MORE COVER 2021 Benefit and Contribution Launch 06 October 2020 - Bankmed
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MORE COVER 2021 Benefit and Contribution Launch 06 October 2020 MORE THAN A MEMBER. MORE WITH BANKMED.
Agenda 01 Bankmed Value Proposition 02 Industry Matters 03 Bankmed Financials 04 2021 Contribution Increases 05 Plan Structure 06 2021 Benefit Enhancements 07 2019 Health Quality Assessment Results 08 Communications Overview 09 Client Management 10 Q and A
Partnership in Exclusivity and Responsiveness 38% Better Value Better Quality Health and Wellness (Closed Scheme) in 2020 (NMG) (HQA) Commitment to Best-of-Class Technology and Innovation Financial Stability Member Experience as Enablers (GCR)
Our partnership spans over more than 100 years - and we are Solvency ratio still going strong Industry average Our financial stability 38.7% VS 34.5% allows us to maintain value for our members 2018 Annual Financial Statements 2018 Council for Medical Schemes Annual Report; The average for restricted schemes in 2018 was 41.9% 2019: 40.5%
Your money is Non-healthcare costs 2018 spent on you Industry average Non-healthcare expenses are the costs 4.9% VS 8.2% associated with running the Scheme e.g. administration and general 2019: 4.8% administration expenses
General Industry Update 1 Bankmed continues to stay close to industry developments 2 Member of the Health Funders Association (HFA) 3 Participating proactively to influence how the healthcare landscape changes 4 COVID-19 dominating industry deliberations 5 Bankmed has been diligent in its own response to COVID-19
Details of Bankmed’s response is available on the Scheme’s website The Scheme’s response includes the following: In-and-out of hospital Virtual and Pulse Oximeter and cost of treatment paid Telephonic additional consultations for from insured benefits consultations high risk members Tests paid for from Relaxation of COVID-19 Isolation insured benefits networks, specifically Hotel benefit for COVID-19
COVID-19 clinical tracker COVID-19 cases by Province BANKMED CONFIRMED CASES | 6 846 | 29 September 2020 131 Tests Positive COVID admitted Recoveries Deaths conducted members members 136 Bankmed 43 036 6 846 904 6 548 110 4 342 173 251 610 87 SA 4 152 480 671 669 - 604 478 16 586 419 13.2% 95.6% 1.6% Proportion Recovery rate Case fatality rate 697 admitted (DH: 94.3%) (DH: 2.2%) 90.0% National 2.5% National recovery rate case fatality rate *We have extended the definition of confirmed positive members to also include admissions coded with U07.1 but not confirmed through pathology testing yet
Bankmed COVID-19 experience As at 29 September Distribution by age and chronicity Admissions for COVID-19 positive members 3000 Distribution of positive members by age and chronicity 904 Y N Members admitted 528 2000 2115 1000 1086 526 1 014 150 78 693 399 210 278 227 234 admissions ICU Ventilator 0 0-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80+ admissions admissions in ICU Age Band Distribution of positive members by current status Admission costs 120% Deceased Active Recovered 100% 3% 8% 14% 15% 6% Completed Average Average Length Death 80% 10% 8% Total cost Admissions Cost of stay rate 60% 97% 97% 98% 98% 96% 93% Other Wards 651 R 28 236 682 R 43 374 6.6 4.8% 40% 85% 76% 77% High Care 158 R 17 737 330 R 112 262 9.7 5.9% 20% ICU 71 R 21 199 023 R 298 578 16.6 34.8% 0% Ventilation 79 R 33 867 578 R 428 704 18.8 68.8% 0-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80+ Total 959 R 101 040 613 R 105 360 8.9 12.5% Source: Internal analysis
Utilisation of Virtual and Telephonic Consultations Consultation Type January to July 2020 August 2020 September June 2020 2020 Virtual Consultations 135 96 45 22 Telephonic Consultations 4 069 2 755 1 271 673 Utilisation of Isolation Hotel Benefit Pulse Oximeter Uptake June 2020 July 2020 August 2020 September August September 2020 2020 2020 Number of 13 15 5 0 Members Number of Approved 424 59 Pulse Oximeters Number of Days 105 116 24 0
