The future of medical schemes depends on technology, trust and transformation
Kevin Aron, principal officer at Medshield Medical Scheme
We understand that medical aid members want clear, simple, and fast access to their benefits. They want to feel supported when they are unwell and before problems start, and most importantly, they want options that match their digital or face-to-face preferences.
Improving efficiency while enhancing the member experience
Most members contribute a significant portion of their monthly budget to their medical scheme. It's only fair that those contributions are used efficiently. The less we spend on administration, the more we can direct toward members' healthcare services. That's why Medshield has invested in digital systems that reduce costs and streamline operations. We have automated processes that integrate with communication channels and other digital tools to improve processing and overall efficiency. This allows us more time to focus on what matters most: caring for our members.
Medshield members now have more ways to engage with the Scheme beyond traditional phone calls or email correspondence. Our member mobile app and WhatsApp service channel allow members to access important information and services at their convenience 24/7. We launched our enhanced Medshield member app at the end of last year, which resulted in a 20% increase in usage. We are continuously monitoring the uptake to ensure long-term value. Many members continue to supplement app use with calls to our call centre, suggesting that confidence in digital-only services is still developing.
Current development priorities include improving app functionality for automated hospital authorisations and chronic medication approvals. For example, members could input procedure reasons directly into the app, reducing the need to phone the contact centre. It has the potential to simplify a currently manual process. In addition, Medshield is exploring further digital service enhancements.
Predicting and managing clinical risk
Beyond operational and access improvements, Medshield proactively uses technology to manage clinical risk. By applying artificial intelligence and predictive modelling with clinical biomarkers, the Scheme identifies members who may be at risk of hospital admission within the next three to six months. Once these members are identified, the Scheme provides clinical support, including clinical coaching or referral to a general practitioner or specialist. The goal is to prevent unwarranted admissions, reduce the need for emergency care, and improve health outcomes for our members and their families.
Technology is also being used to identify members likely to be readmitted post-discharge, for example, due to wound infections. Early engagement helps to identify clinical risk, prevent complications and avoid unnecessary re-hospitalisation.
In addition, Medshield is piloting facial scan technology that can analyse up to 20 clinical health parameters from a person's facial image. Medshield is utilising this as a mass digital health screening tool to direct members to appropriate care to reduce high-cost episodes and to support earlier intervention.
Behaviour change and lifestyle health
Lifestyle-related diseases remain one of the most significant cost drivers for medical schemes. Conditions such as type 2 diabetes, high blood pressure, and obesity are closely linked to behaviours such as inactivity, poor diet, and unmanaged stress.
Medshield is working to address this through behaviour change programmes like Medshield Mind and Medshield Movement. These initiatives support members with educational materials, coaching, and practical advice for managing their health, including child and family-focused interventions.
One proof of concept currently underway has shown that members living with type 2 diabetes can reduce or stop medication with consistent lifestyle improvements while under medical supervision. This programme aims to empower members to improve their quality of life.
Interventions are tailored based on a member's clinical risk profile, ranging from low-touch digital education to personalised nurse coaching. Due to current regulations under the Medical Schemes Act, the Scheme cannot offer financial incentives for improved health outcomes. However, behaviour change remains a key focus area in chronic disease management.
Remaining accessible beyond digital tools
Although the demand for access to digital channels continues to increase, many members still prefer to meet in person. Medshield has made enhancements to our regional offices and walk-in centres and recently relocated our Cape Town and Durban branches after conducting a survey and engaging with members to understand their needs.
Looking ahead, the Scheme is reviewing its benefit design for the 2026 cycle with a strong focus on prevention. With one of the highest solvency ratios in the industry, Medshield is well-positioned to consider enhancements to its preventative benefits while aiming to limit contribution increases. Additional efforts are focused on predicting avoidable healthcare episodes and ensuring members are guided toward appropriate care earlier in their treatment journey.
