My expertise and focus is to provide support across the spectrum of interactions between different role players in the South African healthcare industry. I have in depth situational grasp, understanding and experience of population risk segmentation and subsequent establishment of targeted multidisciplinary care interventions. I have experience in health informatics and supported actuaries and analysts in the interrogation and interpretation of healthcare data to provide insight in reporting and developing risk interventions.

Over the past 2 decades I have developed content, provided training and coaching in various aspects of managed care.

PRODUCT DEVELOPMENT

I understand the need to develop specific programs within a framework to ensure fair and transparent benefit allocation. It is important to keep in mind what the aim is and how to measure if the goal has been reached at the planning of a product. This enables fair distribution of funds for the right reasons.

CREATING CLINICAL SOLUTIONS

We know that a small percentage of people are responsible for a large proportion of healthcare spent. Making a small difference in this population makes a huge difference in people’s lives and helps to stretch the available healthcare rand.

Identifying segments/pockets of populations at risk of becoming high claimants as well as creating clinical risk management solutions, is the skill I used the most during the last part of my career. At each of the companies I worked for, I left with a legacy of at least one of these high-risk intervention programs that still exists years after I left.

MANAGED CARE

II have worked in managed care for all major managed care companies in South Africa. I therefore have an in-depth understanding of all aspects of managed care. This enabled me to lead a team in developing a comprehensive managed care platform.

I have worked in the front line as a medical advisor and worked in a strategic capacity where interventions are created, conceptualised, implemented and executed.

I have worked in an advisory capacity to all departments of administration/managed care ranging from pharmacy benefit management, provider profiling, fraud waste and abuse and many more.

DATA ANALYTICS

My analytical skills are based on my clinical training and insight, years of experience and interest as well as biostatistics training which was part of my epidemiology studies.

I have worked alongside actuaries and analysts in a variation of situations and scenarios. I typically provided clinical input, support in interpreting results with the context required. I have experience in providing support in predictive models including machine learning modelling.

POLICY AND GUIDELINES

I have worked in a policy unit but my epidemiology course also taught me to understand the process of policy and guideline development. Adopting existing guidelines is not always possible. Understanding critical appraisal and evaluation of scientific evidence is needed to fill in gaps and develop new policies and guidelines.

RESEARCH AND TRAINING

Although I have done limited research and publishing in the public domain, I have however done many internal pilot studies, research and writing throughout my career. My epidemiology studies equipped me to plan, execute and document pilot studies with the appropriate methodologies.

COACHING AND TRAINING

Being in a position where I created new interventions required me to develop training material, provide training and coaching in novel ways of executing managed care. I have also done internal and external presentations on a regular basis.

FUNCTIONAL MEASURMENTS

I was director of SADFM (South African Database for Functional Medicine) from 2004 to 2008. I am familiar with the world of rehabilitation and measurement of functionality. I was responsible for data analysis and reporting

COLLABORATION

I am not alone in believing that healthcare should be a team sport approach. I strongly believe that the majority of people involved in healthcare chose this life because they want to do good. I have been instrumental in facilitating collaboration between different role players in healthcare to co-create unique solutions for complex problems.

I have established and coached multi-disciplinary teams to understand and execute their own expertise within a context beyond their own role.