Real Time Monitoring of Schemes

Transcription

1 Real Time Monitoring of Schemes

2 Contents Introduction... 2 Technology... 2 All Single Indicators required... 4 Definitions for the Indicators... 4 Variable Mappings... 9 The time period to submit is as follows: Retrieving the wsdl File User Name and Password Schedule for sending data... Error! Bookmark not defined. 1 P a g e

3 Introduction The Council for Medical Schemes (CMS) is embarking on a project that will enable them to collect data from schemes on a monthly basis. The project is called Real time monitoring (RTM). The data includes statistics that represent the current activity on schemes that can help determine usage patterns and trends. Statistics are only useful if the time period during which they are collected is meaningful. CMS will be collecting the data at the end of the third week of every month. The data collected will be from the previous month. The data collected will only be utilised for internal monitoring as it is unaudited. Technology Web services will collect the indicators from schemes. Web services are application programming interfaces that can be accessed over a network, such as the Internet, and be executed on a remote system hosting the requested services (CMS). The web service technology was decided upon as all schemes do not utilise the same architecture for their systems, some may use oracle, and others may use Microsoft etc. Web services are designed to support interoperable interaction over a network. When consuming the web service, it is important to note that the CMS prohibits schemes from merely creating a front end where a user can capture the required indicators. CMS requires schemes to consume the web service, mapping directly to the financial systems transactional database or data warehouse used by the scheme and do the passing of the required indicators automatically. A diagram of the architecture is illustrated below. 2 P a g e

4 Passes requested data from the data warehouse or transactional database Web Servers Database Application Scheme 1 Application Scheme 2 Application Scheme n RTM Web Service CMS Web Server Web Service will receive indicators and save it to the CMS RTM database Database Each scheme will have to write an application to consume the RTM web service that is exposed on the CMS web server. This application will extract the indicators we stipulated in the RTM web service from the schemes data warehouse or transactional database and pass it through the RTM web service which in turn saves it onto the CMS RTM database. The application that schemes develop to consume and pass the requested data must be programmed in a way that it can run unattended on the specific dates stipulated at the end of this document. 3 P a g e

5 All Single Indicators required Scheme Reference Number Beneficiaries Average age Pensioner ratio Net (deficit) or surplus gross contributions savings contribution net claims incurred in respect of risk carried by the scheme (including claims incurred in respect of commercial reinsurance contracts) total net claims incurred in respect of related risk transfer arrangements (excluding claims incurred in respect of commercial reinsurance contracts) administration expenditure managed care: management services broker fees net impairment losses: trade and other receivables net income or (expense) on commercial reinsurance contracts Current Assets Current liabilities Total Member Funds Unrealised non distributable reserves (revaluation reserves) Funds set Aside for specific purpose Cumulative net gains Encumbered Assets Subordinated loans Total admissions to private hospitals Total beneficiaries admitted to hospital ( count distinct) Total number of days in hospital Total amount charged (Admissions in Hospital) The month the data is being submitted for The year the data is being submitted for A total 0f 27 indicators will be submitted by schemes Definitions for the Indicators Scheme Reference Number: This is the registration number of the scheme as listed in the government gazette. This can be obtained from the table below. 4 P a g e

