MANAGEMENT OF MEMBER COSTS

MHS WELLNESS

DEFINITION
A comprehensive risk management programme that determines the clinical and financial risk of a population of members and that subsequently manages this risk by providing member counselling, educational material, referral to appropriate resources and synergistic interaction with existing on-site wellness programmes. This risk management process improves the health status of individuals, reduces the demand for health care resources and provides a platform for admission to disease management programmes.

• Population risk analysis, including retrospective claims analysis, as well as health risk assessment using Health Profiler,

• Member counselling with a focus on consumer and /or Wellness issues,

• Provision of educational material to members via various media (print copy, Internet and e-mail),

• Electronic lifestyle management programmes such as Exercise Profiler, KynetX.com (an interactive programme focusing on exercise, diet, stress and habit cessation) and LifeGard (an electronic medical record with various applications),

• Planning and implementation of Health Days,

• Reporting and tracking of member health care-seeking and lifestyle behaviour,

• Identification of short and long-term cost-savings to the medical scheme or employer.

• Reduction in the clinical risk of members as a result of improved health status,

• A shift in the focus of health care from that of a curative, reactive process to the proactive promotion of health and prevention of disease,

• Empowered and educated consumers of health care, with appropriate utilisation of health care resources,

• Reduction in the demand for health care resources leading to reduced health care expenses,

• Added values such as productivity gains and increased satisfaction.