Guided Care
We “dare to care” by being involved, caring and supportive.
Our objective is to manage healthcare costs without shifting financial risk to members or employers.
A true patient
advocacy model
Demand Management
We have a reputation for personalised care and attention and through using our unique model of Demand Management®, we provide a high ratio of health professionals per beneficiary making us ideally suited to meet the needs of clients with a vision of delivering a comprehensive healthcare package to their employees/members.
Personalised health guidance
Demand Management provides an interface with health professionals to support beneficiaries’ understanding and healthcare choices. Through predictive analysis, we identify beneficiaries who are at risk. They are then contacted by our wellness nurses either onsite or telephonically to provide the necessary risk assessments and counselling to guide their appropriate use of health care services.
Our integrated managed care solutions include:
Ex gratia process
Health and lifestyle management
Pre-authorisation
Case management
DSP and capitation networks
Protocol development
PMB management
Disease management
Health education
Medicine management
Audiology benefit management
Pharmacy benefit management
Risk management
HIV management
Mental wellness management
Our Unique Differentiator – The Dedicated Nurse
PHA uniquely dedicates a Registered Professional Nurse to every member as their client relationship and benefits consultant. This ensures that every member has access to somebody impartial and authorised to access their medical records to assist them in some of the more complex or difficult decisions they must make. Where possible, in the case of corporate clients, PHA Nurses generally travel to the site for face-to-face interactions. The telephone becomes a secondary medium of choice to contact the Scheme.
Our Dedicated Professional Nurses will provide you, your members, or employers with personal attention. They will guide and counsel you to be in control of your health and healthcare spending through appropriate education and the provision of health information that will empower you to make informed choices about your health.
This unique differentiator is one of the cornerstones through which we provide the human touch, get to know our members better and provide true patient advocacy while continually focusing on client centricity and delivery of their unique healthcare needs and patient preferences.
The Role of the Dedicated Professional Nurse
- Face-to-face interaction with members and employers on-site
- Dedicated focus on a specific group of members per nurse
- Focused attention on health risk factors and minimisation of risk through health
risk management strategies - Education and advocacy – keeping members informed and influencing claiming behaviour
- High touch – personal attention steering members to appropriate use of benefits
PHA has its head office in Westville, KwaZulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.