouraging employees to view digital presentationsand schedule a virtual consultation if further clarity is required

• Project roll-out timelines(Including festive season closure and re-opening dates)

Page 66: MORE COVER - Bankmed · 2020. 10. 12. · 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications ... Partnership in Health and

Thank you

Q&A

MORE THAN A MEMBER. MORE WITH BANKMED.

MORE COVER


Recommended