201617 Annual Performance Plan and Budget INTRODUCTION OF CMS DELEGATION Dr Loyiso Mpuntsha Deputy Chairperson Mr Daniel Lehutjo Acting CE amp Registrar Dr Anton De Villiers General Manager Research amp Monitoring ID: 705885
Download Presentation The PPT/PDF document "The Council for Medical Schemes" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
The Council for Medical Schemes
2016/17 Annual Performance Plan and BudgetSlide2
INTRODUCTION OF CMS DELEGATION
Dr Loyiso Mpuntsha– Deputy Chairperson
Mr Daniel Lehutjo – Acting CE & Registrar
Dr Anton De Villiers – General Manager Research & Monitoring
Mr.
Craig Burton-Durham
– General Manager Legal Services
Mrs Thembi Phaswane – Senior Manager Complaints Adjudication
Ms Waheda Khan – Risk and Performance ManagerSlide3
CONTENTSSlide4
STRATEGIC PLANNING PROCESS
Portfolio Committee feedback
At the Portfolio Committee meeting of 15 April 2015 the Committee raised a number of issues concerning CMS strategic plans. Taking the comments of the Committee
and NDOHinto
consideration CMS has revised the strategic plans 2015 to 2020 as per the inputs received.
CMS
response:
CMS should comment on Transfer from National Treasury
CMS does not receive a transfer from National Treasury. CMS is funded through the raising of levies. CMS does however receive a grant from Department of Health and this is explained in the budget write up in the annual performance plan.
CMS did not follow the framework format
The format of the plans have been corrected as per the framework
There were no explanation on programme structures
Organogram of the organisation has been included in strategic plan under the heading Organisational environment together with the purpose of each of the programmes.
There is no Oriented Goals
The strategic goals did not appear under the heading Strategic Oriented Goals but was included in the strategic plans. The heading has now been added with the strategic goals now featuring under this heading.
There is no baseline information provided for strategic objectives and indicators
baseline information has been provided, the baseline figures have been updated to 2014/15
The contents of the
strategic plan has
not been changed and will remain as per the submission made for 2015-2020. Slide5
PART A: STRATEGIC OVERVIEWSlide6
CMS VISIONSlide7
CMS MISSIONSlide8
CMS STRATEGIC GOALSSlide9Slide10Slide11Slide12Slide13
LEGISLATIVE AND OTHER MANDATES
The Medical Schemes Act (131 of 1998), established the Council for Medical schemes. Section 7 of the Act confers the following functions on Council:protect the interests of the beneficiaries at all times;
control and co-ordinate the functioning of medical schemes in a manner that is complementary with the national health policy;
recommendations to the Minister on criteria for the measurement of quality and outcomes of the relevant health services
investigate complaints and settle disputes
collect and disseminate information about private health care;
make rules, not inconsistent with the provisions of the Act for the purpose of the performance of its functions and the exercise of its powers;
advise the Minister on any matter concerning medical schemes; and
perform any other functions conferred on the Council by the Minister or by the Act.Slide14
Alignment CMS goals to DOH and NDP Slide15
Alignment CMS goals to DOH and NDP Slide16
Alignment CMS goals to DOH and NDP Slide17
Alignment CMS goals to DOH and NDP Slide18
Alignment CMS goals to DOH and NDP Slide19
Alignment CMS goals to DOH and NDP Slide20
Alignment CMS goals to DOH and NDP Slide21
Alignment CMS goals to DOH and NDP Slide22
Alignment CMS goals to DOH and NDP Slide23
Situational AnalysisSlide24
TREND IN THE NUMBER OF SCHEMES
Consolidation: Small-sized restricted schemes144 Schemes in 2000Slide25
TREND IN MEMBERSHIP
Growth: 0.4% (8.78 million to 8.81 million)Negative growth in the restricted schemesSlide26
PERFORMANCE ENVIRONMENT
Strengthening regulatory mandate, amendment of the Medical Schemes Act and Regulations, measuring the quality and outcomes of healthcare in medical schemes (measure value over cost of
healthcare)
Development of a beneficiary registry
Demarcation Regulations
Evaluation of the adequacy of the current solvency framework
Enhancing the effectiveness of Council and its Committees
Improving the visibility and reach of CMS brand
Development of information systems and knowledge management to improve efficiencies in the organisation
Continuous improvement of CMS as employer of choice
Human
Resources Management – vacancy of the Registrar poses challenges
Adequate and sustainable funding for the operations of CMS
Policy Development – NHI
Resolution of complex clinical
complaints
PMB
Revisions – challenge – lack of skills and expertise for the projectSlide27
ORGANISATIONAL ENVIRONMENTSlide28Slide29
CMS PROGRAMMES
