Health Care is a volatile industry with many participants.
Yet the basic transactions remain the same:
- Patient feels unwell
- Patient visits Doctor(s)
- Doctor(s) treat Patient
- Doctor(s) bill Patient
- If Patient is insured, Doctor(s) bill Health Insurance Fund.
But along this seemingly simple chain, there are many participants, each
wielding influence and shaping the direction of modern health care, and
creating a web of contact points and a wide spread of information.
Assuming the patient is insured, Health Insurers become the single
central point of data collection, and analysis is a natural extension to
Up until now, the process of data collection and analysis has been
performed primarily to detect abuse and over servicing in an effort to
contain the costs of healthcare delivery.
Expensive and highly qualified human resources have been employed to
micro manage the costs of episodes and encounters, frequently leading to
confrontation and frustration between role players.
Health care administration systems should be able to perform many of the
routine fraud detection, service and drug pricing, and monitoring over
servicing, abuse and overuse, thus freeing up valuable human resources
to concentrate on managing the actual treatments, measuring outcomes,
and developing and refining effective wellness programs, protocols and
treatment plans for insured patients.
NHA, in conjunction with leading experts in Health Care Management, and
in response to calls from it's clients, has extended it's respected
administration system, Medware, to include a comprehensive health care
management suite, Careware, designed to maximise the availability of
rich data in a central point, and enable skilled managed care personnel
to monitor, manage, define, and refine effective managed health care.
In keeping with the NHA philosophy of inclusive design, the new system
has secure entry points for all role players, ensuring that every
participant has ready access appropriate and useful information that
will ultimately benefit the patient, and by extension, the patient's
risk pool within the fund.
More about Careware
Careware offers a fresh second generation Health Risk Management product
to managed care in Southern Africa. In the challenging world of
healthcare there is a huge need to find new ways of cost effective; risk
focussed managed care without adding to the complexity the current
The Healthcare industry in South Africa is under pressure to provide
solutions that will decrease the non clinical expenditure of funds
without compromising cost effective clinical management and effective
administrative processes. The time has come to simplify processes, to
create seamless systems that will integrate all aspects management of
the healthcare rand.
Medware, the software administration product designed by Neil Harvey and
Associates, has proven itself as efficient and effective to the medical
industry. Neil Harvey and Associates has now also designed a software
solution – Careware - to support the world of managed healthcare.
Careware not only supplies a software system for managed care, it
provides a unique managed care model with integrated clinical support.
The system offers the vital capability of integrating managed care
activities with the claims process. This enables clients to offer a
fast, intelligent authorisation and monitoring process.
Support is offered by a dedicated team of IT developers as well as
clinically trained staff. Clinical support does not end with the system,
but also offers expert clinical and scientific support to clients.
A sophisticated information analysis system ensures effective monitoring
of any trends or dynamics within the funding structure of each client.
Careware has been designed for use by Managed Care organizations or
individual funds. Offering extensive software and clinical
support, it ensures an affordable alternative to high cost Managed Care
The integration of all processes ensures that no effort on any part to
contain costs will be lost. Any cost driving decision or project
will be implemented from the authorisation process to the payment of
The system as well as team expertise, ensures a dynamic model that will
continue to develop new functionalities in line with market developments
and legislative changes. This will be based on a strong co-operative and
consulting relationship between clients and Careware.
Prescribed Minimum Benefits, Risk Equalisation Fund Management and
Reporting are given high priority within the Careware system.
The Careware model provides more service to more members at a lesser
cost, fulfilling the ultimate aim of the private healthcare industry.