OPERATIONAL OVERVIEW TRANSMED MEDICAL FUND 04 October 2007 - - PowerPoint PPT Presentation

OPERATIONAL OVERVIEW TRANSMED MEDICAL FUND 04 October 2007

Presented by: Gys Steyn

Shareholding Total number of calls Corporate Profile Utilisation per Benefit

Index

Quality of Personnel

Shareholding structure

Europ Assistance South Africa (Pty) Ltd

61% 4% 35%

Europ Assistance Holding France Staff BEE

70% 74% 80% 58%

Access Health Africa

30%

Protégé Health BEE MRI Criticare Labour Assist

26%

EA Benevolent Trust & Simeka Group

10% 10%

Sandesh Singh BEE Scientia EA Financial Services (Pty) ) Ltd

40% 2%

Numsa Investment Company BEE EA Benevolent Trust BEE

Corporate Profile

Access Health Africa

• was started in 1995 and is a subsidiary of Europ Assistance

South Africa (Pty) Ltd.

• has been providing medical services to the healthcare industry

for 11 years, while Europ Assistance SA has been a service provider within the industry for the past 22 years.

• has state of the art technology and highly trained and skilled

medical staff.

• has 360 incoming call centre lines.
• unlimited network of approved national service providers.
• provides services in 9 of South Africa’s 11 official languages.

Services Offered

PRODUCTS IMPLEMENTATION DATE Emergency Medical Transportation 01 July 1996 Personal Health Advisor 01 July 1996 Legal, Home & Roadside Assist Access 01 July 2004 International Travel Medical Services 01 July 2004 Access Health has been providing benefits to Transmed members for the past 11 years

Total Calls Received- all Benefits

Total calls Received 2006 – 2007: 17 032

500 1000 1500 2000

J u l

• 6

A u g

• 6

S e p

• 6

O c t

• 6

N

• v
• 6

D e c

• 6

J a n

• 7

F e b

• 7

M a r

• 7

A p r

• 7

M a y

• 7

J u n

• 7

Calls between July 2006 and June 2007

Emergency Medical Assistance

Transportations – Road, Fixed Wing and Helicopter

Total Transportations over 12 month period 2006 – 2007: 3989 Previous year 12 month period: 4057 (Decrease of 68)

Road Ambulance Air Ambulance Helicopter 0.1%

99.8% 0.1%

Total number of Emergency Transportation Claims – 12 month period

Number of Claims Total Rand Value 2007 - 3989 R 5 735 427 Number of claims plus rand value over 12 month period 2006 - 4057 R 4 209 411

Emergency Medical Assistance

Emergency Medical Transportation

• Access Health Africa manages the transportation of the patient, and

advises the Service Provider to transport the patient to the closest, most appropriate hospital depending on the illness or injury sustained.

• The patient will be taken to a hospital in accordance with the Medical

Scheme’s requirements and benefit options.

• In the event that the patient’s condition is stable, the patient will be

transferred to an appropriate network hospital.

• Access Health Africa makes use of approximately 80 accredited Service

Providers in South Africa.

• Private ambulance services are accredited and rated according to

location, level of service and personnel qualifications.

• Access Health Africa is independent and not linked to any hospital group
• r ambulance service provider.

Emergency Medical Assistance

Distribution of admissions by hospital group – 12 month period

Emergency Medical Assistance

39% 21% 14% 14% 12% 0% 0% State Netcare Priv ately O wned Life G roup M ediclinic Clinix G roup Hospice

When is an air-ambulance dispatched?

• Access Health Africa dispatches air ambulance assistance according to

protocols/guidelines designed by the Trauma Department of the University of the Witwatersrand, and in accordance with the medical industry standards.

• The decision to dispatch an air ambulance is determined by medical personnel at the

scene of the incident, as well as confirmation by an Access Health Africa medical doctor.

• Weather conditions may not always permit air ambulance transportation, and in these

circumstances a road ambulance is dispatched.

• Helicopters are not always ideal for transporting seriously ill patients due to restricted

cabin space, vibration and noise levels and therefore are seldom the first option.

• Each medical circumstance is unique and Access Health Africa has the expertise to

manage the emergency appropriately and according to the situation and the protocols.

Emergency Medical Assistance

Summary of Road Ambulance Service Providers used in a 12 month period

ER 24 26% Netcare 29% Independent 44% State 1% ER 24 N etcare In depen den t State

Emergency Medical Assistance

Emergency Evacuation and Medical Expenses up to R1 million per member and a total of R5 million per family

The following incidences are covered:

International Travel Benefit

• The costs of Emergency Medical Transportation to the nearest appropriate

medical facility capable of providing the required treatment, or transportation to a different hospital where necessary, or repatriation to the normal place

• f residence. This includes medical supervision where necessary.
• The costs incurred in a Medical Emergency, while on a journey outside of

the borders of South Africa. Included are doctors fees, hospital expenses, medical and surgical treatment given as prescribed by a registered medical practitioner.

