{"id":3227,"date":"2023-06-12T11:11:12","date_gmt":"2023-06-12T09:11:12","guid":{"rendered":"https:\/\/newmediacreative.co.za\/afrocentric\/?p=3227"},"modified":"2023-06-28T10:18:41","modified_gmt":"2023-06-28T08:18:41","slug":"bridging-the-divide-between-scheme-and-provider","status":"publish","type":"post","link":"https:\/\/newmediacreative.co.za\/afrocentric\/archives\/3227","title":{"rendered":"Bridging the divide between scheme and provider"},"content":{"rendered":"\n<h5 class=\"wp-block-heading\"><strong>The Healthcare Providers Strategic Unit (HPSU) is doing essential work in enhancing the interaction between providers and scheme administrators.<\/strong><\/h5>\n\n\n\n<p class=\"has-vivid-red-color has-text-color has-small-font-size wp-block-paragraph\">By Urvashi Pather and Marisha De Jager<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tensions between healthcare providers and schemes have been simmering for many years. Eyebrows are raised, heart rates increase and the atmosphere becomes gloomy when \u201cprovider queries\u201d are managed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Whether you find yourself in Analytics, Operations, Policy, Coding, Risk Management or elsewhere, we\u2019re a united team in this battle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Providers express similar frustrations when \u201cscheme-related administration\u201d is added to their daily tasks. This, coupled with a lack of knowledge and insight into the processes of scheme management, can cause tensions to rise.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Being aware of this battle, our team at HPSU is taking the lead in finding ways to help.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"624\" src=\"https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-1024x624.jpg\" alt=\"\" class=\"wp-image-3229\" srcset=\"https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-1024x624.jpg 1024w, https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-300x183.jpg 300w, https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-768x468.jpg 768w, https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-1536x936.jpg 1536w, https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/uploads\/2023\/06\/doctor-nurses-laptop-meeting-with-medical-lab-data-idea-innovation-medicine-research-hospital-clinic-smile-happy-motivation-healthcare-teamwork-planning-surgery-insurance-2048x1248.jpg 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"has-vivid-red-color has-text-color wp-block-paragraph\"><strong>Focusing on behavioural change<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HPSU focuses on key projects and initiatives within the healthcare professionals space, striving to enhance the provider\u2019s journey with Medscheme and administered schemes. Having participated in both the provider and the scheme administrative realm, the team has considerable industry experience.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Within the Specialist Outlier Engagement Programme, HPSU aims to bridge the divide between provider and scheme in several ways:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gaining insight into different specialist practice models and demographics<\/li>\n\n\n\n<li>Supporting scheme financial sustainability<\/li>\n\n\n\n<li>Focusing on improving in-hospital cost-efficiency driven through provider behavioural change.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">When the programme started in 2018, only a few providers were engaged every year. Today, the HPSU team engages about 300 specialists per year, who are mainly identified by analysing in-hospital claims data.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The programme is kept alive by continuous innovation and evolution, for example:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refining identification metrics<\/li>\n\n\n\n<li>Monitoring practice efficiencies<\/li>\n\n\n\n<li>Re-engaging providers if needed<\/li>\n\n\n\n<li>Referring certain practices to Fraud, Waste and Abuse for further unpacking should the data and engagement content be questionable.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">More recently, specialist societies have been getting on board in support of the initiative.<\/p>\n\n\n\n<p class=\"has-vivid-red-color has-text-color wp-block-paragraph\"><strong>Facilitating engagement<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HPSU uses a practice efficiency report (PER), compiled by Advanced Analytics, as the main discussion point when engaging with providers. Through conversation, HPSU gains an understanding of practice location, size, special interests of providers, obstacles and limitations, as well as feedback regarding scheme experience.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Engagements are booked with persistence and charm by our admin assistant. Scheduled between daily tasks, four brave HPSU warriors are available to facilitate these engagements. Team members often travel to meet these providers face to face, but they also accommodate virtual and telephonic discussions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">During these engagements, providers are directed to the major cost drivers on their practice\u2019s data sets. The aim is to jointly identify areas where a provider can assist in improving overall efficiency and\/or identifying areas where the data and summary might sway towards misinterpretation of the actual clinical practice.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HPSU has witnessed significant positive behavioural change following engagement. Of the providers that the team engaged in 2021, 73% showed an improvement in total cost efficiency metrics in 2022.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Specialist Outlier Engagement Programme is just one of HPSU\u2019s tactics to bridge the divide between scheme and provider. For more info about the team, initiatives and projects, refer to HPSU One Mind.<\/p>\n<div style=\"display:flex; gap:10px;justify-content:center\" class=\"wps-pgfw-pdf-generate-icon__wrapper-frontend\">\n\t\t<a  href=\"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/posts\/3227?action=genpdf&amp;id=3227\" class=\"pgfw-single-pdf-download-button\" ><img src=\"https:\/\/newmediacreative.co.za\/afrocentric\/wp-content\/plugins\/pdf-generator-for-wp\/admin\/src\/images\/PDF_Tray.svg\" title=\"Generate PDF\" style=\"width:auto; height:45px;\"><\/a>\n\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>The Healthcare Providers Strategic Unit (HPSU) is doing essential work in enhancing the interaction between providers and scheme administrators. By Urvashi Pather and Marisha De Jager Tensions between healthcare providers and schemes have been simmering for many years. Eyebrows are raised, heart rates increase and the atmosphere becomes gloomy when \u201cprovider queries\u201d are managed. Whether [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":3228,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[190],"tags":[199],"class_list":["post-3227","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-our-subsidiaries-afrocentric-06","tag-afrocentric06"],"acf":[],"_links":{"self":[{"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/posts\/3227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/comments?post=3227"}],"version-history":[{"count":3,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/posts\/3227\/revisions"}],"predecessor-version":[{"id":3703,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/posts\/3227\/revisions\/3703"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/media\/3228"}],"wp:attachment":[{"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/media?parent=3227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/categories?post=3227"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newmediacreative.co.za\/afrocentric\/wp-json\/wp\/v2\/tags?post=3227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}