Other Industry Developments 1 Variety of other industry conversations underway, relating to legislation and regulations in the healthcare industry 2 Bankmed is an active participant in these discussions 3 Final report on the Health Market Inquiry (HMI) released in September 2019: But focus shifted to COVID-19 COVID-19 also generated many views about the 4 National Health Insurance (NHI): • Will implementation be accelerated? • Has COVID-19 made it impossible to prioritise NHI? Bankmed’s view: COVID-19 has imposed many lessons that are useful for 5 solutions that we really need in the future, and we intend to stay engaged and contribute to the desired solution, in the best interest of our members
Bankmed Financials
Financials 1 Bankmed’s Invested Reserves 2 Members Savings Accounts 3 The Financial Mechanics of Bankmed 4 The Two Key Financial Ratios 5 Reserve Management 6 Summary
Bankmed’s Investments 1 YTD July: R3.65bn reserves invested 2 Two additional multi-asset managers introduced in March 2019, in order to further diversify investment manager skill Four multi-asset managers: INVESTEC, 3 PRUDENTIAL, ALLAN GRAY and ABAX, and one Money Market manager: TAQUANTA 4 Overall benchmark, related to medical inflation, amounts to CPI + 3.5% over a rolling 3-year period 5 Due to ongoing economic conditions, the benchmark has not been attained over the last 5 years Bankmed’s Investment Committee closely monitors the 6 performance of the individual investment managers, and the overall investment strategy of the Scheme 17
Members Savings Accounts Applies to the Core Saver, Comprehensive and Plus Plans only Consists of contributions paid by members which are allocated to a members savings account and held there to settle certain healthcare costs that aren’t paid from Insured Benefits Although the member pays monthly contributions in this the regard, Bankmed offers the total annual benefit for utilisation as at 1 January Bankmed’s practice in this regard creates a risk of creating member debt to the Scheme, in the form of savings claw-backs 50% Bankmed allocates 50% of the interest rate earned on the Scheme’s money market portfolio to the members, although there is no obligation to pay members any interest The interest is calculated on a monthly basis , but credited to the members savings accounts once annually
The Financial Mechanics of Bankmed GROSS CONTRIBUTIONS RECEIVED (including savings) What comes in to the Scheme? LESS: SAVINGS CONTRIBUTIONS NET CONTRIBUTIONS INCOME RELEVANT HEALTHCARE CLAIMS EXPENDITURE INSURED HEALTHCARE CLAIMS RISK TRANSFER ARRANGMENT MANAGED CARE EXPENDITURE (Non Savings) PREMIUMS What is paid from the Scheme on Medical Costs? Hospital Costs Premiums to provider who then Fees paid to service providers who Doctors commits to cover certain healthcare conduct managed care initiatives in Medication etc. expenditure for the year order to contain healthcare costs
The Financial Mechanics of Bankmed (cont.) GROSS HEALTHCARE RESULT NON-HEALTHCARE EXPENDITURE What is paid by • Administration Fees the Scheme on • Scheme Management Costs Administration Costs (Delivery Costs)? Value to OPERATING DEFICIT members Reserves INVESTMENT INCOME at work NET RESULT 20
The Two Key Financial Ratios Accumulated Reserves / Annual Contributions Reserve • Key indicator of financial health, with statutory minimum of 25% Ratio • Balance between sufficient reserves and using excess reserves to the benefit of members Operating Deficit / Annual Contributions Operating • Incur operating losses to the benefit of Ratio members which investment income must cover
Reserve Management Strategy The actuarially forecasted reserve To maintain the ratio as at the end The budgets for the The upper end of required level of of 2020 is 46.6%, years thereafter will Bankmed’s required required reserve reserves to ensure due to the unusually be aimed at reserve ratio is ratio was maintained long term financial low claims stabilising the between 35%-40% in 2019, at 40.5% sustainability of experience resulting reserve ratio at (38.7%: 2018) the Scheme from the COVID-19 approximately 38% lock-down measures.