The report is presented per the following programmes:The administrative programmes of CMS are effectively focused on the efficient functioning of the office and provide support to the core programmes to efficiently carry out their mandates. The programme is made up of the following 5 sub-programmes:
Programme 1: Administration
Sub-programme 1.1: CEO & Registrar
Sub-programme 1.2: Office of CFO
Sub-programme 1.3: Information and Communication Technology and Knowledge management
Sub-programme 1.4: Human Resources Management
Sub-programme 1.5: Legal Services
The core programmes are mainly concerned with the regulation and stability of the industry. The following programmes make up these:
Programme 2: Strategy office
Programme 3: Accreditation
Programme 4: Research and Monitoring
Programme 5: Stakeholder Relations
Programme 6: Compliance
Programme 7: Benefits Management
Programme 8: Financial Supervision
Programme 9:
Complaints
AdjudicationSlide30
PROGRAMME AND SUB-PROGRAMME PLANSSlide31
Sub-Programme
1.1: Registrar and CEO
The
CEO is the executive officer of Council for Medical Schemes delegated with the mandate of exercising overall management of the office, and as Registrar, exercises legislated powers to regulate medical schemes, administrators, brokers, and managed care organisations.Slide32
Sub-Programme
1.2:
Office of the
CFO
The purpose of the sub-programme is to serve all business units in CMS, the executive management team and Council by maintaining an efficient, effective and transparent system of financial, performance and risk management that complies with the applicable legislation.
The Internal Finance unit also serves the Audit and Risk Committee, Internal Auditors, National Department of Health, National Treasury and Auditor-General by making available to them information and reports that allow them to carry out their statutory responsibilities. By doing this, we help Council to be a reputable Regulator.
Key Focus Areas
Risk Management
Business process mapping – for efficiencies
Strengthening supply chain processesSlide33
Sub-Programme
1.3
: Information and Communication Technology and Knowledge
Management
The purpose of the sub-programme is to serve the CMS business units and external stakeholders by providing technology enablers and making information available and accessible
Key Focus Areas
Virtualisation
Internal software development
Single Exit Price (SEP)
Beneficiary RegistrySlide34
Sub-Programme
1.4:
Human Resource
Management
The purpose of the sub-programme is to provide high quality service to internal and external customers by assessing their needs and proactively addressing those needs through developing, delivering, and continuously improving human resources programmes that promote and support Council’s vision.
We will fulfil this mission with professionalism, integrity, and responsiveness by:
Treating all our customers with respect
Providing resourceful, courteous, and effective customer service
Promoting teamwork, open and clear communication, and collaboration
Demonstrating creativity, initiative, and optimism
By doing this we help the Council for Medical Schemes by supporting its administration and staff through Human Resources Management advice and assistance, enabling them to make decisions that maximise its most important asset: its people and to continue the development of CMS as an employer of choice.
Key Focus Areas
Revision
and alignment
of CMS policies
Retention and succession planning strategies
Recruitment process reviewSlide35
Sub-Programme
1.5:
Legal
Services
The purpose of the programme is to provide legal advice and representation to the CMS and business units to ensure the integrity of regulatory decisions.
Key Focus Areas
Defend the decisions of Registrar and Council
Amendments to the Medical Schemes ActSlide36
Programme 2 : Strategy
OfficeThe purpose of this programme is to engage in projects to provide information to the Ministry on strategic health reform matters to achieve government’s objective of an equitable and sustainable healthcare financing system in support of universal access and to provide support to the office on clinical matters. The purpose of the Clinical Unit is to ensure that access to good quality medical scheme cover is maximised and that regulated entities are properly governed, through prospective and retrospective regulation.
Key Focus Areas
PMB
revisions
Complex clinical
complaints
ICD 10 coding – coding system for South AfricaSlide37
Programme 3:
AccreditationThe
purpose of the programme is to ensure brokers and broker organisations, administrators and managed care organisations are accredited in line with the accreditation requirements as set out in the Medical Schemes Act, including whether applicants are fit and proper, have the necessary resources, skills, capacity, and infrastructure and are financially sound.
