MEDSHIELD MEDICAL SCHEME

Medshield is regarded as one of the most experienced, most knowledgeable and most reliable medical schemes in South Africa. Angela Blackburn, Executive: Operations, discusses their various benefit options as well as the importance of service excellence and how it is achieved.

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Briefly take us through the Medshield journey. How has the Scheme managed to build its trustworthy, credible reputation in South Africa since its establishment?

Medshield was founded in 1968 as Medic Aid and will be celebrating its 50th year of providing healthcare cover to South Africans in February 2018.

In 1974, the Scheme was registered under the name Universal Healthcare, offering a niche medical insurance product under the auspices of the Medical Schemes Act of 1967. The Act did not dictate that there should be a clear distinction between the Scheme and the administrator and risk rating was allowed. Medical schemes operate under a very different legislative environment today. In 1996, the Scheme was renamed and registered as Medshield Medical Scheme, following an amalgamation with Medicare Medical Scheme. Over the years, Medshield always remained a financially stable Scheme with a sound product offering.

Post 1996, Medshield rapidly established itself within the medical aid industry with a simple value-for-money product offering. At that stage, the majority of the Scheme’s members were blue collar, government employees and corporate clients. With a simple transparent product, attention to customer satisfaction and strong work ethic, Medshield achieved excellent growth during the initial years. With the growing private healthcare sector and increasing pressure on the public healthcare system, the legislative changes promulgated in the Medical Schemes Act of 1998 led to a new era in healthcare and medical insurance.

On 1 March 2009, Medshield officially became a self-administered medical scheme. The direct benefit of being self-administered is the significant cost-saving on non-healthcare related expenses. According to an Alexander Forbes study conducted in 2015/2016, Medshield had the lowest non-healthcare expenditure among open medical schemes at just over 11%. The prudent self-administration model utilised by the Scheme delivers direct benefit to Medshield members. Medshield is a successful, trusted healthcare provider because we consistently deliver on our promise to our members. We strive to ensure that members have access to care when they need it most and that healthcare provider services are covered and settled in accordance with the member’s benefit entitlements. The Scheme also understands the value of partnerships, not just with our members and brokers, but with the right healthcare providers. These strategic partnerships have delivered fantastic benefits for members and the Scheme alike.

What should people look for when deciding on the right benefit option? And how is Medshield able to cater for the different lifestyle and budget requirements? What are the various benefit options that you offer?

The Scheme has been operating in the medical insurance industry for half a century and has amassed a unique understanding of the various healthcare needs of South Africans. We designed seven benefit options to ensure a healthcare solution for everyone, irrespective of where they are in their life journey. These options range from affordable low contribution options that provide GP visits with unlimited PMB cover to those options with comprehensive cover. There are also savings options and traditional options with defined benefits.

Choosing the right benefit option is influenced firstly by affordability, particularly during these tough economic times where the cost of living is rising. Secondly, the healthcare needs of the specific person and his/her family are vital in the decision-making process. Medshield’s accredited brokers are very knowledgeable about our offering and the needs of our members. They will conduct a needs analysis to ensure that they select the right plan for the members’ current needs. When consumers are uncertain about which benefit option to choose, it is best to speak to a FAIS accredited Healthcare Broker as they have the capability of conducting a needs analysis. Seeking guidance from a broker eliminates uncertainties around which benefit cover suits you best.

Medshield benefit options

Benefit option
Option overview
Premium Plus
Offers comprehensive cover, which includes unlimited In-Hospital benefits at any hospital of the member’s choice, and a personal savings account for Out-of-Hospital requirements.
MediBonus
Offers extensive cover with unlimited In-Hospital benefits at any hospital of the member’s choice. It also includes a range of Out-of-Hospital benefits such as optical and dental, as well as Day-to-Day benefits for family practitioner visits, radiology, pathology and many other specialities.
MediSaver
Offers unlimited In-Hospital cover through the Medshield Hospital Network, as well as the freedom to manage their own personal savings account for Out-of-Hospital services.
MediPlus
Offers unlimited In-Hospital cover through the Medshield Hospital Network and a comprehensive range of Out-of-Hospital benefits.
MediCore
Offers simple unlimited In-Hospital cover through the Medshield Hospital Network, without any Day-to-Day benefits.
MediValue
Offers unlimited In-Hospital cover and limited Out-of-Hospital benefits for fundamental healthcare needs.
MediPhila
MediPhila is the affordable solution for medical benefits cover. It provides unlimited managed GP visits with unlimited PMB cover through the MediPhila Hospital Network.

