Medical Schemes: Improving the Service Interface with your Administrator and Managed Care Services

Many Medical Schemes do not have the facility or the tools to measure the performance of the administrator or managed care provider against contractual service level agreements. It may also be that their current service level agreement no longer captures the essence of truly satisfactory MEMBER SERVICE, but there is no way that, as a scheme, they are able to accurately establish the level of service quality their members experience.

The management of member’s perceptions, particularly of the service they receive, has become crucial in the quest for member retention.

Our Service Interface business methodology (see process diagram below) enables Schemes to accurately assess the administrator’s adherence to the Service Level Agreement and thus enables them to manage the SLA. The methodology is applicable to both administration and managed care services. It is a great advantage for scheme Principal Officers and Trustees to have an independent qualitative and quantitative audit done using an international benchmark ISO 9001:2000 standard.