6 Scheme Name Ref No AECI MEDICAL AID SOCIETY 1005 AFROX MEDICAL AID SOCIETY 1567 ALLIANCE MIDMED MEDICAL SCHEME 1465 ALTRON MEDICAL AID SCHEME 1534 ANGLO MEDICAL SCHEME 1012 ANGLOVAAL GROUP MEDICAL SCHEME 1571 BANKMED 1279 BARLOWORLD MEDICAL SCHEME 1507 BESTMED MEDICAL SCHEME 1252 BMW EMPLOYEES MEDICAL AID SOCIETY 1526 BONITAS MEDICAL FUND 1512 BP MEDICAL AID SOCIETY 1237 BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND 1590 CAPE MEDICAL PLAN 1034 CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) 1043 COMMUNITY MEDICAL AID SCHEME (COMMED) 1552 COMPCARE WELLNESS MEDICAL SCHEME 1491 DE BEERS BENEFIT SOCIETY 1068 DISCOVERY HEALTH MEDICAL SCHEME 1125 ENGEN MEDICAL BENEFIT FUND 1572 EYETHUMED MEDICAL SCHEME 1585 FEDHEALTH MEDICAL SCHEME 1202 FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) 1271 FOOD WORKERS MEDICAL BENEFIT FUND 1086 GENESIS MEDICAL SCHEME 1554 GOLD FIELDS MEDICAL SCHEME 1568 GOLDEN ARROWS EMPLOYEES' MEDICAL BENEFIT FUND 1270 GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) 1598 GRINTEK ELECTRONICS MEDICAL AID SCHEME 1523 HORIZON MEDICAL SCHEME 1566 HOSMED MEDICAL AID SCHEME 1537 IBM (SA) MEDICAL SCHEME 1111 IMPALA MEDICAL PLAN 1591 IMPERIAL GROUP MEDICAL SCHEME 1559 KEYHEALTH 1087 LA-HEALTH MEDICAL SCHEME 1145 LIBCARE MEDICAL SCHEME 1197 LIBERTY MEDICAL SCHEME 1576 LONMIN MEDICAL SCHEME 1599 MAKOTI MEDICAL SCHEME 1466 MALCOR MEDICAL SCHEME 1547 MASSMART HEALTH PLAN 1495 MBMED MEDICAL AID FUND 1039 MEDIHELP P a g e

7 MEDIMED MEDICAL SCHEME 1506 MEDIPOS MEDICAL SCHEME 1548 MEDSHIELD MEDICAL SCHEME 1140 METROCARE 1535 METROPOLITAN MEDICAL SCHEME 1105 MINEMED MEDICAL SCHEME 1569 MMED 3315 MOMENTUM HEALTH 1167 MOTOHEALTH CARE 1600 NAMPAK (SA) MEDICAL SCHEME 1154 NASPERS MEDICAL FUND 1241 NEDGROUP MEDICAL AID SCHEME 1469 NETCARE MEDICAL SCHEME 1584 OLD MUTUAL STAFF MEDICAL AID FUND 1214 PARMED MEDICAL AID SCHEME 1441 PG BISON MEDICAL AID SOCIETY 1515 PG GROUP MEDICAL SCHEME 1186 PHAROS MEDICAL PLAN 1546 PICK N PAY MEDICAL SCHEME 1563 PLATINUM HEALTH 1583 PRO SANO MEDICAL SCHEME 1454 PROFMED 1194 QUANTUM MEDICAL AID SOCIETY 1516 RAND WATER MEDICAL SCHEME 1201 REMEDI MEDICAL AID SCHEME 1430 RESOLUTION HEALTH MEDICAL SCHEME 1575 RETAIL MEDICAL SCHEME 1176 RHODES UNIVERSITY MEDICAL SCHEME 1013 SABC MEDICAL AID SCHEME 1424 SAMWUMED 1038 SAPPI MEDICAL AID SCHEME 1527 SASOLMED 1234 SEDMED 1531 SELFMED MEDICAL SCHEME 1446 SIZWE MEDICAL FUND 1486 SOUTH AFRICAN BREWERIES MEDICAL SCHEME 1209 SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME (POLMED) 1580 SPECTRAMED 1141 SUREMED HEALTH 1464 TFG MEDICAL AID SCHEME 1578 THEBEMED 1592 TIGER BRANDS MEDICAL SCHEME 1544 TOPMED MEDICAL SCHEME 1422 TRANSMED MEDICAL FUND 1582 TSOGO SUN GROUP MEDICAL SCHEME P a g e

