In this issue by sdsdfqw21


									                                                                                                                    IMPERIAL GROUP MEDICAL SCHEME NEWSLETTER

                FIRST QUARTER 2009

                Letter from the Principal Officer
                                                                                                                                       In this issue
                I hope that the first few months of this year have treated you well, and that you are keeping up your
                                                                                                                                       + From the Principal Officer’s
                New Year’s resolutions. In light of the fact that it is World TB day on the 24th of March, and due
                to the prevalence of this disease in South Africa, we have an article on TB for your interest on
                page 3. We have also included the story of a member who has recently taken control of her life,                        + What is a Treatment Plan?
                through learning to manage her diabetes with the help of our Disease Management department,                            + Manage your condition
                and some more information on the new PMB treatment plans offered through OMHc GP Alliance.                             + Anna’s story - Diabetes
                Please do not hesitate to contact us with your thoughts and questions.                                                   Uncovered
                                                                                                                                       + TB Fact Sheet
                Yours in health
                Johan van der Walt                                                                                                     + Seven Steps to Good Health
                Principal Officer                                                                                                      + Business Update
                Imperial Group Medical Scheme

                What is a Treatment Plan?
                If you have a chronic Prescribed Minimum Benefit (PMB)                     your condition is well controlled. In order to add benefits onto
                condition and require ongoing medical management, you will                 your treatment plan, your doctor is required to submit a clinical
                be automatically registered to receive a PMB Medical Manage-               motivation to our medical management team. This motivation will
                ment Treatment Plan once you have been approved for chronic                be reviewed and you will be informed of the outcome.
                medication. Treatment plans were distributed to all chronic users
                                                                                           Your Scheme has appointed the OMHc General Practitioner
                in January 2009. If you have not received a treatment plan,
                                                                                           Alliance as the designated service provider (DSP) for medical
                please feel free to contact the CBM call centre to request an
                                                                                           management of PMB conditions. Therefore claims will be paid
                additional copy.
                                                                                           at 100% if the services are obtained from a medical practitioner
                                                                                           belonging to this network. If your medical practitioner is not part of
                Treatment plans are guides to assist you, along with your doctor,
                                                                                           this network, your claims will be paid at 75% of Medical Schemes
                in optimally treating your medical condition.
                                                                                           Rate (MSR) once the standard benefits are depleted. For more
                                                                                           information please refer to page 21 your new Member Guide.
                The treatment plan in Figure. 1 is an example of a typical Medical
                Management Plan and you will note that it indicates three main             Important Contact numbers:
                areas of services:                                                         Old Mutual Healthcare Chronic Benefit Management (CBM):
                1. Number of consultations to your general practitioner or specialist      Ph 0860 100 733; Fax 021 5098183; E-mail
                2. List of pathology and radiology tests
                                                                                           Please contact the call centre if you have any queries pertaining
                3. Number and frequency of these benefits
                                                                                           to the medical management treatment plans.

                All newly diagnosed patients receive a standard treatment
                plan for their respective conditions. A panel of expert medical            Figure 1: Medical Management Treatment Plan
                practitioners compile these plans, taking into account evidence-            Tariff Code         Service Description         Discipline   Number Start Date
                based medicine, latest medical research, cost-effectiveness as well          Consults     G.P and Specialist Consultations 14/18/28        4     01/01/09
                as the PMB Legislation.
                                                                                              1232           Haemoglobin Estimation            52          1     01/01/09

                Each patient is unique with specific needs based on the severity              3797                Platelet Count               52          1     01/01/09
                of the medical condition. Therefore, on receipt of your treatment             4114                   Sodium                    52          2     01/01/09
                plan, your doctor together with our medical management team
                                                                                             84202            Nutritional Assessment           84          3     01/01/09
                will customise your plan to provide optimum benefits so that


15064 imperial med newsletter 1st Q.indd 1                                                                                                                                   3/18/09 3:09:29 PM
                                                                                     IMPERIAL GROUP MEDICAL SCHEME NEWSLETTER

                Manage your condition!                                                      Anna’s first reaction to this call was to brush it off with a cursory,
                                                                                            “This is not an appropriate time to talk”. Nombuso, the case
                Imperialmed’s new Disease Management Programmes ensure                      manager, did not give up and continued to call her until Anna
                that those who have an ongoing condition, are given some extra              finally gave in. It was then that the truth began to sink in, as Anna
                attention to prevent avoidable and unnecessary hospital admission           and Nombuso discussed her condition and Anna was forced to
                and procedures.                                                             face reality. Her diabetes was out of control and was having a
                                                                                            major effect on her overall health. For Anna, a busy working
                There are two new programmes, namely the Asthma Programme,                  mother who has very little time to herself, the real wake-up call
                                                                                            was finding out that a number of other ailments she had been
                and the ABC Diabetes Programme which helps to holistically assist
                                                                                            struggling with were linked to her condition. In particular, a septic
                patients in managing their diabetic condition including associated
                                                                                            wound that had caused her most recent hospitilisation was not
                conditions such as high blood pressure and high cholesterol.
                                                                                            healing due to her unstable sugar levels.

