Cimas Medical Aid Society REPORT BACK ON SOCIETY

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Cimas Medical Aid Society REPORT BACK ON
SOCIETYS TRANSFORMATIONMONOMOTAPA HOTEL
NOVEMBER 2 , 2004
cimas
Together we make a difference
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INTRODUCTION

• In February 2004 focus group discussions with
  member firms after an AGM proposal

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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

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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

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Are the expectations in line with Societys
vision and mission ?
RESPONSES - STRATEGIC PLAN EXERCISE
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Societys Vision

• To be a leading provider of comprehensive
  quality healthcare products and services in the
  region

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Mission

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

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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

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Recommended Strategic Direction
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1. RE-ENGINEERING FOR BETTER FOCUS, FLEXIBILITY
   AND STREAMLINING
2. FINANCING ACCESS TO APPROPRIATE CARE
3. FURTHER SEGMENTATION AND PRODUCT INNOVATION
4. IMPROVING SERVICE QUALITY AND IMAGE OF THE SOCIETY

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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
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2 FINANCING ACCESS TO APPROPRIATE CARE

• Involvement in drug procurement
• Setting up well equipped Primary Care Clinics
• Investment in some private hospitals

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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

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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

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THINGS ALREADY DONE!!
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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

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FINANCIALS
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STATE OF THE FINANCES

• Summary of year-end results
• What we do with the surplus
• Why we need reserves

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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)

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THE FUTURE

• Implications of the National Health Insurance
• Cimas as the provider of Healthcare Solutions

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THANK YOU
Together we make a difference