Innovation brings medical scheme members more benefits for less

Medshield Medical Scheme has always been a pioneer and we believe in the innovative digital ecosystem. Picture: Supplied
Medshield Medical Scheme has always been a pioneer and we believe in the innovative digital ecosystem. Picture: Supplied

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The average South African is highly dependent on their smartphone and Covid-19 certainly pushed us even further into the dependence of not only smartphones, but technology in general.

In fact, it gave our country a timely opportunity to reflect and evaluate the use of Artificial Intelligence (AI) and technological innovations as necessary tools for survival in our age.

As a medical scheme that has been in existence for over 52 years in South Africa’s healthcare industry, we have been propelled to quickly adapt almost all our processes to deal with the pressures of the pandemic on the healthcare system, and have found ways to use more technology solutions as an intricate part of our services to members.

AI in our Scheme’s Benefits package

Medshield Medical Scheme has always been a pioneer and we believe in the innovative digital ecosystem.

A member-centric approach and innovatively embracing technology lowers the barriers to affordable, convenient and high-quality private healthcare while also ensuring members are more empowered to take care of their health.

With technology, we have stood by our members and supported them through the challenges of the pandemic.

We announced an affordable 5.9% weighted contribution increase for 2021 which translates to a low R84 increase on our entry-level plans and up to R350 increase on our top end plans. These are the lowest contribution increases in the last 10 years of Medshield’s history.

According to research by Accenture, Applied Intelligence – the combination of data with the power of automation, analytics and artificial intelligence (AI) at scale – can help healthcare providers rapidly achieve efficiencies and next-level performance.

When we launched Medshield SmartCare, we had a massive uptake in 2019, enabling members access to unlimited consultations with nurses and virtual doctor consultations from over 390 clinic rooms countrywide.

The SmartCare WhatsApp Doc has been our latest innovation, allowing access to a real-life doctor who answers member questions via WhatsApp, as a convenient way of accessing a Family Practitioner during the Covid-19 lockdown period.

As we look beyond Covid-19, Medshield has launched the Live Assured package which is about creating certainty, providing assurances and comfort so that members feel more at ease and focus on enjoying their lives without stressing about their healthcare needs.

Live Assured promises to deliver even greater access to member-centric quality healthcare during these highly uncertain times. Free 24/7 trauma and counselling benefit across various platforms, loyalty programs, and at-home exercise routines for members are some of the added benefits we have rolled out to ensure enhanced member value.

AI in our daily Scheme operations

From the onset, we all needed to adapt our operations to allow for WHO regulations on Covid-19 and social distancing. Without technology, our operational performance would have surely suffered but with innovation, our customer ratings averaged 80%, and in May, we saw a further increase to 95%. 

According to research by Accenture, Applied Intelligence – the combination of data with the power of automation, analytics and artificial intelligence (AI) at scale – can help healthcare providers rapidly achieve efficiencies and next-level performance.

As such, we have ensured that using our app, members remain connected and informed, view their membership cards, benefits, do authorisations, locate a network provider and other essential scheme services.

We have already seen how AI has allowed for better claims management. A digital claims-monitoring tool can identify claims, provide a timely alert, raise late payment charges and automate follow-ups.

Pre-authorisation for procedures has also been made possible through AI, which validates the information associated with the request, freeing human resources to focus on higher-value tasks.

Lastly, in clinical coding, AI tools help reduce claim denials and under-recovery of revenue by adding AI and automation to clinical document review.

AI in the wider healthcare industry

As our nation ushers in the National Health Insurance (NHI), the use of AI will become ever more important even in the public sector. At the Department of Health, Covid-19 has helped the government learn new lessons around staffing, health and safety, and health products – all of which will help boost the implementation of the NHI.

As such, they have committed to convert the NHI’s digital capabilities to boast a competent digital system that has accurate data from both public and private sector.

The use of AI to accurately diagnose Covid-19 patients has so far been incredible, offering a computer-generated diagnosis with an accuracy level of 98% all within five minutes, and go beyond testing to include disease-staging, where a patient is told whether to go into ventilation or go home.

The big question is: Will AI replace doctors? Not for a long time. In fact, need to find trusted sources for relevant, medical information remains high and patients and doctors alike want to avoid being entangled with incorrect medical facts and advice especially when they most need accurate input and quality care.

When we launched Medshield SmartCare, we had a massive uptake in 2019, enabling members access to unlimited consultations with nurses and virtual doctor consultations from over 390 clinic rooms countrywide.

This is where AI and humans can collaborate. Access to a real doctor via an online platform such as Medshield SmartCare allows for convenient virtual follow-up consultations with instant full medical history, test results, and better accuracy of follow-up diagnosis at a lower cost for the patient and the Scheme.

Recently, there are new generation mobile apps that use smartphone cameras to measure vital signs like heart rate, mental stress, oxygen saturation, blood pressure and respiration, all from the convenience of your phone with high medical grade accuracy. 

As these apps continue to push the boundaries of medical science, we look forward to seeing more of this emerging technology in South Africa soon and making it available to our Medshield members.


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