Careware: Profile

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
  or,
• 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 data collection.

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 systems.

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.

Benefits:
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 models.

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 claims.

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.