8 UMVUZO HEALTH MEDICAL SCHEME 1597 UNIVERSITY OF KWA-ZULU NATAL MEDICAL SCHEME 1520 UNIVERSITY OF THE WITWATERSRAND - JOHANNESBURG STAFF MEDICAL AID FUND 1282 WITBANK COALFIELDS MEDICAL AID SCHEME 1291 WOOLTRU HEALTHCARE FUND 1293 XSTRATA ALLOYS MEDICAL AID SCHEME 1253 Member: is a natural person, admitted to membership of a medical scheme, who is entitled to healthcare benefits, in terms of the rules of the medical scheme, in exchange for a contribution. Dependant: is the spouse or partner, dependent children or other members of the members immediate family in respect of whom the member is liable for family care and support or other person that, under the rules of a medical scheme, is recognised as a dependant of such a member and is eligible for benefits under the rules for the medical scheme. Beneficiaries: the sum total of members and dependants (adult & child dependants). This includes suspended beneficiaries. Average age: this should be computed per beneficiary based on age as at 01 January of the financial year concerned. Pensioner ratio: beneficiaries older than 65 years of age as a percentage of total beneficiaries. Gross contributions: is amounts payable by members and/or employers, in terms of the rules of the medical scheme for the purchase of healthcare benefits. Gross contributions include savings plan. Net contributions are gross contributions net of savings. Net contributions: Gross contributions net of savings contributions. Relevant healthcare expenditure: represents claims incurred adjusted with net income/ (expense) on risk transfer adjustments. Net Claims ratio: net relevant healthcare expenditure incurred as a percentage of net contributions. Non health expenditure: are costs incurred to administer the medical scheme, inclusive of marketing expensive. Total non health expenditure constitutes of administration expenses, managed care: management services, broker fees and impairment receivables. Administration expenditure: represents costs incurred to administer a medical scheme, inclusive of marketing expenses i.e. operating costs. Managed care: management services: is the cost of managing healthcare expenditure such as disease management, case management and hospital referrals, but does not include the cost of any relevant healthcare services. Broker fees: the remuneration paid to brokers by a medical scheme in respect of the introduction of a member to a medical scheme by that broker and the provision of ongoing services or advice to that member. 7 P a g e

9 Impairment losses: losses recorded when the carrying value of an asset exceeds its recoverable amount. Solvency ratio: the ratio of net assets i.e. accumulated funds, expressed percentage of annualised gross contributions for the period under review. Components for solvency calculation. Refer to Circular 13 of Total admissions to private hospitals: o Hospital admissions = admitted for more than 23 hours, that is count all date of discharge-date of admission> 23 hours o Hospital admissions ( please exclude day cases or same- day procedures) Total beneficiaries admitted to hospital ( count distinct): o Count distinct beneficiaries who were admitted for more than 23 hours. Total number of days in hospital: o Count total number of days for all beneficiaries admitted for more than 23 hours (inclusive of the first day). Total amount charged (Admissions in Hospital): o Count total amount paid for all hospital admissions ( discharge date admission date > 23 hours The month the data is being submitted for: o The scheme must also send through the month number for which they are submitting data. The numbers and corresponding months are as follows: Month Number January 1 February 2 March 3 April 4 May 5 June 6 July 7 August 8 September 9 October 10 November 11 December 12 The year the data is being submitted for: o The scheme must also send through the year for which they are submitting data for. Please note: If any of the indicators do not apply to your scheme, please send through a 0. The month the data is being submitted for is important and should never be 0. The help file Low%20Quality.pdf, will also provide a better understanding of the indicators. 8 P a g e