Reserve Management Strategy (cont.) Year Reserve Ratio Ratio 2016 40.1 % 2017 38.8 % 2018 38.7 % 2019 39.2 % 2020 (forecast) 46.6 % 2021 (budgeted) 38.2%
Summary To keep contribution increases low while 1 maintaining rich benefits, the Scheme needs to run sustainable operating deficits To run sustainable deficits the Scheme’s reserve 2 levels need to be adequate in order to produce the required investment returns The required investment returns must be 3 sufficient to cover the planned operating deficits and grow reserves adequately to keep the Reserve Ratio stable During times when investments are 4 performing poorly, a Scheme has to generate savings elsewhere by utilising effective managed care initiatives and other cost cutting techniques.
Summary (cont.) Regardless of low investment returns, Bankmed 1 has performed well enough over the past few years, to maintain stable contribution increases This has been achieved by savings generated on 2 claims expenditure via effective managed care initiatives and favourable provider tariff negotiations 3 Overall, Bankmed is well managed and financially sound, which is confirmed by its AA+ credit rating
2021 Contribution Increases
Average Contribution Increases 2021 Other Medical Schemes Momentum Health DHMS Medical Scheme Bonitas BestMed 0% (6/12) 3.9% 4.6% 4.0% 0% increase for the first 6 months of the year after which a 5,9% increase will be implemented Fedhealth CAMAF KeyHealth MedShield 8.8% 3.5% 5.0% 5.9%
Annual Increase Comparisons 2016 2017 2018 2019 2020 2021 14 11,9 12 11 10,6 10,7 10,7 10,2 9,9 10 9,5 9,2 8,9 8,7 8,9 8,6 8,3 8,2 8,2 8,1 7,9 7,9 8 7,8 7,9 8 7,7 7,3 7,3 6 4,6 3,9 4 3,5 3,6 2 0* 0 DHMS Momentum Bonitas CAMAF Bankmed * 0% increase for the first 6 months of the year after which a 5,9% increase will be implemented 28
2021 Bankmed Contribution Increases Plan 2015 2016 2017 2018 2019 2020 2021 Increase Increase Increase Increase Increase Increase Increase Essential 3% 5% 6.5% 6% 5.5% 5% 2.5% Basic 6% 5% 6.5% 6.5% 6.5% 6% 2.5% Core Saver 6% 6% 7.5% 7.5% 7.4% 7% 3.5% Traditional 7.5% 7.8% 8% 8.25% 7.4% 7% 3.5% Comprehensive 8.5% 8.5% 8% 8.5% 8.5% 7.8% 3.9% Plus 9% 9.5% 9% 8.75% 9% 8% 3.9% Average 7.9% 7.8% 7.9% 8.1% 7.9% 7.3% 3.6% Annual limits of many medical categories were increased generally by 4.5%
Plan structure
A Plan to suit everyone Top of range Plan with savings and an ATB Plus (safety net) for when savings are exhausted Comprehensive range of benefits paid from both insured Comprehensive and savings out-of-hospital Wide range of benefits with annual sub-limits for day-to-day expenses. Traditional Network Plan Contributions Core Saver Hospital plan with a savings component for day-to-day expenses Wide range of primary care benefits (including non PMBs) available via Basic GP Entry Plan Network Essential Lean, low cost Plan. Benefits limited to PMBs only available via GP Entry Plan Network Managed Care Programmes Wellness-Based Incentive Programme Bankmed Balance available to all members Wellness and Preventive Care Benefit range and specific networks
Essential and Basic Plan Overview Plan Benefits Essential Plan Basic Plan Entry level Plan, suited for low healthcare needs. Low contribution Plan with IH and OH benefits Positioned for PMB cover only and chronic disease benefits Wellness and Preventative Care Benefits Rich spectrum, expect for contraception Rich spectrum Restricted GP Network Yes Yes Specialist Network Yes Yes GP Specialist Referral Yes Yes Hospital Network Yes Yes Pathology, Radiology and Medication Restricted formularies Managed Care Programmes HIV Programme and Oncology Programme: PMB level of cover only Optometry Benefit No Isoleso Optometry Network Basic Dentistry No Yes
Core Saver, Traditional, Comprehensive and Plus Plan Overview Plan Benefits Core Saver Plan Traditional Plan Comprehensive Plan Plus Plan Young, healthy members with Plan provides comprehensive Designed for moderate to Plan suitable for moderate to high relatively low healthcare needs. medical cover to meet moderate high healthcare needs for Positioned for healthcare needs for members Limited MSA for to high healthcare needs. members who want a savings who want a savings component day-to-day expenses Network Plan. component and ATB Wellness and Preventative Care Rich spectrum Rich spectrum Rich spectrum Rich spectrum Benefits Medical Savings Account Yes No Yes MSA + ATB GP Network Yes Yes Yes Yes Specialist Network Yes Yes Yes Yes GP Specialist Referral Yes Yes No No Hospital Network No Yes No No Managed Care Programmes PMB level of cover Cover for both PMBs and Non-PMBs subject to pre-authorisation Optometry Benefit Subject to MSA Insured Insured / MSA MSA / ATB Basic Dentistry Subject to MSA Insured Insured MSA / ATB Dental Admissions Emergency/PMB cover only R1 950 deductible 33
