Eternity Private Health offers a unique in market experience of Managed Care in the form of “Care Coordination” which at the highest level is Managed Care actively taken to the members of the scheme to manage the risk of Medical Schemes, in effect the patient is proactively managed and is not only interacted with at the point of medical emergency and or need.
An extension of this approach has been the in-house developed wellness programmes which offer a further enhancement to clinical risk management, namely:
- Medicine Risk Management Programme
- Hospital Risk Management Programme
- Disease Risk Management Programme
- Maternity Management
- HIV Management Programme
- Oncology Management Programme
- Cardiac Support Line
- Emotional Wellness Programme
- Respiratory Programme
In each of these programmes the best practice clinical guidelines are employed with a member centric approach and tried, tested and accredited business processes in place to ensure a consistent and repeatable experience to members who engage with these programmes.
As an example of the “Eternity Healthcare developed” programmes, the following 3 programmes were identified as high risk and high cost conditions within our current client base, to which Eternity Healthcare then developed a Care Coordinated approach to manage these patients:
- The Cardiac Support Line: This programme offers follow-up and support for all members, and their families, who have recently been in hospital with heart related conditions and other cardio-vascular diseases.
- The Emotional Wellness programme: This programme has been developed to enable members to approach their mental health in a holistic manner. The programmes offers the following benefits:
a. Extensive psychotherapy benefits (in conjunction with the scheme);
b. On-going telephonic support;
c. Access to literature;
d. A stress line.
- The Respiratory Programme: This programme has been designed to assist members with any of the following conditions:
a. Asthma;
b. Chronic Obstructive Pulmonary Disease (COPD);
c. Allergic Rhinitis;
d. Bronchiectasis.
A further example of “Care Coordination” within Eternity Private Health is of the integration between workplace wellness programmes and scheme wellness programmes, a link which is often not utilised by restricted, employer based medical schemes.
Eternity Private Health is in the process of developing a cutting edge approach to employee wellness and wellness programmes in the workplace. Through the integration of employee programmes, such as ICAS, into the Eternity Private Health wellness and rewards programme, which are then linked into the scheme management programmes, Eternity Private Health can bring a holistic view to employers that would see Medical Schemes as an extension of the wellness offering.
A practical example of this approach would be when a employee attends a wellness day, at the wellness day the employee is identified as being at risk of depression. This employee is then automatically referred to the Medical Scheme for registration and management on the “emotional wellness programme”, as supplied by Eternity Private Health.
The employee now has access to the full suite of benefits offered by the Medical Scheme from a funding point of view, this data is shared with the internal employee wellness programme and the Eternity rewards programme. This employee then has access to the internal employee wellness programme from an emotional point of view and could have access to the gym at a reduced rate through the rewards programme.
Thus, through the integration of the 3 programmes the employee would have automatic access to a full spectrum of services to treat and manage their condition in a process flow that is centred around the member and ensuring that that member, who is also an employee, gets the best possible care for their condition and manages both the scheme risk and employer risk of a poorly managed, untreated or unidentified patient.
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