In today's healthcare environment, members want more than just cover. They want easy access to support, whether online or in person, which helps them stay healthier for longer. Medshield adapts to these changing needs by using innovative technology, enhancing day-to-day processes, and proactively addressing health issues before they escalate. It's about making healthcare work better for real people in real life.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Zawya
an hour ago
- Zawya
South Africa: Monitoring and learning for impact, Vodacom calls for bold shift in CSI
As South Africa grapples with record unemployment, deepening inequality and a critical skills shortage, Vodacom is challenging the private sector to rethink its approach to social investment – by embedding monitoring, evaluation and learning (MEL) in core business functions, not just in social investment. Speaking at the 2025 Trialogue Business in Society Conference, Vodacom SA director of external affairs Takalani Netshitenzhe said impact was central to overcoming inequality. 'Only impact measurement can assist us to make sure we deal with inequality in our country,' said Netshitenzhe. The conference was held on 13 and 14 May at The Galleria in Sandton, Johannesburg under the theme 'Driving impact, inspiring change'. The Vodacom Foundation was one of six corporate sponsors who partnered with Trialogue to discuss pressing matters impacting the corporate social investment and development in South Africa. The foundation and Trialogue presented a panel discussion entitled 'Embedding a culture of monitoring, evaluation and learning to scale impact'. During the discussion, Netshitenzhe was critical of the traditional approach to corporate social investment, which entails 'paying lip service, writing a cheque, and walking away'. 'That's not partnership – it's outsourcing responsibility,' she stressed. She admitted that Vodacom itself was previously more focused on outputs – such as how many schools it had connected to the internet – rather than outcomes. As a result, its good intentions often went awry. 'When we donated routers and SIMS to schools and walked away, those routers often ended up in cupboards, or simply disappeared,' she said. 'If we're serious about addressing inequality and building a sustainable society, MEL must be embedded from the outset – not retrofitted once programmes are running.' The Vodacom SA executive was joined on the panel by Gcobani Zonke, the deputy president of nonprofit organisation (NPO) Ubuntu Pathways, and Dr Karen Kotschy, a research associate and freelance MEL consultant. Today, the telecommunications corporation places unemployed graduates from the Vodacom Youth Academy in some of the schools and NPOs it works with. Placing information technology technicians within schools has translated into a higher and more effective usage of the technological devices it places in the schools. Additionally, the company no longer counts how many social workers it deploys to schools, but how the psychosocial support impacts the well-being of children, teachers, parents and the broader community. To support this shift, Vodacom has established a dedicated MEL department – an unusual move in the corporate sector. 'Our MEL journey is still evolving, but we're gaining the trust of our partners and stakeholders. We're seeing the power of MEL to shape stronger, more accountable programmes,' Netshitenzhe said. Learning – a critical feature of MEL Dr Kotschy called for MEL practitioners to be positioned at the heart of strategic business and programme decision-making. 'MEL teams need to se themselves as more than just technical people doing their thing on the side – they must adopt an advocacy role,' she asserted. 'Relational and transformational skills are needed for this new approach to M&E.' She acknowledged that smaller NPOs may lack resources but urged them to start with simple reflection practices and build from there, adding: 'they should focus on the learning part of MEL first'. Zonke, who is based in Gqeberha, explained that communities were an integral part of their monitoring and learning practices. 'We build our indicators alongside the community, based on what teachers, nurses, and caregivers tell us really matters. We make sure voice of community is heard – we conduct caregiver satisfaction surveys and then integrate that data into our programmes.' He said the early childhood development teachers Ubuntu worked with didn't 'just collect developmental data – they co-design social and emotional indicators to assess the safety, attachment and wellbeing of the children'. Ubuntu's cradle-to-career model for vulnerable youth uses MEL not only for donor accountability but to adapt programmes in real time. 'We move and then we stop and evaluate. That way, you can see where you may have gone wrong. However, that's not failure – it's simply how we learn,' he pointed out. Netshitenzhe agreed that 'MEL allows us to accept that things don't always go according to plan', but any weaknesses provide an opportunity to 'do the right thing'. From data collection to strategic learning Netshitenzhe warned against last-minute data collation for ESG reports. 'When you rush to compile stats and nobody checks the numbers, you lose credibility. We've learned the hard way – you can't sign off what you can't verify,' she said. 'Now, we hold every unit accountable for the data they provide, and our auditors validate it before publication.' As South Africa moves toward large-scale social investments, such as the R100bn transformation fund, Vodacom argues that MEL needs to be embedded in such investments to ensure accountability. 'You can't wait for programmes to launch and then ask what the impact is,' said Netshitenzhe. 'You start with the problem, define the outcomes, and build MEL into the DNA of delivery.'