                The Disease Management Programmes represent a partnership
                                                                                            Nombuso worked through a process with Anna where she asked
                between yourself, the disease case managers and your medical
                                                                                            a number of exploratory questions around her lifestyle and her
                practitioner. The case managers will assist you to take control
                                                                                            experience of her condition.
                of your condition by providing information on your condition,
                suggestions to improve your lifestyle and additional medical
                benefits, if required. The case manager will co-ordinate with your          This process helped Anna to take ownership of her problem and
                medical practitioner to ensure that your treatment plan is sufficient       recognise where she had made bad choices.
                for the optimal control of your condition. The aim of a Disease
                Management Programme is to improve your quality of life, stabilise          The next step involved discussing Anna’s lifestyle and looking at
                your condition and prevent unnecessary hospitalisation. It is most          ways that Anna could make different food choices, increase her
                important that you are comfortable following the treatment plan so          exercise levels, and generally improve her overall health, in a way
                that the programme is successful.                                           that fitted her lifestyle.

                                                                                            It was explained to her that once members are placed on a Medical
                                                                                            Management Treatment Plan, they have access to certain services
                                                                                            to help them change their situations. In Anna’s case she was
                                                                                            provided with access to annual visits to a podiatrist, a dietician
                                                                                            and an opthalmologist, all covered by IMPERIALMED. Nombuso
                                                                                            emphasised the importance of regular testing and monitoring of her
                                                                                            glucose levels at least three times a day, as well as other information
                                                                                            on her condition that Anna was not previously aware of.

                                                                                            Anna is now in a very stable condition and hasn’t had to be
                                                                                            hospitalised for over two years. She regularly visits her GP
                                                                                            and checks her sugar levels throughout the day. She takes her
                                                                                            medication strictly and tries to ensure that she exercises daily.
                                                                                            Where previously Anna felt ashamed of her condition and ignored
                                                                                            it, she is now proud to cook healthy meals for herself and her
                                                                                            family. After finding out that her diabetes ran in the family she has
                                                                                            ensured that her children join in on her activities and good eating
                                                                                            habits, to give them the tools they need to be healthy.

                                                                                            Symptoms of diabetes include: excessive thirst and urination;
                *Anna’s Story - Diabetes Uncovered                                          hunger; abdominal fat; a strange sweet apple taste in the mouth;
                At the age of 32, while pregnant, Anna was diagnosed with
                                                                                            dry skin; fungal infections; wounds that don’t heal and bad
                diabetes after a random blood test. Even with a history of
                                                                                            circulation (particularly in feet).
                diabetes in the family, she did not take this medical condition too
                seriously and did little to control her condition. Ten years later after
                                                                                            If you have any of the above ailments, pop into your nearest USAP
                numerous trips to the hospital, a growing medical history of other
                                                                                            registered pharmacy and take advantage of the new Wellness
                inexplicable illnesses and her sugar levels being sky high, she was
                                                                                            Benefit by having your blood sugar tested. The best way to combat
                earmarked as a high risk patient and contacted by the OMHc
                                                                                            a disease like diabetes is to diagnose it early, educate yourself
                Disease Management Department.
                                                                                            and make lifestyle changes. See the table of the seven steps to
                 *Not her real name.                                                        health later in this newsletter.


15064 imperial med newsletter 1st Q.indd 2                                                                                                                       3/18/09 3:09:32 PM
                                                                                         6 months for TB to be cured completely, but within 2 weeks of
                                                                                         starting treatment, the person will no longer spread the disease.

                                  Remember                                               It is of utmost importance that you do not stop taking your

                                  World TB Day
                                                                                         medicine once you feel better, but follow the full prescribed term of
                                                                                         medication, as the risk of a drug resistant strain of TB which is very
                                                                                         difficult to treat, is possible. It is also important to immunize your

                                  - 24 March                                             children against the disease at a clinic, before their first birthday.

                                                                                         If you have TB, take care to cover your mouth when you cough
                                                                                         to avoid spreading the germs. And always try to live a healthier
                                                                                         lifestyle by eating balanced meals and taking care of yourself.
                                                                                         Balanced meals consisting of food like meat, fish, eggs, beans,
                                                                                         mills, amasi, brown bread, maize meal, vegetables and fruits.
                TB Fact Sheet                                                            Follow the seven steps to good health below.

                TB is a disease that mainly affects the lungs, but can be found
                in any other of the body’s organs. It is caused by a germ called
                Mycobacterium tuberculosis. The germs are present in the
                sputum coughed up by those that have TB of the lungs. The germs
                usually destroy the soft tissue of the lungs, and this causes cavities
                (holes) in the lungs, resulting in difficulty breathing and coughing
                up blood. If untreated, TB can cause death.

