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INTRODUCTION OF CMS DELEGATION

INTRODUCTION OF CMS DELEGATION. Prof Yosuf Veriava – Chairperson of CMS Dr Loyiso Mpuntsha – Vice Chairperson of CMS Mr Daniel Lehutjo – Acting CE & Registrar Dr Anton De Villiers – GM: Research & Monitoring Mr Craig Burton Durham – GM: Legal Services

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INTRODUCTION OF CMS DELEGATION

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  1. INTRODUCTION OF CMS DELEGATION • Prof Yosuf Veriava – Chairperson of CMS • Dr Loyiso Mpuntsha – Vice Chairperson of CMS • Mr Daniel Lehutjo – Acting CE & Registrar • Dr Anton De Villiers – GM: Research & Monitoring • Mr Craig Burton Durham – GM: Legal Services • Ms Julindi Scheepers – Chief Financial Analyst

  2. ANNUAL REPORT PRESENTATION ON PERFORMANCE INFORMATION, FINANCIAL STATEMENTS AND INDUSTRY PERFORMANCE 2014/15

  3. Contents • Annual Performance Information report • Annual Financial Statements • Industry Report • Utilisation Statistics • Financial Information • Governance

  4. Budget Programmes The report is presented per the following programmes: • Programme 1: Office of the CEO & Registrar The programme comprises of 3 sub-programmes • Sub-programme 1.1: CEO & Registrar • Sub-programme 1.2: Strategy Office • Sub-programme 1.3: Complaints Adjudication Unit • Programme 2: Corporate Services The programme comprises of 3 sub-programmes • Sub-programme 2.1: Internal Finance • Sub-programme 2.2: Information and Communication Technology and Knowledge management • Sub-programme 2.3: Human Resources Management • Programme 3: Accreditation • Programme 4: Research and Monitoring • Programme 5: Stakeholder Relations • Programme 6: Compliance • Programme 7: Benefits Management • Programme 8: Legal Services • Programme 9: Financial Supervision

  5. Strategic Goals Goal 1: • Access to good quality medical scheme cover is maximised Goal 2: • Medical schemes are properly governed, are responsive to the environment, and beneficiaries are informed and protected Goal 3: • CMS is responsive to the needs of the environment by being an effective and efficient organisation Goal 4: • CMS provides influential strategic advice and support for the development and implementation of strategic health policy, including support to the NHI development process

  6. Overview of annual performance report 2014/15 • CMS’s performance against planned targets in the financial year ending 31 March 2015. • Audited by the Auditor-General – no material findings on the usefulness and reliability of the reported performance information for the programmes • CMS achieved 86% of its planned targets • Total number of indicators 35 • Negative deviations 14% (5) • Positive/exceeded deviations 40% (14) • No deviation/objectives met 32% (11) • Indicators outside control of CMS 14% (5)

  7. Overview of targets in annual performance report 2014/15

  8. Programme 1: CEO & Registrar

  9. Sub-Programme 1.1 :Office of the CEO & Registrar

  10. Negative Deviations and corrective actions 1.2.2.3 Provide clinical opinions There were a large backlog to be cleared during the year due to staff constraints, as well as a demand for new increasingly complex clinical matters. The unit cleared much of its backlog due to interventions that were put in place eg. Block week. Additional resources have been budget for in the unit for 2 additional positions for 2015/16. 1.3.2.1 Complaints resolution Deviation due to complex complaints taking longer than 120 days to resolve 2.2.3.1 ICT operations and infrastructure 2.2.3.2 Software development and maintenance Due to electrical interruptions and ageing infrastructure the network, server uptime and software availability was negatively affected – corrective action was taken to avoid future disruptions – new generator acquired 2.3.3.1 Recruitment and talent management Deviation was mainly due to the positions not filled within the 90 days targeted timeframe - the unit aims to improve their turn around times with a new online system for vacancies that has been implemented.

  11. Programme 1.2 : Strategy Office

  12. Programme 1.3 : Complaints Adjudication Unit

  13. Programme2: Corporate Services

  14. Programme 2.1: Internal Finance Unit

  15. Programme 2.2 : Information and Communication Technology and Knowledge Management

  16. Programme 2.3: Human Resource Management

  17. Programme 3: Accreditation

  18. Programme 4: Research and Monitoring

  19. Programme 5: Stakeholders Relations

  20. Programme 6: Compliance

  21. Programme 7: Benefits Management Unit

  22. Programme 8: Legal Services

  23. Programme 9: Financial Supervision unit

  24. Annual Financial Statements 2014/15 • Audit report • Statement of financial position • Statement of financial performance • Irregular expenditure • Forensic investigation

  25. Audit Report • Report on the financial statement – financial year end 31 March 2015 • Submitted in time by 31 May 2015 • No material adjustment after 31 May 2015 • Unqualified Audit Opinion • Irregular expenditure

  26. Statement of financial position

  27. Statement of financial position

  28. Statement of financial position

  29. Statement of financial position

  30. Statement of financial performance

  31. Revenue (note 11)

  32. Revenue from exchange transactions

  33. Other income

  34. Statement of financial performance

  35. Statement of financial performance

  36. Statement of financial performance

  37. Statement of financial performance

  38. Irregular expenditure

  39. Irregular expenditure

  40. Plans to address irregular expenditure • CMS has appointed a dedicated supply chain officer • Internal policies have been reviewed to be in line with supply chain management regulations

  41. Membership and Utilisation Dr Anton de VilliersGeneral Manager: Research and Monitoring

  42. Outline 1. Membership and Number of Schemes 2. Utilisation data 3. The cost of the PMB’s 4. Managed Care 5. Resources and Membership Conclusions 6.

  43. Trend in the number of schemes Consolidation: Small-sized restricted schemes 144 Schemes in 2000

  44. Trend in membership Growth: 0.4% (8.78 million to 8.81 million) Negative growth in the restricted schemes

  45. Healthcare benefits paid Total Healthcare benefits paid R124.1 billion R111.7 billion in 2013 11.1% increase R14 185 pabpa R12 892 pabpa in 2013 10% increase Healthcare benefits paid from risk pool R111.8 billion R100.7 billion in 2013 11.1% increase R12 783 pabpa R11 616 pabpa in 2013 10.1% increase Benefits paid from savings R12.3 billion

  46. Total Benefits paid per discipline All Specialists: 23.5% (5 categories)

  47. Total Benefits paid to Specialists • All Specialists: 23.5% • Anaesthetists: 2.07% • Pathology : 5.32% • Radiology: 4.31% • Medical Specialists : 6.61% • Surgical Specialists: 5.2%

  48. Prevalence of Chronic Conditions (per 1 000 beneficiaries) Increase in prevalence rates for the industry. Is it a concern? Top 5: Hypertension, Hyperlipidaemia, DM2, Asthma and HIV

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