In a business that’s as established as Medshield, the operational and procedural functioning is crucial—how are you constantly improving and innovating with regard to operations and procedures?

Service excellence is one of the strategic pillars at Medshield and it focusses on operational efficiency. To achieve service excellence, a quality measurement system must be in place. Through ongoing surveys of stakeholders, members, brokers and healthcare providers, Medshield gains insights on key areas of focus. In addition, Medshield commissions an annual industry survey to understand the competitive landscape in which we operate and to tailor our deliverables to inform our standards and adjust the necessary items to the environmental factors influencing our target market. Medshield is an ISO9001:2008 accredited medical scheme, which means that the Scheme conforms to the Quality Management System standards.

This means that we continuously monitor and improve performance; provide confidence to existing and potential members and enhance member satisfaction. We proactively strive to align with changing market conditions. Members prefer simplicity and as part of my management style, I encourage the Medshield operations team to keep processes simple and straightforward in order to ensure that members understand us when they contact the Scheme for information or services they require. As a self-administered Scheme, it is important that we keep abreast with new technologies. Taking the members’ needs into consideration, we consistently design and innovate to achieve the ultimate goal of enhancing the healthcare funding experience for our members.

Medshield’s innovation process aims to deliver a customer-centric experience, where we ‘own’ the customer query until it is resolved. This process ensures that the resolution is effortless for the member whilst constantly demonstrating care and compassion. We do still take cognisance of the ever-changing technology environment and seek to enhance the customer experience through our mobile applications that are user-friendly and familiar. Our technology innovation is centred on convenience for our members and access to information 24/7, 365 days a year.

What are some of the biggest challenges you face in this division and how are they overcome?

The core of the Medshield operations division is to keep all stakeholders, especially the members, satisfied. Customer satisfaction is the biggest challenge. To overcome this, we focus on service excellence as a whole. Through defined processes, ongoing member education, innovation and empowerment, the Scheme consistently strives to satisfy members, respond to queries and minimise complaints at all costs.

What would you regard as some of your greatest successes within the scope of your current position?

As mentioned earlier, the Scheme successfully completed the final 1SO 9001:2008 audit in December 2016 and is now ISO:9001 accredited. This confirms that Medshield conforms to Quality Management Systems standards and has clearly defined processes. Continuous measurement thereof is key to upholding standards in the healthcare space.

What is involved in your work as Executive: Operations—what are your responsibilities and what excites you most about your role?

My role as Executive: Operations involves working closely with the Scheme’s Executive Committee of which I am a member, to determine the long-term strategic objectives of the business and to support the Principal Officer with the implementation and delivery of the Board-approved Scheme strategy. I also provide operational oversight and management of the Scheme’s operations within the administration of the business, ensuring that the operational divisions achieve their functional objectives as stated in the organisational strategy.

The opportunity to build and lead an effective and cohesive management team, to implement effective succession planning and ultimately develop people is very exciting and satisfying.

How would you describe your leadership style? What kind of leadership is necessary in order to ensure success?

My approach to leadership is providing direction through clear communication and motivating people in order to get the desired business results. It is important to inspire the workforce to support the Scheme’s vision and mission. To be most effective, I believe one should adopt one’s leadership style by selecting one that is most suitable for each situation one is dealing with.

I believe if you can’t skillfully manage human relationships and interactions, you will fail in your attempt to successfully lead teams to ensure success. The quickest way to demotivate people is to criticise them. Leaders need to accentuate the positive and utilise mistakes as opportunities to mentor for continuous improvement. Set high goals for people and let them know you believe in their ability to reach these goals. 

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