New Isago Strategy paying dividends
· Points to technology as a top investment priority
· Bomaid’s financial position is very strong – CFO
The Chief Executive Officer (CEO) of the country’s leading medical aid provider, Botswana Medical Aid Society (Bomaid), Moraki Mokgosana, has said they are well geared towards transforming the medical aid to unlock additional growth that will ensure that they continue to create value to the members and beneficiaries without fail.
The upbeat Mokgosana was speaking during a roundtable discussion with the local media on Monday, adding that the medical aid industry has been hit hard by COVID-19.
“First things first, our priority is ensuring the health, happiness and holistic wellbeing of our members, being over 93,000 across Botswana. Health and well-being must not be a privilege but a right for all, and our role is to help people not only when they need our support, but to actively help champion their wellness before there is “need’’,” said the optimistic Mokgosana.
He said as part of transformation through the Isago Strategy, Bomaid is incorporating technology in its health care operations, saying that is reflected by the state-of-the-art health screening Abby Machine.
“In crafting this strategy, we recognised that our role as a medical aid fund transcended beyond that of being merely transactional or as a funding conduit but one that requires a closer interest in evaluating the value that our customers (our members) were getting from the clinical interventions that we as Bomaid cover,” he said, adding that their approach is based on value-based care and patient centred care.
Mokgosana said the medical aid is experiencing a decline in members due to a number of factors, with some people having lost jobs following the COVID-19 pandemic. However, he maintained that Bomaid remained attractive to the members based on its 16 diverse packages.
Meanwhile, Bomaid Chief Financial Officer (CFO) Galeboe Busang said they are stable financial position, with their reserves able to service claims for the next four (4) months.
According to Busang, by the end of June 2023, Bomaid had made a surplus of P1 million.
“As we continue to have a surplus on our reserves, we have to plough every pula for the good benefit of our members. We are not a profit-making entity and we need to be agile on how we guard against the reserves as we are depending on one source of income (member subscriptions),” she added.
Furthermore, Galeboe said that in Q1 Bomaid reported the fund’s insolvency ratio above the 25% regulatory requirement set by the Non-Banking Financial Regulatory Authority (NBFIRA).
“This indicates that we have a strong financial position. We are not allowed to go bankrupt as per the regulatory requirements. In 2021, we made a P100 million loss due to COVID-19 claims and in 2022 we made a loss of P81 million and this reduction tells us that we can close 2023 at a surplus,” she said.
For her part, Bomaid Chief Clinical Services Officer Dr Malebogo Kebabonye said they are committed to ensuring value-based care by guarding against the over-servicing of consultation money by members.
“When we look at over-servicing on various products, sometimes we realise that some elements are highly over-subscribed while others are subscribed and then this creates an imbalance whereby, we see that our members prefer the easy way out i.e., consultation and it is often overused,” she said.
As a result of this imbalance, Dr Kebabonye said the take up of high-impact interventions remains lower meaning that members will continue to pay for consultation when there is no change in what they are seeking health attention for. She said Bomaid draws plans to guard against consultation overuse.
Meanwhile, Mokgosana said overuse of consultation fees, which is P5000 per annum, is very common.
“The fact of the matter is that we will allow you as a member to go wherever you want to see the doctor of your choice and we pay for the consultation. However, when you have reached P2500, which is about 10 visits but no change yet, we have to have a conversation and chat new path that is impactful,” he said.
Mokgosana added: “We are talking about value-based care – we want to be part of the treatment plan. The conversation we have with our members will allow us to see if there is a need to escalate you to a high level of care and maybe to a specialist if the health condition incurred doesn’t improve. This is in line with our strategy whereby we want to be involved in the wellbeing of our members and not just be in a transactional relationship where we pay for the consultation claims. We are keen on transformation”.
Mokgosana said they do not regret spending P100 million on COVID-19 claims, saying they are a compassionate service provider that cares about its members.
“We are very proud of how we handled the Covid-19 pandemic in saving our members from the shocking experience. We always collect money from our members and we had to plough it back by paying out the claims for the affected members,” noted Mokgosana.
In addition, Mokgosana said Bomaid also took COVID-19 as a learning curve to prepare for future pandemic shocks; buttressing that having strong financial reserves will remain their key priority.
He also said Bomaid is committed to tackling the prevalence of Non-Communicable Diseases (NCDs), which needs the adoption of a new, more active tactic to health care.
According to him, Bomaid will reserve a budget to tackle the NCDs as they remain a threat to the national health and if they are not actively addressed, they be a burden to the health system in the long run.