With the growing demand for the delivery of quality cost-effective healthcare services, the need to introduce flexible, alternative forms of reimbursement is now a reality for all medical schemes. In order to sustain the private healthcare sector, healthcare providers need to receive adequate payment that allows for appropriate incentives so as to provide efficient, affordable, quality healthcare.

When selecting providers to participate in the network, the Yarona Healthcare approach is that of a combination of analysing hard data such as cost and services offered, as well as applying industry knowledge and judgement about the provider willingness to negotiate.

To implement successful alternative reimbursement models takes careful planning, sound management and a commitment to efficient operations. It is also common to find more than one reimbursement model present in a single relationship. This being the case, Yarona Healthcare Network ensures that on either side (provider and funder) of the equation the ability to manage these transactions are present. We do this by the implementation of comprehensive communication and training strategy of all stakeholders.

At Yarona Healthcare Network, we also understand that price is not the only factor that must be considered. Other considerations include provider credentials, measures of quality and accessibility to members. To this end, we provide additional services which include:

• Geo-mapping (members and providers)
• Benchmarking reports to identify cost effectiveness
• Peer Review sessions with a quality focus

Risk models are reviewed quarterly where cost and utilisation management are reviewed ensuring the facilitation of viable network contracts. In other words, part of our management objectives is to ensure that we only facilitate viable network contracts. This is critical to ensure that a network contract is always a viable solution for the client.

Contracted providers are profiled quarterly in terms of:

• Formulary compliance
• Diagnosis coding
• Reimbursement models
• Cost-effectiveness

Yarona Healthcare Network participates in Peer Review sessions which are chaired by Peer Review Committees at the various contracted IPA bodies. Peer Review is an important component to ensure the delivery of cost-effective, quality healthcare. These sessions identify those providers whose practice profiles are currently outside the norm or cost-effective target and consults with the provider in taking appropriate corrective action.