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A COMMITMENT TO BEING THE BEST

When you aim to be the best at what you do, and you have a committed team of dedicated individuals driving you forward, being the best is almost a given. Dries la Grange, CEO of BESTmed Medical Scheme, leads this outstanding team, and his passion for the members as well as his staff is clearly evident.

BESTmed Medical Scheme originated in 1964 as the Statutory Organisations Medical Scheme, initially founded to cater for the employees of statutory organisations.

In July 1990, the scheme changed its name to BESTmed and restructured into a more competitive organisation, and started to attract membership from the private sector. "We offer healthcare cover for payment - medical insurance," says la Grange. "We offer a wide range of products, ranging from basic hospitalisation to really comprehensive cover. We also offer the administration services to support the scheme."

In addition to products offered to individuals, BESTmed places a large focus on corporate clients. "We offer on-site consultants at certain campuses, we hold corporate health days at least every two years, and we offer actuarial services to our corporate clients," says la Grange. "We also provide risk management services that detail the status of an organisation's top management. All of our services are personalised - we believe that if you don't render a service on a personal level, it isn't worth it."

In order to offer clients the best possible service, BESTmed has undergone two major transformation processes over the years. "The first was in 1989/90, when the whole industry was really only assessing claims, and paying them out," says la Grange. "We decided that we needed to improve our management of information relating to claims, and obtain better information on the claim itself. We changed from a process where we were only performing data capturing, to one where we actually started paying claims real-time online."

Sine 1990, BESTmed is one of the few medical schemes that processes claims within 24 to 48 hours of them being received in the building. "Any claim received before the 15th of the month will be paid by the 17th, and any claim received by the 30th of the month will be paid by the 2nd of the next month," explains la Grange. "This makes a huge difference when it comes to our competitiveness."

The second phase of transformation for BESTmed was bringing in managed health care - managing the health of its members better. "The planning stages started in 1997, but we really got it off the ground in 1999, when we established our own managed health care division within BESTmed," explains la Grange. "We have our own doctors, our own nursing sisters, we do our own pre-authorisations. We also have our own disease management programmes, such as cancer management, where the nursing sister gets in touch with the member concerned on a regular basis, receiving updates, and liaising with doctors."

La Grange says that this is also a very personal service, and that the nursing sisters become very attached to the members in their care. "It is an important service that we offer," he says. "It provides a support function for members at a critical time in their lives, and it teaches us that every member is an individual, and that although they may have the same disease as another member, the way they react to their situation is different."

Along with the process of introducing managed health care, BESTmed also took the opportunity to revamp its IT system, upgrading to the system designed by Neil Harvey & Associates - the MedWare system. "Currently, approximately 70% of our claims are done electronically," says la Grange. "Making the transition to an upgraded IT system has definitely impacted positively on our performance. If you have better information, you can make more accurate predictions, and therefore manage risk more efficiently, which is what any managed health care system comes down to - there are many medical schemes out there offering similar products. The key is to be more efficient than the competition, and for that you need information."

As in any industry, the medical scheme industry has its own challenges, and la Grange says that one of these is coping with legislative changes, as well as the reforms that are currently taking place in government. "From January next year, no product that has multiple savings levels will be registered by government," he says. "This impacts upon our flexibility - as well as the flexibility of the other players in the industry. It is a challenge we will have to find creative solutions for."

An important challenge for la Grange is building relationships and partnerships with providers. "Pharmacists, for example, are currently in a position of great uncertainty," he explains. "From BESTmed's side, we negotiate dispensing fees with the pharmacists that we feel are fair," he says. "These fees may be a little more than what is prescribed, but they need to be able to run their businesses properly in order to provide our members with good service, so this is beneficial to all parties."

BESTmed concludes contracts with all willing providers, which take away the surprise of co-payments at the point of service for members, as well as ensure that the price paid is fair towards both parties. "Another important aspect of our partnerships is that we ensure that we pay our providers very quickly," says la Grange. "We make sure that the money is in our provider's bank account within seven days."

BESTmed also aims to add value from a health point of view to participating employers. "We don't just want to be an expense on the financial statements of a company - we want our participating employers to really perceive us as adding a valuable service," explains la Grange.

One of the driving forces behind BESTmed's commitment to service excellence is to differentiate itself by means of rendering world class service. "People measure their experiences by the service they receive, and we want to be the benchmark in this regard in the medical scheme industry, no matter what that person's frame of reference is - whether it is local or international," says la Grange. "We have started with the process of identifying what we need to benchmark ourselves against the world's best, and we aim to exceed that. Our staff is very committed, and they are aware of the goals they have to achieve."

As part of this drive to become a world class health care provider, BESTmed plans to further enhance its IT capabilities. "We will also enhance our communication strategies," says la Grange. "We will extend the publication of our brochures detailing the options available to include more of the languages spoken in South Africa. Currently, some of the brochures are available in Zulu, Tswana, English and Afrikaans."

Another important development is the establishment of facilitators for the scheme in the rural areas. "We will employ facilitators from the rural communities - people who are trusted by the communities - and empower them to really assist members and potential members," says la Grange. "Due to the nature of the services we offer, it is sometimes difficult to understand all the procedures, and these facilitators will be trained in explaining them in layman's terms."

La Grange sees the key to the successful future of BESTmed as relationships with key stakeholders, the most important being members and service providers. "We will have to develop more contracts with providers, and ensure that we personalise these relationships," he says. "Also, from an IT perspective, we must be quicker, and acquire and generate even more accurate information. This goes a long way towards improving member relations, as does ensuring that we never forget that members are people - they are individuals with unique needs, and we need to cater for them as best possible."

It is a point of pride for la Grange that BESTmed's membership figures rose by a double-digit percentage last year, while the rest of the industry decreased by around 1%. "This shows that we are getting our marketing mix right," says la Grange. This is not just his personal opinion, but the documented opinion of the Global Credit Rating Company, which awarded BESTmed an A+ rating in February of this year.

BESTmed's customer-centric approach, and its commitment to meaningful relationships with service providers is sure to bring the organisation closer to its goal of becoming a world class organisation - an achievement that from all appearances, is not far off.