                How do people get TB?
                The disease is passed on, through inhalation, when an infected
                person coughs, sneezes or spits and the germs in the air are
                breathed in by others. Not all of those infected with the germs
                contract TB. In most cases the germs are sealed off in the body
                and they do not multiply. However, if the body’s immune system
                is low, they may develop the disease. You are at risk if you: have
                come into close contact with TB patients; suffer from diabetes,
                AIDS (particularly if you drink a lot of alcohol) or drug addiction;
                have poor nutrition and lack of food; suffer from stress or live in
                poorly ventilated, overcrowded rooms.
                                                                                         Seven Steps to Good Health
                The signs and symptoms of TB:
                                                                                         Let 2009 be the year where you take up the challenge to ensure
                +   A cough for longer than 2 weeks
                                                                                         that you take care of yourself so that you are likely to suffer fewer
                +   Chest pains
                                                                                         health problems.
                +   Tiredness and weakness of the body
                +   Loss of appetite and weight
                                                                                         You are encouraged to implement the following seven steps in
                +   Night sweats, even when it is cold
                                                                                         your life.
                +   Coughing up blood

                How is TB diagnosed?                                                      + Step 1    Eat well, but not too much of the wrong foods
                TB is diagnosed through a sputum test, a lung X-ray or a skin test        + Step 2    Quit smoking
                (on children). If a person has been diagnosed with TB, all children
                                                                                          + Step 3    Exercise regularly
                under five years of age that have been in contact with that person
                should be examined too.                                                   + Step 4    Maintain or reduce your weight

                                                                                          + Step 5    Avoid excessive use of alcohol
                How can TB be prevented and treated?
                TB can be cured with little or no complications. Medication must,         + Step 6    Get enough sleep
                however, be commenced as soon as possible and it must be taken
                                                                                          + Step 7    Practice some method of relaxation on a daily basis
                regularly according to the instructions given at the clinic. It takes


15064 imperial med newsletter 1st Q.indd 3                                                                                                                   3/18/09 3:09:37 PM

                Business Update

                You may by now, through media reports, be aware of Old Mutual South Africa’s
                transaction with Lethimvula Investments Limited (Lethimvula). The transaction involves
                the sale of 100% of Old Mutual South Africa’s (OMSA) shareholding in Old Mutual
                Healthcare (OMHc). Lethimvula already owns shares in Medscheme Holdings, one
                of the largest administration and managed care organisations.

                It is important to note that the transaction is subject to approval by the Competition
                Commission. Both OMSA and Lethimvula have followed all due processes and are
                positive that the approval will be forthcoming in the next few weeks.

                The change of shareholders of OMHc will not impact on the benefits of the
                IMPERIALMED members. The Scheme will continue operating as it currently
                is, since OMHc is the administration and managed care service provider.
                The transaction will not have an adverse impact on service. OMHc will be part
                of a larger organisation that is well entrenched in the healthcare space.

                We will keep you posted on any new developments on the transaction.

                Contact us

                Should you have any queries regarding the Imperial Group Medical Scheme, please refer these to the Administrator, Old Mutual Healthcare,
                at the following addresses:

                    IMPERIAL GROUP MEDICAL SCHEME                                   Oncology Case Manager (cancer patients)               OMHc GP Alliance
                    PO Box 90                                                       Tel: 021 509 2273/4                                   Tel: 0860 467 374
                    Howard Place 7450                                               Fax: 021 504 9394
                    Website:                                                                               EMERGENCY SERVICES
                    E-mail:                               HIV/AIDS Case Manager                                 Europ Assistance
                                                                                    Tel: 0860 467 374                                     Tel: 0861 737 283
                    Claims Enquiries & Membership Confirmations                     Fax: 021 504 9394/021 509 7336                        or 0861 RESCUE
                    Tel: 0860 467 374
                    Fax: 021 509 3165                                               CHRONIC MEDICATION                                    FRAUD HOTLINE
                                                                                    Chronic Benefit Management                            Tel: 0800 222 117
                    MANAGED CARE SERVICES                                           Tel: 0860 100 733
                                                                                                                                                                Greenroom 3.2009 JB15064

                    Hospital Confirmations (pre-certifications)                     Fax: 021 509 8183
                    Tel: 0860 100 081                                               E-mail:
                    Fax: 021 509 0218

                                                                                                                       Administered by:
                DISCLAIMER: Information and articles in this newsletter do not constitute medical advice or a
                medical claim for any product of any nature whatsoever on behalf of the publisher, the Medical
                Aid, Old Mutual or the distributor. Consult a qualified health care practitioner for diagnosis or
                treatment of any diseases or medical conditions.


15064 imperial med newsletter 1st Q.indd 4                                                                                                                     3/18/09 3:09:39 PM

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