Health Risk Management Briefing Session

1. Health Risk Management Briefing Session • 01 February 2012

2. ROAD ACCIDENT FUND • BRIEFING SESSION – Health Risk Management System • GAUTENG • RFP/RAF/2012/00009 • DATE: 01 FEBRUARY 2012 • RAF - MENLYN

3. AGENDA • Welcome • 2. Introduction of the RAF members • 3. Circulation of Attendance Register • 4. Presentation By RAF - BAU/Case Management Unit • 5. Q & A • 6. Closing

4. RAF OVERVIEW • Established through an act of Parliament in 1996. • Started operating in 1997. • National Public entity in accordance with schedule 3A of the PFMA. • Governance: Parliament through SCOPA; Ministry of Transport; Board of RAF • Provide compulsory cover to all users of South African roads, both citizens and foreigners, against injuries sustained or death arising from MVA within the borders of South Africa. Provide appropriate cover to all road users within the boarders of South Africa • Rehabilitate and compensate persons injured in a timely and caring manner • Promote safe use of all South African Roads • Social responsibility to re-integrate victims of road accidents to society. • Pays medical and related services costs; general damages; loss of income; loss of support and funeral expenses. • RAF pro-actively reaching out to communities by expanding the footprint, enhancing processing capability by improving business processes and systems. • Values: Ubuntu; Freedom to succeed and Pride in what we do.

5. ZIMBABWE NORTHERN PROVINCE MOZAMBIQUE BOTSWANA Pietersburg MPUMALANGA Pretoria Mmabatho Johannesburg GAUTENG NORTH WEST NAMIBIA Welkom Upington FREE STATE KWAZULU NATAL Kimberley Bloemfontein Pietermaritzburg LESOTHO Durban NORTHERN CAPE Umtata ATLANTIC OCEAN EASTERN CAPE Grahamstown East London Stellenbosch WESTERN CAPE Cape Town Port Elizabeth INDIAN OCEAN

6. BACKGROUND • Current transformation process. • Envisaged nine provincial offices for origination of claims. • All claims to be processed centrally at the Benefit Administration Unit (envisaged). • Claimed benefits include Medical; General Damages; Funeral; LOE and LOS. • Medical Unit is responsible for payment of past medical expenses; rehabilitation services; life care and supplier claims. • 2010/2011 Financial year 195,634 medical claims lodged • 187,168 finalized • 2010/2011 medical claims cost close to 800 million rand • Predicted increase – 8-10 % • Pre authorization of rehabilitation and life care services • Payment to claimants, service providers , attorneys

7. RAF CASE MANAGEMENT • Hospital based case managers • First RAF contact with the injured • Manual reports • Case management Unit BAU • Retrospective Assessment • Refer to field case managers • Field case managers • Home visits • Assess needs and initiate strategies • No service provider network • Undertakings Department • Pre authorisation • Payment for services

8. Health Risk Management Specifications • A health risk management system to proactively manage all medical, surgical and rehabilitative accident related interventions by applying best practice regimens • Pre authorisation • Hospital admissions • Prostheses • Assistive devices • Medical procedures • Case management • Clinical audit • Medical peer review • Rehabilitation programmes • Private nursing and specialised wound care • Service provider network arrangements

9. Specifications contd..... • Interactive solution • Software able to run on IBM or HP • Operating system- one of Unix, Aix, or Windows • Databases– Oracle or MSSQL • Standard operating procedures • Pre loaded Health Intelligence • Rejection of chronic/pre existing but allow exceptions • Exclusion management e.g. drug interactions, allergies • Protocols and formularies for cost effective treatments • Able to create patient specific rules • Flagging and tracking of updates • Automated updates – current best practice

10. Details of the Bid • Documents can be couriered or hand delivered at the reception during: • Mondays - Fridays • Working hours • 7h45 a.m. – 16h00 p.m. • Please ensure that register is signed at the reception • Closing date and time should be strictly adhered to: • 9 February 2012 at 11h00 a.m. sharp

11. Details of the Bid • Request for proposals: Appointment of a service provider to provide • Health Risk Management System • Closing date 9 February 2012. • All questions / enquiries outside this forum will be via email to: tsholok@raf.co.za not later than 11:00 on 2nd February 2012. • Questions/ Answers will be published on the RAF website by 3rd February 2012.

12. Compliance • Compulsory Documents (Valid original Tax Clearance Certificate) • Page 5-Checklist of documents to be submitted • Please ensure that document is signed where required • Complete proposal should be submitted

13. Technical Mandatory Requirements • The service provider must have full local solution support. • (please provide the structure of the support team to the RAF) • NB: Bidders who do not meet functional mandatory requirements will be disqualified and will not be considered for further evaluation on the functional requirements.

14. Technical / Functional Requirements • The functional / technical criterion that will be utilized to test the capability of service providers • Technical /functionality will be evaluated against the following detailed requirements: • Project plan and methodology • Experience • Standard operating procedures • Security features • Training • Report generation • NB: Bidders who score LESS than (60% out of 85%) will not be considered for site visits • Site visit • NB:Bidders who score LESS than (80% out of 100%) on functionality including site visit will not be considered for further evaluation on Price and BEE

15. Evaluation • 90/10 principle will be used. • Price and BEE

16. QUESTIONS • ?

17. THANK YOU