2021 Benefit Enhancements
The principles behind the annual review include the following: To enhance benefits/innovation - these do come at a cost but are 1 necessary to remain competitive and be the medical scheme of choice for the banking industry 2 To optimise Risk Management in order to keep contribution increases as low as possible To consider a tiered differentiation in benefits between Plans 3 especially for the “discretionary benefits” where members perceive value and would therefore consider higher premiums justifiable 4 To lower out of pocket payments 5 To improve member experience
2021 Enhancements informed by Minimal enhancements in favour of lower COVID-19: Mental Health Member-centric Employer Group contribution Lockdown/Job issues on an philosophy of requests increases due to insecurity/Isolation incline Bankmed the state of the economy
Mental Health Disorders • Mental health disorders are emerging as the number one cost driver in the healthcare sector • The impact of mental illness is not only felt in the healthcare sector. It is also the largest contributor to global disability and accounts for 10 billion days of work lost on an annual basis • The most common condition within the mental illness cluster is depression, typically accounting for greater than 50% of all members registered with a mental illness and more than 50% of total spend on mental health disorders
Mental Health Disorders • “As many as one in six South Africans suffer from anxiety, depression or substance-use problems (and this does not include more serious conditions such as bipolar mood disorder or schizophrenia), according to statistics released by the South African Depression and Anxiety Group (SADAG)” • Previously the focus was on four chronic diseases (cardiovascular, diabetes, respiratory and cancer) that contributes to 60% of deaths. The focus currently is on five chronic diseases that contributes to 75% of deaths, the fifth one being Mental Health • The very concerning incline in Mental Health conditions is certainly • Impacting productivity of the employee base due to absenteeism and presenteeism • Impacting the claiming patterns • Impacting scheme sustainability
The Social Impact of Mental Illness on South African patients • 17% cannot take care of dependents • 26% are separated or divorced • 47% lose friends (a key part of their support network) • 49% experience negative family relationships • Only 27% of South Africans reporting severe mental illness ever receive treatment. This means that nearly three-quarters of these sufferers are not accessing any form of mental health care at all • South Africa has one of the highest rates of gender-based violence (GBV) • 23 South Africans commit suicide every day
The Social Impact of Mental Illness The lifetime prevalence of Depression in SA is 9.7% or 4.5 million. About 20% of South Africans will experience a depressive disorder at least once in a lifetime. Depression is a treatable condition and between 80% and 90% of people have a good response to treatment. Depression has a serious impact on the South African economy. Depression costs SA more than R218bn in lost productivity: • R28bn is attributable to absenteeism (unscheduled absence from work) • R190bn is attributable to presenteeism attending work while unwell)
Mental Health Disease Management Programme Comprehensive programme that includes both out-of-hospital and in-hospital support. The following are some components of the programme: • Members on all six plans have access to the mental health programme, however plan benefits will apply with respect to condition cover • The programme looks at strategies across the spectrum from the healthy to those members requiring comprehensive inpatient care • The healthy and at risk segments are promoted through regular screening at wellness days and online • Access to a mental wellbeing module on the website which includes information that promotes mental well-being e.g. advice on mindfulness, meditation exercises • Access to counselling should someone at risk wishes to speak to a counsellor • A primary care programme which is GP level of care. This is a crucial component and the mainstay of treatment
