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04/13/2023 1
Medscheme International Presentation
Mauritius
Our vision
“Creating a world of sustainable
healthcare”
Medscheme
www.medscheme.co.za www.medschemeinternational.com
Our values
“Integrity”
Med
sch
eme
Intr
od
uct
ion
Proven 40-year track record of leadership in Southern Africa.
Largest managed care provider and third largest healthcare administrator in Southern Africa.
€140 million annual turnover.
40% South Africa market share.
More than 3,000,000 lives under management.
Client base includes 32 leading medical schemes in public and private sectors.
22 offices across Africa and Mauritius.
Highly capable and experienced management team.
2 800 employees.
International BPO operation in Mauritius
Our values
“Integrity”
Med
sch
eme
Mau
riti
us
Inte
rnat
ion
al B
PO
Established in Mauritius in 1982
Medscheme acquired 30% stake in 2001; 100% stake in Oct 2010
Only health insurance TPA in local market:
•32% market share (63,000 members)
International BPO facility established in 2007 (VHI):
•Medical coding (ICD9 and ICD10)•Data capture & claims processing•Health care Administration (Mauritius since 1982)
146 employees, 2 shifts
Current capacity for 450 seats over 3 shifts (but scalable)
Proprietary health insurance system (Schema 6) – “system in a box”
Work on client systems via Citrix
Medscheme Holdings
Medscheme Mauritius
Mauritian domestic market
Medscheme International
International BPO contracts
Our vision
“Creating a world of sustainable
healthcare”
Medscheme Mauritius and Medscheme International is a 100% subsidiary of Medscheme holdings (south Africa)
A member of JSE listed Afro centric group.
Our Values“Empowerment”
Our vision
“Creating a world of sustainable
healthcare”
Medscheme operational Divisions
Our Values
“Accountability”
LeadershipMISSION
STATEMENT
We create access to sustainable,
affordable, quality healthcare through the application of
innovation and expertise, delivered
as an efficient, seamless experience
André Meyer - Chief Executive Officer
André joined Alexander Forbes Financial Services in 1987 as a Retirement Fund Consultant and subsequently transferred to Durban, where he headed the local Negotiated Benefits Unit for the company.
He was appointed Divisional Director in 1991 and in 1997 was transferred to the Health Care Consultants Division as Deputy Managing Director later becoming joint Managing Director responsible for the Health Management Solutions and the Communications Division of Alexander Forbes. He also represented Alexander Forbes on the Board of FIHRST Management Services.
In April 2003, André was appointed as Medscheme’s CEO and, supported by the Executive and management teams steered the Group through the successful turnaround strategy and acquisition process.
Lee Callakoppen - Executive Director: Human Capital
Lee obtained a degree in Information Science from the Rand Afrikaans University in 1997 and qualified as an Industrial Sociologist in 1999 after completing his honours. He then furthered his education in Business Management and is currently pursuing an LLB degree.
He began his career in operational management in the retail sector and later moved into Human Capital, holding positions in various industries ranging from retail to telecoms to media. Lee held the position of HR Executive for the Primedia Content Division before joining Medscheme in 2007.
As Executive Director, Human Capital, he is responsible for the continued implementation of Lethimvula Healthcare’s strategy to become an employer of choice.
Our Values
“Accountability”
LeadershipMISSION
STATEMENT
We create access to sustainable,
affordable, quality healthcare through the application of
innovation and expertise, delivered
as an efficient, seamless experience
Anthony Pedersen – Managing Director: Medscheme International Anthony is a qualified Chartered Accountant having completed a Bachelor of
Commerce and an Honours Bachelor of Accounting Science. He completed his training at Arthur Andersen and is a member of both the South African Institute of Chartered Accountants and the New Zealand Institute of Chartered Accountants.
After a short time as Head of Internal Audit in the retail sector, Anthony joined Sovereign Health in May 1999 as General Manager of Finance and was subsequently appointed as Financial Director in 2001. Sovereign Health was acquired by the Momentum Group in 2005 at which time he became Chief Financial Officer of Momentum’s Group Benefit business cluster.
