Health Risk Management

Health Risk ManagementPHAs founding vision is to use innovation and cost effective Health Risk Management to create long term sustainable healthcare that is always available for its clients and members. This drives everything we do, and is complemented by careful management of healthcare costs as well as a relentless drive for operational efficiency and client centricity.

Our Managed Care services are data driven and we have the capacity to receive claims and authorisation data from administrators, other managed care providers as well as payroll systems. We currently integrate with Metropolitan Health Risk Management, Medikredit and MSO for our closed scheme clients, and Mediscor and Medikredit for our open scheme clients.

Before it happens, When it happens and After it happens.

If your hospital risk management service is not fully integrated with your disease management services, you may be missing an important component of Health Risk Management. Although there are benefits in price based management of a hospital event, this does not address the principal cost drivers of an admission to hospital ie. the admitting doctor and the patient.

Our Integrated Hospital and Major Claims Management Solutions Include:

  • Hospital, Oncology and Major Radiology Authorisations
  • Case Management Discharge Planning, Updates and Site Visits
  • Hospital Account Auditing
  • Specialist Authorisations and Benefits
  • Disease Management (Outreach and Outcomes Focused)
  • Hospital Services Utilisation Management
  • Protocol Development
  • Chronic Condition Management
  • Maternity Management Program  (Including Ante and Post Natal Care)
  • HIV Management Program
  • Mental Wellness Program
  • Acuity Level Management
  • Pathology Claims Management
  • Oncology Management
  • Medicine Management
  • Dental Benefit Management
  • Designated Provider Networks and Capitation Networks

Clinical Management Committee

PHA’s clinical and funding decisions are reviewed and assisted with by our Clinical Committee. This is a team comprising of independent academics and healthcare professionals across multiple disciplines that have an in-depth understanding of clinical medicine, as well as the factors governing both the funding and provision of healthcare services. The team further assists in developing clinical guidelines and protocols based on current and future best practice, monitors ethical and professional codes of conduct of providers, and ensures that strong clinical governance and quality assurance in the provision of care and funding decisions are maintained.


Health Risk Management

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