10 Variable Mappings Variable Name Type Description Validations ischemerefno Integer Scheme Reference Number numeric ibeneficiaries Integer Beneficiaries iaverageage Average age Values must be between 1 and 100 ipensionerratio Pensioner ratio Values must be between 0 and 100 inetdeficitsurplus Net (deficit) or surplus Values may not be 0 igrosscontributions gross contributions isavingscontribution savings contribution Values may be 0 or inetclaimsincurred itotalnetclaimsincurred net claims incurred in respect of risk carried by the scheme (including claims incurred in respect of commercial reinsurance contracts) total net claims incurred in respect of related risk transfer arrangements (excluding claims incurred in respect of commercial reinsurance contracts) administration expenditure greater iadministrationexpenditure imanagedcaremanagements managed care: management services Values may be 0 or ervices greater ibrokerfees broker fees Values may be 0 or greater inetimpairmentlossestrade net impairment losses: trade and Numeric AndOtherReceivables other receivables inetincomeexpensecommre net income or (expense) on Numeric InsContract commercial reinsurance contracts icurrentassets Current Assets icurrentliabilities Current liabilities itotalnoadmpvthosp Integer Total admissions to private hospitals itotalnobenadmhosp Integer Total beneficiaries admitted to hospital (count distinct) itotalamtcharged Total amount charged (Admissions in Hospital) 9 P a g e

11 itotalnodayinhosp (18,0) Total number of days in hospital itotalmemberfunds Total Member Funds Values may not be 0 iunrealisednondistres ( Unrealised non distributable reserves Numeric 18,2) ifundssetaside Funds set Aside for specific purpose Values may be 0 or greater icumulativenetgains Cumulative net gains iencumberedassets Encumbered Assets Values must be 0 or greater isubordinatedloans Subordinated loans Values may be 0 or greater imonthsubmittingfor int The month number the data is being submitted for. The table with the corresponding numbers to send are displayed above. IYearSubmittingFor int The year for which you are submitting numeric data. Username string Use the Username found below Password string Use the Password found below The time period to submit is as follows: Beneficiaries : Must be as at the end of the relevant month Average age : Must be as at the end of the relevant month Pensioner ratio : Must be as at the end of the relevant month Net Deficit Surplus : Must be as at the end of the relevant month including all the months from January Year to Date (YTD) Gross contributions : Must be as at the end of the relevant month including all the months from January YTD Savings contribution : Must be as at the end of the relevant month including all the months from January YTD Net claims incurred : Must be as at the end of the relevant month including all the months from January YTD Total claims incurred : Must be as at the end of the relevant month including all the months from January YTD Admin : Must be as at the end of the relevant month including all the months from January YTD Managed care : Must be as at the end of the relevant month including all the months from January YTD Broker fees : Must be as at the end of the relevant month including all the months from January YTD 10 P a g e

12 Net impairment losses : Must be as at the end of the relevant month including all the months from January YTD Net income on re-insurance : Must be as at the end of the relevant month including all the months from January YTD Current assets : Must be as at the end of the relevant month Current liabilities : Must be as at the end of the relevant month Total admissions to private hospitals: Must be as at the end of the relevant month including all the months from January YTD Total beneficiaries admitted to hospital: Must be as at the end of the relevant month including all the months from January YTD Total amount charged (Admissions in Hospital): Must be as at the end of the relevant month including all the months from January YTD Total number of days in hospital: Must be as at the end of the relevant month including all the months from January YTD Total member funds : Must be as at the end of the relevant month Unrealised non distributable reserves: Must be as at the end of the relevant month Funds set aside : Must be as at the end of the relevant month Cumulative net gains : Must be as at the end of the relevant month Encumbered assets : Must be as at the end of the relevant month Subordinated loans : Must be as at the end of the relevant month Retrieving the wsdl File The web service resides at the wsdl file can be retrieved using the above address. Copy and paste the above address in your web browser. You will be presented with the screen below 11 P a g e

13 Click on Service description and save the page you get as RealTimeMonitoring.wsdl You will be able to consume the web service using this file. The web service has one method called GetKeyIndicators, which accepts the variables. User Name and Password Please call Rozana Abdul on or for your schemes username and password. 12 P a g e