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Cimas Medical Aid Society REPORT BACK ON SOCIETY’S TRANSFORMATION MONOMOTAPA HOTEL NOVEMBER 2 , 2004. cimas. Together we make a difference. INTRODUCTION. In February 2004 focus group discussions with member firms – after an AGM proposal. OUTCOMES. Service Expectations

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  1. Cimas Medical Aid SocietyREPORT BACK ON SOCIETY’S TRANSFORMATIONMONOMOTAPA HOTEL NOVEMBER 2 , 2004 cimas Together we make a difference

  2. INTRODUCTION In February 2004 focus group discussions with member firms – after an AGM proposal

  3. OUTCOMES • Service Expectations - Quick claims turn around - Product innovation - Value for money - No cash outlays - International cover - Improved communication - Maintain cross subsidies but introduce some savings

  4. OUTCOMES Cont. • Organisational Structure - Involvement in health delivery - Risk Management / Review investment strategies. - No demutualisation - Consider JVs/Strategic partnerships - Ensure sustainability - Find resolution to ZIMA/NAMAS impasse - Corporate governance

  5. RESPONSES - STRATEGIC PLAN EXERCISE Are the expectations in line with Society’s vision and mission ?

  6. Society’s Vision To be a leading provider of comprehensive quality healthcare products and services in the region

  7. Mission To provide customers in Zimbabwe and the region with comprehensive value added innovative healthcare solutions to the benefit of members, employees and stakeholders

  8. Major challenges identified during strategic planning • Declining quality of health services – especially for the lower end of the market • Erosion of purchasing power • Flight of medical skills • Entry of new players providing international cover

  9. Recommended Strategic Direction

  10. RE-ENGINEERING FOR BETTER FOCUS, FLEXIBILITY AND STREAMLINING • FINANCING ACCESS TO APPROPRIATE CARE • FURTHER SEGMENTATION AND PRODUCT INNOVATION • IMPROVING SERVICE QUALITY AND IMAGE OF THE SOCIETY

  11. 1. Re-Engineering For Focus, Flexibility & Streamlining • Healthcare Services Division (Centre of Excellence , clinics, hospitals and dental) • Medical Services Division (Laboratories, Haemodialysis, Chemotherapy, Ambulance) • Medical Aid Division • Investments • HEALTHGUARD International

  12. 2 FINANCING ACCESS TO APPROPRIATE CARE • Involvement in drug procurement • Setting up well equipped Primary Care Clinics • Investment in some private hospitals

  13. 3 FURTHER SEGMENTATION AND PRODUCT INNOVATION • Creating and re-designing packages at top end of market offering foreign treatment cover • Creation and re-designing products at lower end of market in line with Society's Primary care clinics initiatives • Introduction of contingency limit/savings • Regional marketing of Global Travel Cover • Investigate entrance into foreign markets • Offer special schemes

  14. 4 IMPROVING SERVICE QUALITY AND IMAGE OF THE SOCIETY • Commission and conduct image and customer care programs • Expand EDI and EFT to members and providers • Install intranet and improve staff training • Review all benefit limits • Select CASE management tool • Establish Cimas Help Desks at major health provider sites

  15. THINGS ALREADY DONE!!

  16. Cimas Improved Service Initiatives • Emergency Hospital Admissions • Cash advances to providers e.g. hospitals and radiologists, etc. • Direct payment arrangements with - Opticians - beginning November 2004 - Pharmacies - beginning November 2004 • Electronic Funds Transfer / Electronic Data Interchange • Expedited Processing of high cost claims

  17. FINANCIALS

  18. STATE OF THE FINANCES • Summary of year-end results • What we do with the surplus • Why we need reserves

  19. What we are doing with the Reserves • Financing health services provision – requires capital • Improving benefits e.g. drug re-imbursements (C and B now paid at 80% and 90% on Private Hospital, General and other packages) • Contributions stabilization • Statutory Reserves (Medical Services Act)

  20. THE FUTURE • Implications of the National Health Insurance • Cimas as the provider of Healthcare Solutions

  21. cimas THANK YOU Together we make a difference

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