Health Risk Management Briefing Session

01 February 2012

ROAD ACCIDENT FUND

BRIEFING SESSION – Health Risk Management System

GAUTENG

RFP/RAF/2012/00009

DATE: 01 FEBRUARY 2012

RAF - MENLYN

AGENDA

1. Welcome

2. Introduction of the RAF members

3. Circulation of Attendance Register

4. Presentation By RAF - BAU/Case Management Unit

5. Q & A

6. Closing

RAF OVERVIEW• Established through an act of Parliament in 1996.

• Started operating in 1997.

• National Public entity in accordance with schedule 3A of the PFMA.

• Governance: Parliament through SCOPA; Ministry of Transport; Board of RAF

• Provide compulsory cover to all users of South African roads, both citizens and foreigners, against injuries sustained or death arising from MVA within the borders of South Africa. Provide appropriate cover to all road users within the boarders of South Africa

• Rehabilitate and compensate persons injured in a timely and caring manner

• Promote safe use of all South African Roads

• Social responsibility to re-integrate victims of road accidents to society.

• Pays medical and related services costs; general damages; loss of income; loss of support and funeral expenses.

• RAF pro-actively reaching out to communities by expanding the footprint, enhancing processing capability by improving business processes and systems.

• Values: Ubuntu; Freedom to succeed and Pride in what we do.

Page 5RAF PowerPoint Toolkit and Instruction Guide

FREE STATE KWAZULU NATAL

MPUMALANGA

GAUTENGNORTH WEST

NORTHERN CAPE

WESTERN CAPE

EASTERN CAPE

NORTHERN PROVINCE

LESOTHO

ATLANTIC OCEAN

INDIAN OCEAN

BOTSWANA

ZIMBABWE

MOZAMBIQUE

NAMIBIA

Pietersburg

Mmabatho

UpingtonKimberley

Stellenbosch

Cape Town Port Elizabeth

Grahamstown East London

Umtata

Durban

PietermaritzburgBloemfontein

Pretoria

Johannesburg

Welkom

BACKGROUND

• Current transformation process.• Envisaged nine provincial offices for origination of claims.• All claims to be processed centrally at the Benefit Administration Unit

(envisaged).• Claimed benefits include Medical; General Damages; Funeral; LOE and

LOS.• Medical Unit is responsible for payment of past medical expenses;

rehabilitation services; life care and supplier claims.• 2010/2011 Financial year 195,634 medical claims lodged• 187,168 finalized• 2010/2011 medical claims cost close to 800 million rand• Predicted increase – 8-10 %• Pre authorization of rehabilitation and life care services• Payment to claimants, service providers , attorneys

RAF CASE MANAGEMENT

• Hospital based case managersFirst RAF contact with the injuredManual reports

• Case management Unit BAURetrospective AssessmentRefer to field case managers

• Field case managersHome visitsAssess needs and initiate strategiesNo service provider network

• Undertakings DepartmentPre authorisationPayment for services

Health Risk Management Specifications

A health risk management system to proactively manage all medical, surgical and rehabilitative accident related interventions by applying best practice regimens

• Pre authorisation Hospital admissions Prostheses Assistive devices Medical procedures

• Case management• Clinical audit • Medical peer review• Rehabilitation programmes• Private nursing and specialised wound care• Service provider network arrangements

Specifications contd.....

Interactive solution Software able to run on IBM or HP Operating system- one of Unix, Aix, or Windows Databases– Oracle or MSSQL

Standard operating procedures Pre loaded Health Intelligence Rejection of chronic/pre existing but allow exceptions Exclusion management e.g. drug interactions, allergies Protocols and formularies for cost effective treatments Able to create patient specific rules Flagging and tracking of updates Automated updates – current best practice

Details of the Bid

Documents can be couriered or hand delivered at the reception during:

Mondays - Fridays

Working hours

7h45 a.m. – 16h00 p.m.

Please ensure that register is signed at the reception

Closing date and time should be strictly adhered to:

9 February 2012 at 11h00 a.m. sharp

Details of the Bid

Request for proposals: Appointment of a service provider to provide

Health Risk Management System

• Closing date 9 February 2012.

• All questions / enquiries outside this forum will be via email to: tsholok@raf.co.za not later than 11:00 on 2nd February 2012.

• Questions/ Answers will be published on the RAF website by 3rd February 2012.

Compliance

• Compulsory Documents (Valid original Tax Clearance Certificate)

• Page 5-Checklist of documents to be submitted

• Please ensure that document is signed where required

• Complete proposal should be submitted

Technical Mandatory Requirements

• The service provider must have full local solution support.

(please provide the structure of the support team to the RAF)

NB: Bidders who do not meet functional mandatory requirements will be disqualified and will not be considered for further evaluation on the functional requirements.

 

Technical / Functional Requirements

The functional / technical criterion that will be utilized to test the capability of service providers

Technical /functionality will be evaluated against the following detailed requirements:

Project plan and methodology Experience Standard operating procedures Security features Training Report generation

NB: Bidders who score LESS than (60% out of 85%) will not be considered for site visits

Site visit

NB:Bidders who score LESS than (80% out of 100%) on functionality including site visit will not be considered for further evaluation on Price and BEE

Evaluation

90/10 principle will be used.

Price and BEE

QUESTIONS

?

THANK YOU