South African Medical & Dental Practitioners Network

contracting

Our unique contracting approach allows for SPNX Network to contract with the IPA and tie in the individual doctor. This facilitates both a relationship with the IPA as well as with the PP who provides benefit to the member. Through our contracting with the local or regional IPA, SP Net achieve critical mass quickly, be it when introducing a new contractual requirement; reviewing the annual tariff increase; and/or performing a Peer Review mechanism that accommodates demographic differences.

 

However, SPNX Network through the cooperation agreement it has with major GP networks on the market, also facilitates contracts with these networks. We do also facilitate individual contracts with individual General Practitioners who are not affiliated to any IPA or network to ensure accessibility for members. SPNX has contracts that it has negotiated and functions as a Designated Service Provider (DSP).

 

Below are various types of contracting models we utilize.

Capitation

  • Consultation + agreed to list of procedures + related surgical and consumerable + medicine formulary items are capped
  • Management tool – Credentialing, Peer Review and Utilisation benchmarking
  • Peer management and Marketing fee for SP Net

Cost Shifting

  • Consultations - NRPL + 5% (non-dispensing) and 15% (dispensing)
  • Medicines - SEP + contracted % mark up
  • Management tool - Credentialing, Peer Review and Utilisation benchmarking
  • Peer management and Marketing fee for SP Net

Take On

  • Consultations and Procedures - National Reference Price List (NRPL) with no member co-payment
  • Management tool - Credentialing, Peer Review and Utilisation benchmarking
  • Medicines - Single Exit Price and Professional Fee (mark up)
  • Peer management and Marketing fee for SP Net

Flat Fee

  • Consultation + agreed to list of procedures + related surgical and consumerable items can be rolled up into a Flat Fee
  • Medicines can be included or excluded
  • If Medicines included = SEP + Professional Fee with no admin fee
  • Management tool - Credentialing, Peer Review and Utilisation benchmarking
  • Peer management and Marketing/management fee for SP NX

Fee For Service

  • TManagement tool -Provider Credentialing, Peer management and Utilisation benchmarking; and Marketing/management fee for SP NX