South African Medical & Dental Practitioners Network

medicalservices

SPNX offers managed healthcare services to medical schemes and companies that seek medical services and/or managed healthcare for its members and gives them an opportunity to contract with a specific provider network where there is an agreed to/negotiated tariff, broad-based accessibility for their members and quality of care. SP NX also provides an Agency role whereby it provides doctors for a specific contract; and monitors the service and quality outcomes as per an agreed Service Level Agreement

 

Our strategy has been to follow a phased risk sharing approach whereby risk models/alternative reimbursement are structured phases with increased risk sharing as the contract matures and progresses. We have had this particular model with at least two scheme administrators. In line with the philosophy of phased risk sharing we always strive to improve and enhance the approach to cost and utilization management within the network.

 

Our services are largely driven by the following managed care principles and initiatives:

  • Provider driven healthcare delivery;
  • Disease Management where possible;
  • GP Gate keeping to secondary healthcare;
  • Negotiate alternative reimbursement models and risk sharing with schemes;
  • Sharing risk in Hospital Benefit Management;
  • Sharing risk in Dental, optometry, and other Benefit Management where the doctor has an influence in managing these downstream costs;
  • Quality Assurance programmes that include: Utilization Review and Peer Management (Peer Review)