Zawya
an hour ago
- Zawya
Cloud-based tools reshape how South Africa's businesses communicate
The digital communications landscape in South Africa and globally continues to shift, with cloud-based telephony tools increasingly replacing legacy PBX systems. This is according to Braintree, a local Microsoft solutions partner, which says tools such as Microsoft Teams Calling and Operator Connect are becoming core to how businesses collaborate and manage voice services. Doug Morrison, VP of modern workplace at Braintree, says companies are moving away from hardware-dependent systems toward software-based platforms that integrate voice, chat and video services under a single interface. 'Digital-first has become the default,' he says. 'It's not just about replacing phones; it's about embedding communication into business workflows.' Braintree cites IDC figures showing that unified communications as a service (UCaaS) accounted for 89% of global market revenue, with Microsoft leading the market at 44.7% share. These platforms allow companies to manage voice calling without traditional infrastructure, routing calls directly into Microsoft Teams through certified telecom partners. Braintree refers to the Forrester Total Economic Impact report, which found that small and medium businesses using Microsoft Teams Calling saw up to 45% total cost of ownership savings over three years, with enterprise customers reporting 17% savings. Both categories reported positive returns on investment. Beyond cost, Braintree says organisations are adopting cloud communications for greater flexibility and scalability. Operator Connect, Microsoft's voice integration service, enables organisations to provision and manage phone systems directly in the Teams admin centre, removing the need for on-site PBX equipment. Security has also become a key consideration. Cloud-based systems allow for encrypted communication, remote patch management, and access controls. Braintree notes that this is especially relevant for businesses with hybrid or remote workforces. Mobility is another driver. Employees can make and receive calls from any internet-connected device, which Braintree says reduces the need for fixed desk phones and enables flexible work policies. It adds that AI features now available in cloud systems can support compliance, call transcription, and workflow automation. Looking ahead, Braintree expects greater convergence between telephony, collaboration tools, and emerging technologies like AI and omnichannel messaging platforms. 'As tools become smarter and more integrated, communication is shifting from something you do separately to something embedded in how work gets done,' Morrison says.
Zawya
an hour ago
- Zawya
As the years go by, when should your business replace its PC hardware?
Common sense dictates that South African businesses hold onto their technology for as long as possible. In the face of turbulent market conditions and economic uncertainty, as well as the fact that they can represent a significant upfront capital investment, PC hardware needs to deliver as much value as possible and be capable of supporting modern business operations in the long term. Werner Joubert, Commercial SYS business director (South Africa and SADC) at Asus But what happens when that hardware starts to show its age? Telltale signs and helpful tips Upgrading hardware may feel like a grudge purchase in the moment, but the fact is that upgrading comes as a result of a company's technology stack no longer being able to fully meet its digital and IT needs or is hurting its business activities or operations in an optimised manner. Some of the signs that it's time to upgrade your PC include: - Outdated platforms: If your device is unable to run the latest versions of essential business platforms and applications, then it's time to upgrade. A prime example of this is the upcoming end-of-life deadline for Windows 10, which is prompting many users to upgrade to devices that can run Windows 11. - Application performance: As application workloads become more hardware-intensive, users may discover their older hardware cannot run them optimally. Apps may be slow to start up and run, negatively impacting business and users' productivity. - Multitasking: With businesses relying more and more on digital-first functions and processes, users may find themselves unable to carry out multiple tasks on their PCs at the same time, further impacting productivity and performance. - Noise and heat: Constant noise from a PC's fan signals the PC is generating a lot of heat, which can indicate that it is working overtime to carry out computational tasks. That all said, businesses can also take steps to prolong the lifespan of their devices without having to outright replace them. This includes keeping the devices clean and free of dust, which can lead to overheating, regularly defragmenting and reformatting hard drives, keeping them in cool, dry working environments. Users should also adhere to optimised power and battery life management practices, while businesses can also upgrade components (if possible) such as Ram and storage. A lifecycle well spent With the help of a formal PC lifecycle policy, South African businesses can better manage the lifespan of their devices, starting with the initial purchase planning and ending with their decommissioning and ethical disposal. This includes several important practices. For example, businesses should base the length of PC lifecycles on workloads and users' needs. Not every organisation or user is equally reliant on their hardware, so businesses should deploy a uniform distribution system where possible, meaning they should procure and allocate devices based on groups' and departments' individual use cases (e.g. a programmer requires a PC with high advanced computational capabilities while a salesperson needs a PC with levels of portability and good battery life). By doing so, businesses can also track device warranties and oversee support options, ensuring everyone in the organisation remains connected and capable of fulfilling their digital responsibilities. A lifecycle policy also creates the opportunity for businesses to integrate their technology into their organisation's greater sustainability goals and objectives. Knowing when and how to replace PC hardware (i.e. e-waste) can align with businesses' initiatives to lower their carbon footprints and minimise the impact of their operations on the environment. Upgrade strategically to stay competitive, innovative, and agile Never underestimate the impact of old or outdated hardware on business continuity, with devices unable to fully leverage the latest generation of enterprise applications (and that includes new technologies such as AI, which marks a turning point in multiple industries across South Africa) or process-intensive workloads. The result is not just a rig that's slow to boot up, but a liability that hinders overall productivity and performance. By keeping up to date and investing in capable, up-to-date hardware, local businesses can remain competitive in their respective industries, reinforce their ability to innovate using digital platforms and solutions, and be agile towards shifting consumer and market needs and expectations.
