2. Medscheme
Our vision
“Creating a world
of sustainable www.medscheme.co.za www.medschemeinternational.com
healthcare”
3. Proven 40-year track record of leadership in Southern Africa.
Largest managed care provider and third largest healthcare administrator in Southern
Africa.
Introduction
Medscheme
€140 million annual turnover.
40% South Africa market share.
More than 3,000,000 lives under management.
Client base includes 32 leading medical schemes in public and private sectors.
22 offices across Africa and Mauritius.
Highly capable and experienced management team.
Our values 2 800 employees.
“Integrity” International BPO operation in Mauritius
4. Medscheme Mauritius Established in Mauritius in 1982
Medscheme acquired 30% stake in 2001; 100% stake in Oct 2010
International BPO
Only health insurance TPA in local market:
•32% market share (63,000 members)
International BPO facility established in 2007 (VHI):
•Medical coding (ICD9 and ICD10)
•Data capture & claims processing
•Health care Administration (Mauritius since 1982)
146 employees, 2 shifts
Current capacity for 450 seats over 3 shifts (but scalable)
Proprietary health insurance system (Schema 6) – “system in a box”
Our values
Work on client systems via Citrix
“Integrity”
5. Medscheme Mauritius and Medscheme International
is a 100% subsidiary of Medscheme holdings (south Africa)
A member of JSE listed Afro centric group.
Our vision
“Creating a world Medscheme Holdings
of sustainable
healthcare”
Medscheme
Medscheme Mauritius International
Mauritian domestic market International BPO contracts
7. André Meyer - Chief Executive Officer
Leadership André joined Alexander Forbes Financial Services in 1987 as a Retirement Fund
Consultant and subsequently transferred to Durban, where he headed the local
MISSION Negotiated Benefits Unit for the company.
STATEMENT He was appointed Divisional Director in 1991 and in 1997 was transferred to the
Health Care Consultants Division as Deputy Managing Director later becoming joint
Managing Director responsible for the Health Management Solutions and the
We create access to Communications Division of Alexander Forbes. He also represented Alexander Forbes
on the Board of FIHRST Management Services.
sustainable,
In April 2003, André was appointed as Medscheme’s CEO and, supported by the
affordable, quality Executive and management teams steered the Group through the successful
turnaround strategy and acquisition process.
healthcare through
the application of
Lee Callakoppen - Executive Director: Human Capital
innovation and
Lee obtained a degree in Information Science from the Rand Afrikaans University in
expertise, delivered 1997 and qualified as an Industrial Sociologist in 1999 after completing his honours.
He then furthered his education in Business Management and is currently pursuing
as an efficient, an LLB degree.
seamless experience He began his career in operational management in the retail sector and later moved
into Human Capital, holding positions in various industries ranging from retail to
telecoms to media. Lee held the position of HR Executive for the Primedia Content
Division before joining Medscheme in 2007.
As Executive Director, Human Capital, he is responsible for the continued
Our Values implementation of Lethimvula Healthcare’s strategy to become an employer of
choice.
“Accountability”
8. Anthony Pedersen – Managing Director: Medscheme International
Anthony is a qualified Chartered Accountant having completed a Bachelor of
Commerce and an Honours Bachelor of Accounting Science. He completed his
Leadership training at Arthur Andersen and is a member of both the South African Institute
of Chartered Accountants and the New Zealand Institute of Chartered
MISSION Accountants.
After a short time as Head of Internal Audit in the retail sector, Anthony joined
STATEMENT Sovereign Health in May 1999 as General Manager of Finance and was
subsequently appointed as Financial Director in 2001. Sovereign Health was
acquired by the Momentum Group in 2005 at which time he became Chief
We create access to Financial Officer of Momentum’s Group Benefit business cluster.
In January 2007, Anthony relocated to Mauritius to establish a health insurance
sustainable, business for Momentum. In this capacity, Anthony gained significant operational
experience in the administration of health insurance plans and risk management.
affordable, quality In October 2010 he joined Medscheme as Managing Director of both the Groups
Mauritian operation (Administrators and Consultants Ltd) as well as the groups
healthcare through International business based in Mauritius.
In his current role, Anthony is responsible for driving the group’s strategy to
the application of diversify the business into new markets.
innovation and Head of International Business – Asia, Australasia & USA
expertise, delivered Holds a MA, MBA degree with specialization in Finance, from university of
Madras and national institute of management studies. Also a Certified Financial
as an efficient, Planner with industry experience of over 9 years. Prabhu has rich Marketing &
business development, project management, strategic planning experience
seamless experience coupled with investments and corporate finance deep knowledge and
understanding. He is also a member of prestigious professional associations, CII
(UK)and CFA institute member. Currently he is pursuing his law degree from
University of London (Exterior).
At Medscheme he is responsible for international business development and
Our Values market research for the following regions Asia, Australasia, United States. He is
designated to champion and support new market entry and group strategy of
Medscheme. His core international business activity is health care & insurance
“Accountability” KPO new business acquisition and business retention. Prabhu is also executive
management committee member for Medscheme international.
