2020 INTEGRATED REPORT

one of the biggest uncertainties was the question of how to manage the pandemic on an individual basis. However, very soon after the first case was identified in South Africa, our regulator, the Council for Medical Schemes, added COVID-19 to the list of conditions qualifying for prescribed minimum benefits. This made it mandatory for schemes to cover the medical costs of members who had contracted the virus. With this established, we could, both as an administrator and a managed healthcare provider, gear up to deal with COVID-19-related claims. In the area of occupational health, there were many challenges when it came to providing cover for medical staff, especially frontline staff dealing with COVID-19 patients in hospitals. Schemes had to develop new clinical protocols specifically for members working in healthcare facilities who were testing for the virus on an ongoing basis. It is important to mention that our staff embraced the changes that were thrust upon them by circumstance, even though this was both practically and emotionally challenging. This was in no small part due to the involvement of the Employee Assistance Programme, which was on hand throughout the pandemic to help individuals with both work-related and personal issues. Notwithstanding all the challenges, we met the conditions of our service level agreements across all schemes, which is a notable achievement. RISKS, CHALLENGES AND OPPORTUNITIES The greatest risks to the business are the constantly changing regulatory environment and the consolidation of the medical schemes administration market. We are one of 11 administrators competing for the business of the 80 medical schemes in South Africa. As schemes merge and consolidate, they become bigger, but the overall pool of clients becomes smaller. Accelerating technological change represents both a challenge and an opportunity. The challenge is one of keeping up in a constantly evolving environment, while the opportunity this presents is one of getting closer to our clients and their members, and of maintaining a process of continuous improvement. INNOVATION The roll-out of our private client service model has been very successful. This is a customised private client experience for themedical scheme environment and aims to provide for the first-time resolution of queries. The objective of the model is to provide a high-touch environment with exceptional levels of service, especially to professional members, who expect only the best. In support of this objective, we continuously implement technological innovations and enhance both our online capabilities and the functionality of our mobile app. To illustrate, the on- boarding of new members takes less than 24 hours and our app is frequently voted as the best healthcare app in the android app store. In addition, our new ‘Friendly’ capability went live at the end of 2020. This is a back-end capability that uses Artificial Intelligence (AI) to read paper claims and convert them into a digital format. This will add a new level of efficiency to claims processing, especially for schemes that still receive most claims on paper or as scanned documents. Innovations currently in the pipeline include communicating with members via WhatsApp for Business; the use of SnapScan for collection of contributions, which will automatically allocate the contribution received; a 24/7 self-service option for both members and providers, accessible via our telephone system; and voice-recognition capabilities for when members contact our call centres. We are also planning to use AI-assisted robotic process automation to enhance some of the processes in our Managed Healthcare division. PROSPECTS Our prospects for 2021 are good. The schemes we administer and manage are stable, as are their membership bases. Growth is anticipated from a growing membership at scheme level as well as from new services, such as disease and dental management, for our current schemes. Improved services will help to secure these members, and this will have long-term benefits for both the company and our clients. Costs will be minimised by the introduction of new efficiencies, such as remote working and the technological advances we are making. The affordability of medical aids remains a major issue for members and this naturally increases the risk of attrition. A further immediate risk is that of medical professionals in private practice choosing to emigrate for various reasons. PPSHA nevertheless continues to hold steady despite operating in such a fluid environment and we look forward to a successful year in 2021. GROUP PERFORMANCE AT A GLANCE | 67