MEDICAL aid administration has reached unprecedented levels of sophistication and administrators place their clients at risk when they fail to consistently raise the bar in terms of service delivery," says Kevin Aron, managing director of Medscheme Health.

"Gone are the days when an administrator can invest in the best technology and sit back complacently.

"There's a minefield of legislation with which principal offers and boards of trustees must comply and there is ever-increasing pressure to ensure that the medical scheme remains relevant and competitive.

"Of course, there's the often-overlooked principle that an administrator's own house must also be in order. Every aspect of its operational systems impact its clients", he says.

Industry surveys have repeatedly shown that after value-for-money healthcare benefits, efficient, quality administration is next on a medical scheme member's priority list.

Aron adds, "While the Board of Trustees is responsible for designing and marketing the benefit offerings, it is the, medical scheme administrator that provides the network and transaction processing-power to keep the medical scheme operating efficiently.

"A brilliant benefit structure cannot compensate for poor administration - which is why the selection of the right medical scheme administrator is such a crucial decision for the trustees to make."

He makes the point that the development of quality administration begins with listening to the members.

"It is all too easy to make assumptions about member's needs - but that can be a costly mistake. Voice of the customer surveys are essential to develop the insight necessary to makes the difference between merely competent and market-leading administration."

To achieve this insight Medscheme has embarked upon the implementation of ISO 9001:2008 across the business. It has already achieved certification within its largest business unit and is currently rolling out the project across the rest.

Aron explains that, while continuous improvement philosophies such as Toyota's famed "keizan" focus on incremental process improvements, what differentiates the ISO 9001:2008 standard is its particularly strong focus on the customer.

"While the objective of the ISO certification is to promote a culture of continuous business improvement, the process begins with understanding the customer.

"Those insights should align management systems, processes and services to not only meet but exceed customer expectations.

"The ISO 9001:2008 standard provides a tried and tested framework for taking a systematic approach to managing the organisation's processes so that they consistently turn out a product that satisfies customers' expectations."

The standard also provides guidance on, among other things, record-keeping, controlling documents, processes, controlling and monitoring the effectiveness of the quality management systems in determining gaps between actual performance and client requirements.

However, this is only part of the equation. The other is a sophisticated information technology platform.

Aron explains that successful medical scheme administration also involves an extensive national network of healthcare providers including hospitals, clinics, healthcare professionals as well as dispensing pharmacies.

"The administration system that underpins the medical scheme must have the capacity to manage this network, while processing massive transaction volumes and integrating seamlessly with databases housing members' particulars and clinical history.

"In addition the system must have the ability to intelligently analyse data and identify trends at a micro and macro level. All these factors must integrate effectively to eliminate any wastage in the healthcare system and ultimately to deliver a cost effective, quality service experience to the member whenever he or she has any interaction with the medical scheme", he says.

This strong focus on the customer and quality has paid handsome dividends.

PMR Africa conducts an annual survey of the healthcare industry and for the last two consecutive years both Medscheme Health and Medscheme Health Risk Solutions have received the highest overall scores for excellence in administration and managed care respectively.

Medscheme Health received a Golden Arrow Award for the highest overall score of all accredited administrators measured across 24 relevant service indicators. Similarly, Medscheme Health Risk Solutions received Diamond, Gold and Silver Arrow awards across all 14 managed care service categories as well as a Diamond Arrow award for excellence in HIV/AIDS disease management.
Medscheme's open scheme clients have also benefitted with one being awarded the prestigious Orange IndexTM and another thinkmoney.co.za subscriber's survey for the best medical scheme in South Africa.

Aron says that while the results of these independent surveys are gratifying, it is important to engender a culture of creative dissatisfaction within the organisation.

"When an organisation touches the lives of 2,6million South Africans, even an error rate of less than one percent translates into thousands of less than happy customers.

"There is always room for further improvement", he concludes.

Loraine Tulleken: Business Report, 28 May 2010