Mental Health Disease Management Programme • The Premier Plus GP Network will play a pivotal role in this programme. This network is already managing Diabetes, Cardiovascular Disease and HIV for Bankmed. Mental Health will be an extension to the Premier Plus Programme • The GP will enrol member onto programme e.g. Major Depression monitor compliance to medication, ensure follow up visits, script renewal etc. • Coaching and educational material will be provided • The programme includes a hospital DSP/Network which Bankmed is already participating in, case management and discharge planning by a care coordinator • Enrolment on a relapse prevention programme to provide the necessary support on discharge to prevent unnecessary readmissions • The implementation will be phased in. The employers EAP is included as part of this model
Frail Care 1 Frail care is an existing benefit 2 Members on the top 3 plans have access to this benefit 3 The benefit is, however, complex. 4 2020 benefit: 50% of cost limited to R470 per day 5 2021 benefit: Flat daily rate
Health Quality Assessment (HQA)
Health Quality Assessment • Benchmarking exercise in the funding industry • Highlights key quality issues in the SA medical scheme industry • Drives improvement in the delivery of evidence-based medicine • 18 schemes participated in 2019 HQA from 9 different Administrators • Comprised of 115 benefit options • Represented 7,29 million beneficiaries (81,63% of the medical scheme population) • 206 Indicators in four categories are evaluated, namely: 1. Prevention and Screening 2. Hospitalisation 3. Maternity and New-born 4. Chronic Disease Management
Definition of Quality Agency for “the degree to which healthcare services for Healthcare Research individuals and populations increase the and Quality (AHRQ) likelihood of desired health outcomes and are consistent with current professional defines quality as knowledge”.
Bankmed compared to Industry | 2019 Primary Care (Including Screening) Indicator Bankmed Industry Benchmark CMS Flu vaccine coverage > = 65years (%) 28.38% 20% 61% 3.85% Prevention Pneumococcal vaccine coverage ≥ 65 years old (%) 9.60% 3.49% 72.7-77% N/A Cervical Cytology coverage (previous 3 years) (%) 41.96% 32.67% 59.3-75.2% 15.99% Mammogram coverage (ages 50-74 years in previous 2 37.90% 24.07% 72% 32.68% years) (%) Bone densitometry coverage for all females aged Screening 9.25% 7.25% N/A N/A 65 years or older (%) Colorectal cancer screening ≥ 50 years in previous year 14.91% 10.79% N/A N/A (FOBT, %) Percentage of beneficiaries ≥ 2 years old visiting dentists 32.45% 21.61% NA N/A
Bankmed compared to Industry | 2019 Chronic Disease Management Indicator Bankmed Industry HbA1c coverage for Diabetic patients (%) 65.56% 60.31% Cholesterol related tests coverage for Diabetic patients (%) 60.33% 55.00% Monitoring Nephropathy for Diabetic patients (%) 71.56% 67.23% Diabetes Podiatrist cover (%) 6.65% 3.52% Statin coverage (%) 62.08% 56.42% % of Hypoglycaemia related hospital events 0.56% 4.59% Lower Limb amputations per 1 000 diabetics 2.23 3.16
Bankmed compared to Industry | 2019 Chronic Disease Management Indicator Bankmed Industry Aspirin coverage for IHD beneficiaries (%) 83.04% 69.78% Cholesterol test coverage for IHD beneficiaries (%) 61.63% 53.25% Ischaemic Heart Statin Coverage for IHD beneficiaries (%) 82.05% 75.38% Disease Beta blocker coverage 52.48% 49.96% Flu coverage of IHD registered beneficiaries 25.09% 18.66% Lung function test coverage 15.63% 11.47% Asthma Flu vaccine coverage 16.01% 12.27%
Bankmed compared to Industry | 2019 Chronic Disease Management Indicator Bankmed Industry Flu vaccine coverage (%) 25.17% 18.47% Cardiac Failure ACE & ARB inhibitor coverage (%) 56.56% 61.73% 10 day post discharge follow up (%) 13.2% 39.69% Depression 30 day post discharge follow up (%) 30.54% 47.47% Multiple admissions for Depression 1.81% 0.78% Flu coverage for COPD beneficiaries (%) 34.29% 28.77% Lung Function test coverage for COPD beneficiaries (%) 37.53% 33.52% COPD COPD beneficiaries admitted once for respiratory condition (%) 31.40% 27.32% COPD beneficiaries admitted more than once for respiratory condition (%) 10.82% 9.54%