In January 2007, Anthony relocated to Mauritius to establish a health insurance business for Momentum. In this capacity, Anthony gained significant operational experience in the administration of health insurance plans and risk management. In October 2010 he joined Medscheme as Managing Director of both the Groups Mauritian operation (Administrators and Consultants Ltd) as well as the groups International business based in Mauritius.
In his current role, Anthony is responsible for driving the group’s strategy to diversify the business into new markets.
Head of International Business – Asia, Australasia & USA
Holds a MA, MBA degree with specialization in Finance, from university of Madras and national institute of management studies. Also a Certified Financial Planner with industry experience of over 9 years. Prabhu has rich Marketing & business development, project management, strategic planning experience coupled with investments and corporate finance deep knowledge and understanding. He is also a member of prestigious professional associations, CII (UK)and CFA institute member. Currently he is pursuing his law degree from University of London (Exterior).
At Medscheme he is responsible for international business development and market research for the following regions Asia, Australasia, United States. He is designated to champion and support new market entry and group strategy of Medscheme. His core international business activity is health care & insurance KPO new business acquisition and business retention. Prabhu is also executive management committee member for Medscheme international.
Our values
“Mutual Respect”
Med
sch
eme
Inte
rnat
ion
al
Ser
vice
s
Health care administration
Health BPO
Revenue Cycle management
solution
Claim Administration
Billing & coding
services
Data capture & processing
Insurance verification
Claims audit
Health risk management
solutions
International Health Outsourcing Services
“Innovation”
Hea
lth
Ad
min
istr
ativ
e se
rvic
e o
ffer
ing
Medscheme Health TPA Service
Client record management
Contribution /premium management
Claims management(assessing)
Client services (call center)
Retention (out bound call center)
Data and information Management
Fund Management
Financial Management
Key accounts (pay point client services)
Client walk in services
Sales and Marketing
Commissions Management
Provider claims and queries management
Fraud control & Audit
Business & Market intelligence
E- commerce
“quality service”
Med
sch
eme
Inte
rnat
ion
al
BP
O s
ervi
ce
Claim processing
Data image processing and capture
Intelligence claim edit
Claim screening and negotiating
Claim auditing
HIPAA standards management
Revenue cycle Management
Data entry & Data conversion
Data verification
Re –pricing and negotiation
Provider contract interpretation
Benefits validation
High risk claim review
Online updating
Mailroom service
Intelligence queue/data cleansing
Data mining and reporting
Case management
HEALTH INSURANCE CLAIM PROCESSING
“Innovation”
He
alt
h R
isk
& M
an
ag
ed
Ca
re
Exp
erti
se
Hospital utilization management
Managed oncology program
Wellness program
Counseling of high claimers
Chronic medication management
Managed radiology program
Managed dental program
Managed pathology program
Alternative fee structure / re-imbursement
Disease management
Health risk assessment
Specialists and GP networks
Technology services and electronic medicine management
MHRS – Medscheme Health Risk Solution
“Innovation”
Hea
lth
Ben
efit
Man
agem
ent
Hospital Benefit
Management
Oncology Benefit
Management
Optical Benefit Management
Dental Benefit Management
HIV/AIDS Management
Benefit Management Cluster
“Innovation”
Mau
riti
us
Fac
ts
Mauritius Key Facts : Favorable Outsourcing Climate
GMT+4 hoursDutch colony; French colony; English colony; independence 1968Constitution based on Westminster Parliamentary modelPolitical stability; multi-party system – elections every 5 yearsOfficial language is English, but French & Creole mostly used Population of 1.28 millionFreedom of religion; Hindu majority (65%)29.2% of workforce below 30 yearsFavorable tax regime (15%flat rate) – 3% for international co’s34 attractive double taxation agreementsFree economy, no currency controlExcellent connectivity – SAFE cableLow cost, well qualified workforce
“Innovation”
Wh
o
can
ben
efit
?