9. Medscheme International
Services
International Health Outsourcing Services
Our values
“Mutual Respect”
10. Medscheme Health TPA Service
Client record management
Contribution /premium management
Health Administrative service
Claims management(assessing)
Client services (call center)
Retention (out bound call center)
Data and information Management
offering
Fund Management
Financial Management
Key accounts (pay point client services)
Client walk in services
Sales and Marketing
Commissions Management
Provider claims and queries management
Fraud control & Audit
“Innovation” Business & Market intelligence
E- commerce
11. HEALTH INSURANCE CLAIM PROCESSING
Claim processing
Data image processing and capture
Medscheme International
Intelligence claim edit
Claim screening and negotiating
Claim auditing
BPO service
HIPAA standards management
Revenue cycle Management
Data entry & Data conversion
Data verification
Re –pricing and negotiation
Provider contract interpretation
Benefits validation
High risk claim review
Online updating
Mailroom service
Intelligence queue/data cleansing
“quality service” Data mining and reporting
Case management
12. MHRS – Medscheme Health Risk Solution
Health Risk & Managed Care Hospital utilization management
Managed oncology program
Wellness program
Counseling of high claimers
Expertise
Chronic medication management
Managed radiology program
Managed dental program
Managed pathology program
Alternative fee structure / re-imbursement
Disease management
Health risk assessment
Specialists and GP networks
Technology services and electronic medicine management
“Innovation”
14. Mauritius Key Facts : Favorable
Outsourcing Climate
GMT+4 hours
Dutch colony; French colony; English colony;
independence 1968
Mauritius Facts
Constitution based on Westminster Parliamentary model
Political stability; multi-party system – elections every 5
years
Official language is English, but French & Creole mostly
used
Population of 1.28 million
Freedom of religion; Hindu majority (65%)
29.2% of workforce below 30 years
Favorable tax regime (15%flat rate) – 3% for
international co’s
34 attractive double taxation agreements
Free economy, no currency control
“Innovation” Excellent connectivity – SAFE cable
Low cost, well qualified workforce
15. Who can benefit from our services?
Medscheme International
Third party Administrators
Who can benefit ?
Insurance Companies
Medical Billing Companies
Managed care organizations
Government organizations
Private Practice
Hospitals
Pharmacies
Pharmacy Benefit Management companies
“Innovation”
16. Few names from our Valued client list
Medscheme International
Our clients
“Quality” South Africa
17. Quality Business Back up
Disaster Recovery Site
Medscheme International Fully operational offsite data centre & disaster recovery
Disaster Recovery site
site at
La Tour Koenig
2 hour recovery delay
Daily data backup stored off-site
Tested 3 times per annum
Power redundancy
UPS
Generator power
Connectivity redundancy
1 Mb Nomad backup line
“Innovation”
18. Quality
Medscheme International
Quality Management System - ISO 9001:2008
accreditation
Quality @
HIPAA Compliance
SAS 70 certified
Process Improvement - Six Sigma
“Innovation”
19. Connectivity
Leadership
MISSION
Medscheme
STATEMENT Nomad VPN
Nomad VPN International
backup
We create access to backup
sustainable,
affordable, quality
MT line MT line
healthcare through
the application of
innovation and
expertise, delivered
BT MPLS IS MPLS
as an efficient, Client Port Louis
organisation
seamless experience
Our Values
“Accountability”
20. World-class technology and communications
Salient facts:
Technology
•Total data storage capacity 256
TB.
•Hardware partners are EMC,
CICSO, AVAYA and UNISYS.
•95% of software supplied by
Oracle, Novell Linux and
Microsoft.
•Proven SAP integration to clients
Proven hardware and and healthcare providers
Full implementation of •Data in Disaster Recovery
software optimised to deliver
international best environment is on average 15
optimum benefits to both
practice seconds behind our Production
clients and the company.
data.
•One of the first companies
globally to implement Oracle
technologies to achieve
operational storage efficiencies,
using tiered storage on Oracle
11G.
•All databases are running the
latest version of Oracle 11G
Release 2 - another first in the
industry.
“Innovation”
21. NEXUS IT – World class
Health Technology
Hospital
Aid for Aids
management
Provider Nexus IT Medicine
management management
Disease
management
“Speed & System
Excellence”
23. Your outsourcing Benefits
Medscheme International
Benefit of outsourcing
minimize operations cost and maximize revenue.
Example : Relief from employee expenses ,benefits
and facility expenses.
Access to specialized service which are not your core
expertise functions
On time service delivery
Your valuable resource can focus on core competencies
Great saving on infrastructure , software and
technology cost
Your business never sleeps. ( time zone benefit)
Your business can handle any volumes because you
have Medscheme international – “the Health Expert”
can help you to address your growing business needs.
Upto 40 % reduction on your business operations cost
“Innovation”
24. Contact us
MEDSCHEME Medscheme International
1st floor , Tower A
1Cyber city
Ebene , Mauritius
Irish Health
Request Quote :
Insurers
Send your detailed project outsourcing
requirement to Managed
prabhum@medschemeinternational.com , Care if you
wish to talk to our project team kindly reach @
+230 4231666 .
Our vision
“Creating a world
of sustainable
healthcare”
25. MEDSCHEME
Irish Health
Insurers
Managed
Care
THANK
Our vision
YOUFund
“Creating a world
of sustainable
healthcare”
