Medical Scheme & Health Insurance Consulting

Sophisticated projections models, advanced IBNR calculations, and standardised actuarial reporting equip medical schemes and health insurers to better manage their product lines, and design improved products.

We dig deeper into the data to understand the drivers of claims experience to suggest mitigations and improvements. Insight provides advice on managed care programs, provider network design and monitoring, and fraud analytics to help funders manage their risks. We help design and monitor alternative reimbursement models and progressive contracting between providers and funders including fixed fees, per diems, and capitation contracts. Insight’s Signal model analysis quantifies benefit richness for the market of schemes and options to show value for money to help identify competitive positioning and gaps in product range.