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Medical scheme solutions

Our health value proposition offers flexibility and tailor-made solutions.

As a well-entrenched, cost-effective service partner with a proven track record, our key differentiators include flexibility, scalability of systems, excellent data warehousing and analytics capabilities:

  • improving member engagement through smartly sharing relevant information of the individual’s health journey
  • promoting change in provider behaviour by connecting reimbursement to improved health outcomes
  • ensuring optimal integration for superior outcomes through relevant clinical and risk management solutions
  • innovative technology, bolstered by agile processes that ensure cost efficiency and continuous improvement.

Administration

Our clients include the largest restricted medical scheme, the fastest growing open medical scheme and a number of blue-chip corporate brands. Momentum Health Solutions has significant influence and the ability to help influence the future shape of healthcare based on our stakeholders’ needs.

The ability to integrate with and leverage efficiencies in the broader Momentum Metropolitan Life Limited environment ensures that we provide value for money to our clients.

  • Driving cost-efficiencies and service excellence
  • Benefiting from economies of scale we aim to offer affordable healthcare services at a very competitive cost per member per month
  • We pride ourselves on maintaining service levels that exceed our SLA agreements without compromising on quality of service
  • Telephonic, email and online chat servicing capabilities offered
  • Seamless billing agreements and processes
  • Minimising fraud, waste and abuse

Health risk management

Our risk management interventions provide sustainable healthcare with long-term outcomes.

We use robust data management systems and advanced data analytics to guide our decision-making processes and have partnered with field experts in order to provide specialised services in a cost-efficient manner.

Our differentiated approach stems from years of experience in funding healthcare in South Africa and a deep understanding of the provider landscape, governing legislation and consumer behaviour.

Keeping abreast of the latest developments in the healthcare industry, we can proudly position our organisation as a knowledgeable strategic partner.

Some of our unique features include:

  • an integrated care model
  • risk stratification algorithms initiating patient-centric lifestyle and wellness coaching
  • a broad range of in-hospital interventions
  • enhanced customer experience solutions
  • a patient advocacy model to empower individuals
  • incentivised wellness solutions linking benefit design and complementary products
  • interactive maternity programme
  • robust health technology assessment and health economic evaluation methods
  • predictive health management
  • robust provider profiling informing outcomes-based reimbursement models
  • experienced and agile teams to ensure basics are managed appropriately
  • capacity to explore innovation and new technology
  • a rich fraud, waste and abuse profiling system with interactive analytics tools.

Benefit design

  • Custom-made innovative solutions that drive engagement and support reduced absenteeism and improved productivity in the workplace
  • Create stand-alone or integrated medical scheme, insurance, wellness and complementary product solutions
  • Competitive pricing solutions that complement product design and benefit from the economies of scale we offer
  • Flexibility that speaks to actual client and scheme needs
  • Complete legislative compliance ensured
  • Data analysis, segmentation and reporting facilitate recommendations
  • Offered as a stand-alone but works hand in hand when integrated with our health risk management and provider engagement
  • Design can be complemented by a range of value-add products like Multiply, HealthReturns and HealthSaver

Reporting

  • Holistic reporting aims to provide an integrated view to clients and stakeholders along with recommendations and planned actions
  • Indicating movements, trends and pro-actively identifying potential risks
  • Financials, servicing and ROI measurements
  • Reporting can be adapted and customised to best meet individual stakeholder needs

Loyalty and rewards

Medical scheme and health insurance clients can choose to make use of complementary products available from Momentum, part of Momentum Metropolitan Life Limited, to seamlessly enhance their healthcare experience and extract more value for what they pay. These incentive offerings and voluntary complementary products include a world-class lifestyle and rewards programme, Momentum Multiply. It is important to note that Momentum and Momentum Health Solutions are also separate entities to medical schemes we administer.