Number of declarations and claims over 12 month period

• No. of Declarations

Number of Claims Total Value 2007 - 1675 27 R688,000.00

International Travel Benefit

2006 - 1414 6 R63,654.00

International & Local Emergency Incidents 2007

International Travel Evacuation: 69 yr old bi-lateral leg amputee contracts septicemia while in Australia in Sept 2007 R300 000 Estimate While visiting family in Australia, Mr X, contracted septicemia and the doctors did have much hope for his

• survival. After a few weeks he spent four weeks in ICU, Europ Assistance repatriated him back to South

Africa. Local Emergency Transportation: 87 yr old woman with hypertension An elderly lady called the 24 hour emergency number complaining about heart palpitations, difficulty swallowing, speech slurred and face drooping on one side. An ambulance was dispatched immediately and Mrs X is recovering in hospital.

Personal Health Advisor provides professional assistance on how to deal with any health question. Highly experienced nurses will identify the nature of the situation, give advice and information to the caller utilising a sophisticated medical database, in nine official South African languages.

Medical Advice

Personal Health Advisor

The product includes an Audio Health Library – a telephonic information service consisting of an audio text information library of 520 pre-recorded health topics. This service is

• ffered in most of the official South African languages.

1 General medical problems 287 2 Chest pain 170 3 Abdominal pain 158 4 Breathing difficulties 147 5 Neurological deficit 141 6 Depression 110 7 Urinary tract 86 8 Diarrhea 83 9 Dizziness 74 10 Eye problems 73

Top Ten Calls per Category

Personal Health Advisor

Personal Health Advisor and Audio Health Library

Total Inbound Calls over 12 month period: 10 447 TRANSMED - Total Inbound Calls – 01/07/2006 to 30/06/2007

4994 798 386 3758 827 672 78 84 23 Any call with symptoms Health info Call for Drs Referral Counseling Drug info Benefit information Other (general enquiries, etc) Audio Health Library

Personal Health Advisor

Re-direction report – 12 month period REDIRECTION REPORT

CALLER INTENT PRIOR TO CALL

• NO. OF

CALLERS

• NO. OF CALLERS

RECEIVED LOWER ALTERNATIVE % CALLERS RECEIVED LOWER ALTERNATIVE

Would have called doctor 89 48 70% Contact Pharmacist 71 40 56% Would have visited doctor 772 361 47% Would have gone to Emergency Room 1425 729 51%

Personal Health Advisor

PHA – Age / Sex Distribution July 2006 – June 2007

1.82% 0.80% 1.08% 2.03% 1.94% 4.57% 2.66% 3.10% 3.56% 5.35% 5.26% 5.73% 4.69% 13.93% 2.74% 0.65% 1.13% 1.52% 1.83% 1.98% 2.44% 3.43% 2.83% 3.03% 4.05% 4.59% 4.53% 8.74%

0-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76+

M ale Fem ale

Personal Health Advisor

Advice and guidance is provided on matters such as:

Legal Assistance – Access

Legal Assistance

Maintenance agreements Employment contracts and general working conditions Domestic workers agreements and conditions of UIF Instituting a claim against the Road Accident Fund A number of standard legal documents are available and will be provided at the member’s request. The Legal Assist line includes a free, 30-minute consultation and if required, a practicing attorney will draft one letter or make a telephone call to a third party.

Legal Assistance Calls - TOP TEN CATEGORIES OF ADVICE

CATEGORIES OF ADVICE

• NO. OF MEMBERS

RECEIVED ADVICE COST SAVING ON ADVICE GIVEN TOTAL 243 R 145,800.00 Family Law 39 Law of Contract 38 Matrimonial Law 35 Wills and Estates 31 Insurance Law 26 Consumer Rights 23 The Law of Delict 21 Employment 11 Criminal Law & Procedure 10 General Court Procedure 9

Legal Assistance

Roadside Assistance – Access

This is a 24-hour help line which provides beneficiaries with access to essential services in the event of a vehicle breakdown within the borders of South Africa.

Road & Map Assistance

Map Assist

A 24 – hour direction service when travelling in South Africa. The helpline offers assistance when you are lost, if you have left your direction notes at home or need confirmation that you are on the correct route. Clear directions are given telephonically, whilst on-route or faxed, or e-mailed.

Home Assist is a 24-hour telephone assist help line providing beneficiaries with access to a network of service providers in case of emergencies arising in the home. Access Health arranges for a service provider to Assist with the following:

Home Assistance - Access

General household maintenance, repairers for household appliances Glaziers, locksmiths, tree-fellers Pest control This is an access service only and the member is liable for the costs

• f the service provider.

Utilization - call statistics

Legal, Home & Roadside

95% 3% 2% Legal H

• me Assistance

R

• adside Assistance

Dr Allan Milne – Medical Director 10 years experience focused on Air Ambulance evacuations plus managed travel clinics. Over 20 years experience in the medical and travel industry. Manager (Travel Assistance) Mirriam Mokgathle With nearly 30 years experience in health services management and community nursing sciences, May ensures that the medical knowledge and support offered to callers remains at a high standard. Manager (Nurse Line) May Boeyden Manager (Emergency Services) - Skhumbuzo Nyoni Team Leader and flight co-ordinator with over 20 years’ experience in assisting / managing medical emergencies. Diana Sharp – EMS Manager Over 20 years experience in the medical and travel industry

Quality of Personnel