Bankmed compared to Industry | 2019 Hospitalisation Indicator Bankmed Industry Stents 1.36 1.48 Cardiac Average length of stay for all cases (days) 5.93 5.45 Procedures Readmission for any reason within 30 days 8.04% 10.83%
Bankmed compared to Industry | 2019 Maternal and New-born Indicator Bankmed Industry Number of Teenage Pregnancy (10-19 years inclusive) cases per 1 000 2.55 2.52 teenage beneficiaries TSH Coverage in New Borns (≤ 6 weeks old) (%) 90.31% 83.52% Maternal and Hepatitis B serology coverage during pregnancy 65.97% 42.70% New-born HIV Screening during pregnancy 72.31% 46.02% Haemoglobin (Hb) test coverage during pregnancy 80.38% 77.42% Caesarean Section rate 73.19% 76.04%
Bankmed compared to Industry | 2019
2021 Integrated Communications Overview
Our message to our client's and members Educate Delight Add value Enhance the Your partner in health, Educate and member journey wellness and inform members and experience lifestyle design across all channels
Key message 1 Educate We help create a Smart member through educational and informative campaigns: A ‘Smart’ member: • Better understands their benefits and Plan options to make more informed Plan choices • Knows how to optimise their managed and preventative care programmes to stay healthy • Is digitally savvy and can access Bankmed platforms i.e. App, website and social media platforms etc. • Engages on multiple communication channels for convenience and ease of use • Enhances their wellness and healthy habits through regular engagement in wellness initiative’s, PHAs, etc. • Understands their health status and derives insights about their health to make informed decisions (data-driven insights)
Key message 2 Delight We delight our members by enhancing the member journey and experience across all channels: App Website Social Email SMS Print Re-Launch Re-Launch Launched Segmented SMS optimised to Print is on hold October 2020 October 2020 LinkedIn communication replace postal unless specifically March 2020 via email to during COVID-19 required at specific audiences Employer Group i.e. members with Clients but co-morbidities online copies are etc. always available
Enhancing the member journey and experience App | Phase 1: new features New Benefit and Medicine Brand and screen Phase 2 coming login screen Limit tracker Tracker enhancements soon…. Provides members with New design presents the Keeps track of all the key messages. member with a detailed medicine a member needs description of the benefit, to take by adding it to their the limits associated with Pillbox. Reminds the the benefit, member of when to take how much has been used, their medicine and when to and which claims have renew their script. accumulated to the benefit. Set the appearance of your medicine so it’s easily recognisable. Each medicine reminder can be set up precisely according to the instructions set.
Enhancing the member journey and experience Website | new features Enhancing the member journey and experience across all channels:
Enhancing the member journey and experience Linkedin Get the latest information at your fingertips: • Health and wellness information • Industry news • Topical information such as the COVID-19 pandemic • Opinion pieces from our Healthcare and Clinical experts • Member stories • Participation in medical and health forums • Benefit and Plan information
Key message 3 Add value We add value to our members and clients through rich, engaging and relevant content: • Thought Leadership • News blog on our website • Collaboration with Employer Group Clients (Campaign toolkits) • Access to information around the Global Pandemic and what Bankmed is offering members – COVID-19 webpage
Client Management
Employer Clients 63
Client Management • Custodian Support • Roadshow Project Planning • Marketing the Project • Preferred channels • Communications Content and Distribution • Encouraging employees to view digital presentations and schedule a virtual consultation if further clarity is required • Project roll-out timelines (Including festive season closure and re-opening dates)
Contact Us www.bankmed.co.za 0800 BANKMED (0800 226 5633) http://www.facebook.com/BankmedSA/ http://twitter.com/Bankmed_SA Mobi App
MORE COVER Thank you Q&A MORE THAN A MEMBER. MORE WITH BANKMED.
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