Key Focus Areas
Clinical effectiveness and value proposition of managed care
Broker RemunerationSlide38
Programme 4: Research and
MonitoringThe
purpose of the programme is to serve beneficiaries of medical schemes and members of the public by collecting and analysing data to monitor, evaluate and report on trends in medical schemes, measure risk in medical schemes and develop recommendations to improve regulatory policy and practice. By doing this we help the Council for Medical Schemes to contribute to development of policy that enhances the protection of the interests of beneficiaries and members of public.
Key Focus Areas
Research projects
Analysis of process and outcomes data per benefit option in medical schemes
Prevalence of Chronic Diseases in Medical Schemes: 2009 – 2015
A Comprehensive Inflation Guidance Framework for the Medical Schemes Industry
Review of solvency framework
Benefit option classification
Analysis of utilisation statistics
Scheme risk measurement system
provide
technical assistance
to major strategic health reforms like
the
NHISlide39
Programme 5: Stakeholders
RelationsThe
purpose of the programme is to create and promote optimal awareness and understanding of the medical schemes environment by all regulated entities, the media, Council members and staff, through communication, education, training and customer care interventions.
Key Focus Areas
Member awareness survey
Enhance visibility of CMS as a brand through campaigns and advertising
Training
Trustees (accredited programme)
Induction Training sessions for newly appointed/elected trustees
Brokers
Scheme specific training
communication
guidelinesSlide40
Programme 6:
ComplianceThe
purpose of the programme is to serve members of medical schemes and the public in general by taking appropriate action to enforce compliance with the Medical Schemes Act.
Key Focus Areas
good corporate governance
practiced by medical schemes
trustee
remuneration guidelines
Curatorship's
InspectionsSlide41
Programme 7: Benefits Management
UnitThe
purpose of the programme is to serve beneficiaries of medical schemes and the public in general by reviewing and approving changes to contributions paid by members and benefits offered by schemes. We
analyse
and approve all other rules to ensure consistency with the Medical Schemes Act. This ensures that the beneficiaries have access to affordable and appropriate quality health care. By doing this we help the Council for Medical Schemes ensure that the rules of medical schemes are fair to beneficiaries and are consistent with the Act.
Key Focus Areas
Electronic filing of rules
scheme rules are registered to cover the required health care benefits
Reviewing registered rules
Model rules
Fair treatment of
beneficiariesSlide42
Programme 8: Financial Supervision
unitThe
purpose of the programme is to serve the beneficiaries of medical schemes, the Registrar’s Office and Trustees by
analysing
and reporting on the financial performance of medical schemes and ensuring adherence to the financial requirements of the Act. By doing this, we help the Council for Medical Schemes monitor and promote the financial performance of schemes in order to achieve an industry that is financially sound.
Key Focus Areas
Monitor financial soundness
Annual return systemSlide43
Programme 9 : Complaints Adjudication
UnitThe
purpose of the programme is to serve the beneficiaries of medical schemes and the public by investigating and resolving complaints in an efficient and effective manner. By doing this, we ensure that beneficiaries are treated fairly by their medical schemes.
Key Focus Areas
complaints resolution process
- enhancing
System
of alternative dispute
resolutionSlide44
OVERVIEW OF 2016/17 BUDGET AND MTEF ESTIMATESSlide45
Assumptions used in creating the 2016/17 budget
Inflationary increase.......................6.2% (as per MTEF guidelines)Non-essential increase………………….4.5%General salary increase...................6.0%No new permanent positions
45Slide46
PROPOSED BUDGET 2016/17
46Slide47
LEVY TREND
47Slide48
Expenditure per unit
48Slide49
OCCUPATIONAL LEVELS AT CMS
OCCUPATIONAL LEVEL
MALES
FEMALES
FOREIGN NATIONALS
TOTAL
Total Blacks
A
C
I
W
A
C
I
W
M
F
Top management
0
0
0
0
0
0
0
0
0
0
0
0
Senior management
2
0
1
4
2
0
0
1
0
0
10
6
Professionally qualified, experienced specialists and mid management
13
0
2
2
9
1
1
5
2
0
35
33
Skilled technical and academically qualified workers, junior management, supervisors
9
2
0
1
29
3
1
5
0
0
50
49
Semi-skilled
2
0
0
0
2
0
0
0
0
0
4
4
TOTAL PERMANENT
26
2
3
7
42
4
2
11
2
0
99
92
People with disabilities (Skilled technical and academically qualified)
0
0
1
0
0
0
0
0
0
0
1
1
GRAND TOTAL
26
2
4
7
42
4
2
11
2
0
100
93Slide50
economic description
50