Medical Scheme & Health Insurance Consulting

Over the past 20 years we have built a comprehensive medical scheme and health insurance consulting capability which provides services to clients across multiple countries. We offer our clients insights and perceptions gained through a deep understanding of both funding (demand) and supply sides of the healthcare economy. We dig deeper into the data to understand the drivers of claims experience to suggest mitigations and improvements. Through the use of sophisticated projections models, advanced IBNR calculations, and standardised actuarial reporting we equip medical schemes and health insurers to better manage their product lines, and design improved products.

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.