The Healtcare Value Chain

Associated Fund Administrators Botswana acts as a facilitator for client medical schemes and adds value by providing medical aid schemes with administrative, operational and systems capabilities to enable them to manage their relations with

• Their members (member relations)
• Healthcare providers to ensure the optimisation of healthcare spend (optimising healthcare spend)
• Healthcare providers and medical scheme beneficiaries to ensure effective healthcare (effective healthcare).

A function that medical schemes outsource to Associated Fund Administrators Botswana is assisting members to understand their medical scheme benefits and rules, while facilitating the processing and payment of healthcare claims. This function includes the

• Collection of medical scheme contributions
  
• Adjudication of healthcare claims, including claim assessment
  
• Payments to healthcare providers and/or reimbursements to medical scheme members
  
• Management of the beneficiary database
  
• Resolution of queries from beneficiaries and healthcare providers.
  

Optimising Healthcare Spend

As a healthcare fund manager, Associated Fund Administrators Botswana plays a central role in ensuring the efficient spending of each healthcare Pula received. Intelligence gathered from, and through the group companies; and trade association activities enables Associated Fund Administrators Botswana to develop products, that in partnership with the schemes, address specific categories of healthcare spend.

Effective Healthcare

Effective case management, at an individual beneficiary level, leverages off the on-going managed care initiatives, and is elevated to the level of integrated care by its disease management programmes. The success of this area of Associated Fund Administrators Botswana's business is highly supported by Medscheme and its extensive clinical skills base. The ability to measure the outcome of product application provides Associated Fund Administrators Botswana with the information to continually enhance and expand its product profile.

Client Relationship Management

Managing the relationships between client medical schemes and Associated Fund Administrators Botswana and ensuring that clients receive a high level of service from the Group, is central to Associated Fund Administrators Botswana's ongoing success. This important function should ensure that BPOMAS stays ahead of trends in consumerism and client care.