Med
sch
eme
Inte
rnat
ion
al
Who can benefit from our services?
Third party AdministratorsInsurance CompaniesMedical Billing CompaniesManaged care organizationsGovernment organizationsPrivate PracticeHospitalsPharmacies Pharmacy Benefit Management companies
“Quality”
Ou
r cl
ien
ts M
edsc
hem
e In
tern
atio
nal
Few names from our Valued client list
South Africa
“Innovation”
Dis
aste
r R
eco
very
sit
eM
edsc
hem
e In
tern
atio
nal
Quality Business Back up
Disaster Recovery SiteFully operational offsite data centre & disaster recovery site at La Tour Koenig2 hour recovery delayDaily data backup stored off-siteTested 3 times per annum
Power redundancyUPSGenerator power
Connectivity redundancy1 Mb Nomad backup line
“Innovation”
Qu
alit
y @
Med
sch
eme
Inte
rnat
ion
al
Quality
Quality Management System - ISO 9001:2008 accreditation
HIPAA Compliance
SAS 70 certified
Process Improvement - Six Sigma
Our Values
“Accountability”
LeadershipMISSION
STATEMENT
We create access to sustainable,
affordable, quality healthcare through the application of
innovation and expertise, delivered
as an efficient, seamless experience
Medscheme International
Port Louis
MT line MT line
BT MPLS IS MPLS
Nomad VPN backup
Nomad VPN backup
Connectivity
Client organisation
“Innovation”
Tec
hn
olo
gy
Full implementation of international best
practice
Proven hardware and software optimised to
deliver optimum benefits to both clients and the
company.
Salient facts: •Total data storage capacity 256 TB.
•Hardware partners are EMC, CICSO, AVAYA and UNISYS.
•95% of software supplied by Oracle, Novell Linux and Microsoft.
•Proven SAP integration to clients and healthcare providers
•Data in Disaster Recovery environment is on average 15 seconds behind our Production data.
•One of the first companies globally to implement Oracle technologies to achieve operational storage efficiencies, using tiered storage on Oracle 11G.
•All databases are running the latest version of Oracle 11G Release 2 - another first in the industry.
World-class technology and communications
“Speed & System Excellence”
NE
XU
S I
T –
Wo
rld
cla
ss
Hea
lth
Tec
hn
olo
gy
Hospital management
Medicine management
Disease management
Provider management
Aid for Aids
Nexus IT
“Profitability &
Performance ”
MEDSCHEME NUMBERS
Key Financial Information
Road Traffic Accident Fund
Irish Health Insurers
Managed Care
Audited 16 months
2010€’000s
Audited 12 months
2009€’000s
Audited 12 months
2008€’000s
Audited 12 months
2007€’000s
Revenue 146,699 78,943 88,606 101,204
Profit before taxation 16,227 7,934 6,261 11,932
“Innovation”
Ben
efit
of
ou
tso
urc
ing
M
edsc
hem
e In
tern
atio
nal
Your outsourcing Benefits
minimize operations cost and maximize revenue. Example : Relief from employee expenses ,benefits and facility expenses.
Access to specialized service which are not your core expertise functionsOn time service deliveryYour valuable resource can focus on core competenciesGreat saving on infrastructure , software and technology cost Your business never sleeps. ( time zone benefit)Your business can handle any volumes because you have Medscheme international – “the Health Expert” can help you to address your growing business needs. Upto 40 % reduction on your business operations cost
M
ED
SC
HE
ME
Irish Health Insurers
Managed Care
Our vision
“Creating a world of sustainable
healthcare”
Request Quote :Send your detailed project outsourcing requirement to prabhum@medschemeinternational.com , if you wish to talk to our project team kindly reach @ +230 4231666 .
Contact us
Medscheme International1st floor , Tower A1Cyber city Ebene , Mauritius
M
ED
SC
HE
ME
THANK YOUFund
Irish Health Insurers
Managed Care
Our vision
“Creating a world of sustainable
healthcare”
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