Combining excellence in care management with state-of-the-art business intelligence to meet the needs of each medical scheme and its members.

We subscribe to a model of personalised care, with a strong emphasis on ensuring optimal, clinical and financial risk management through the application of evidence based, scientifically justified clinical protocols based on international best practices.

UNIVERSAL CARE MODEL

INTEGRATED CARE

Universal Care believes in doing things the right way. No matter what the circumstances, we will always endeavour to provide:

• The Right Treatment
• By the Right Person
• In the Right Place
• At the Right Time
• For the Right Price

Through its comprehensive and expert approach, Universal Care offers an integrated care management service to medical scheme clients under one umbrella. The Universal Care offering enables medical schemes to contract cost-effectively with a single entity which provides the full range of managed care services.

Our integrated approach enables the sharing of information between the various care management functions and our administration division, which streamlines clinical funding decisions, and improves the responsiveness and quality of our service. This way, savings to the scheme are maximised and can be passed onto members in the form of lower contributions.

 

CLINICAL COMMITTEE

Universal Care has a full-time Clinical Committee comprising a team of healthcare professionals and experts who review clinical and funding decisions, and develop clinical guidelines which conform to the latest international best practice and scientific evidence. The Clinical Committee comprises a team of doctors, nurses and pharmacists, with input from independent academics, who have an in-depth understanding of clinical medicine as well as factors governing both the funding and provision of healthcare services.

The Clinical Committee also 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.

 

BUSINESS INTELLIGENCE

A dedicated business intelligence unit, utilising the latest technology, ensures that our risk managers have access to detailed information and decision support systems through our Universal Care data warehouse.

Universal’s database of healthcare risk management and administrative information spans more than a decade, and enables detailed analytical and data management procedures for the purposes of utilisation management, benchmarking, case mix adjustment and risk-adjusted mathematical modelling. Regular feedback and reports are provided to decision makers and clients.

 

FLEXIBILITY

Universal Care provides a highly personalised service to each of our clients. The application of our risk management models is customised to the requirements of each individual medical scheme client.

Universal Care has the ability to apply individual scheme-specific and even option-specific rules and reimbursement models.

 

PERSONLISED CARE

Universal Care subscribes to a philosophy of personalised care. The requirements of individual members are carefully assessed from a clinical risk management perspective to ensure an optimal outcome when care plans are approved and funding decisions made.

Motivations and requests for special care are considered and managed in consultation with the attending healthcare professional, taking into account scientific evidence from clinical guidelines, the medical literature, clinical trials and international best practice.

This approach ensures that the most appropriate, cost-effective and affordable care is funded. Importantly however, is the fact that an individual member’s care requirements are carefully considered and assessed, to ensure access to the most appropriate care available in the circumstances.

 

Universal Care Services

Universal Care delivers a new brand of personalised care management, focusing on the individual member’s healthcare needs, backed up by international standards and evidence-based medicine. While subscribing to best practice principles, Universal Care ensures that members gain access to quality and appropriate care, at the most affordable cost.

The Universal Care Guidelines include protocols developed locally by our team of medical advisors, pharmacists and case managers, as well as international protocols acquired from world leading organisations in healthcare management and actuarial services.

Universal Care offers the following care management services:

– pre-authorisation of hospital admissions,

– hospital services utilisation management,

– case management and site visits,

– acuity level management,

– discharge planning,

– hospital account audit,

– disease management programmes for common chronic diseases,

– HIV/AIDS programme,

– pathology services management,

– oncology management,

– medicine management,

– dental benefit management,

– trauma benefit recovery service,

– designated provider networks and,

– capitation networks.

With over twenty years of experience, Universal Care has developed skills to provide the various services to its customers in an effective and integrated manner so that the benefit to the customer is maximised.

The Universal Care approach is enhanced by its strategy to build partnerships with provider networks, which has enabled medical schemes contracted to the company to offer low-cost capitation-based options as part of their benefit plans, and to benefit from preferred provider relationships which create savings for members.

Universal Care also facilitates negotiations on innovative alternative reimbursement models with selected hospital groups and centres of excellence, resulting in cost containment and reduced member contributions, whilst maintaining a high quality of care.