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Disease Risk Management


 

The programme aims to promote a positive attitude and approach to disease, while simultaneously facilitating cost-effective, appropriate care. A core contribution to the success of the programme is the nature of mutual cooperation and the establishment of synergistic relationships between members, the treating doctors and the case manager.

 

In order to ensure an optimal health status for patients suffering from chronic illnesses, the following is necessary:

 

  • A well-informed, motivated patient
  • Provision of appropriate treatment
  • Regular monitoring of disease specific markers
  • Support systems where necessary.

The following diseases are intensively managed:

  • Hypertension
  • Hyperlipidaemia
  • Cardiac Failure
  • Coronary artery disease
  • Dysrythmia
  • Diabetes I and II
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression.
  • Bipolar Disorders
  • Post Traumatic Stress Disorder
  • Substance Abuse and Dependence
  • Pregnancy (Maternity)
  • Back pain (Spinal)

The management process includes member empowerment through education, the promotion of wellness, the pre-authorisation of access to consultations, tests, referrals, medicine and hospital benefits, and the rational and appropriate management of all costs incurred by the affected members. The programme is managed with a strong emphasis on primary healthcare and focuses on the role of wellness and prevention in all member groups.

 

Differentiating features
  • Metropolitan Health Risk Management determines the quiver of diseases by investigating pooled risk in large medical schemes. We can extend this risk rating to clients on an individual basis.
  • Metropolitan Health Risk Management's integrated care plans facilitate one-stop management for several diseases, where this is applicable in one patient.
  • Metropolitan Health Risk Management makes available patient information in many different ways, including direct access on our website.
  • Our patient profile system allows the case manager to view the current risk profile of the member, make an informed decision and minimise the risk of an event. This important information forms the basis of total risk management.
  • Metropolitan Health Risk Management offers the advantage of managing Care Plans for optimum disease management for the Prescribed Minimum Benefit diseases, and/or managing these conditions through the scheme's designated service provider.
  • The systems and processes developed for this programme can be applied for the provision of lifestyle plans in the promotion of wellness.

An integrated approach addresses utilisation, strengthens communication efforts and supports a Consolidated Disease Management programme.