Using beneficiary age as the sole measure of scheme health will not provide an accurate assessment and should rather be viewed in relation to claims ratio. In other words, just because a scheme’s average beneficiary age is higher than the industry norm, it doesn’t by default mean that the scheme will experience a higher claims ratio. One needs to look at intrinsic risk, age and gender of the membership as well as how risk is being managed in order to get an accurate picture of the true risk of the scheme.
In the case of an Agility administered scheme, such risk is offset by the implementation of effective disease management in the form of the Patient Driven Care™ (PDC™) programme which has eliminated the use of age as a core factor for determining risk and has seen survival rates dramatically improving. This means that a scheme considered as “old” ten years ago, would no longer fall into this category under the current scenario.
Of course, the sophistication of a scheme’s managed care interventions and technology play a key part in this equation and Agility has, for example, implemented numerous interventions to mitigate any negative impact of beneficiary age on claims ratio through:
- Its unique PDC™ patient management programme which replaced the traditional market disease state programmes that manage individual chronic diseases as opposed to a member’s total health profile. do not address the health risk, only the specific disease risk. In contrast to these traditional programmes, the PDC™ programme assists high risk members to effectively manage their healthcare benefits and access additional care where necessary to avoid catastrophic, and often costly, health events. The holistic risk of the member is managed at the same time, thus ensuring better health and financial outcomes for both member and medical scheme.
- Agility’s predictive model imbedded in the integrated risk management system ensures that all medical scheme members and their beneficiaries are continuously risk rated according to mathematical and statistical models. As a result, at risk members are targeted by, and subsequently enrolled in, the PDC™ programme through a rolling effect and not as static, once off identification process.
This has resulted in significant returns for Agility’s client schemes with one in particular seeing a phenomenally successful turnaround in reserve from single digits to a projected 16% for 2017.