How medical schemes can better serve the needs of members

South Africa has many strengths, but customer service is not generally regarded as among our stronger suits. South Africa’s largest closed medical scheme is challenging this negative national stereotype, as it breaks new ground to bring great service to its members.

“Whether in restaurants, retail or the healthcare industry, there are a number of factors contributing to this less-than-favourable scenario, including lack of competition, customer apathy, lack of response to complaints and arrogance on the part of many service providers, explains Bella Mfenyana, GEMS executive of contracts and operations.

“Government Employees Medical Scheme recognises that in order to improve our own track record, as well as the way South African customer service is regarded internationally, change is needed at every level of society.

“Over the last year, GEMS has had a long hard look in the mirror and taken to heart some of the constructive criticism members have shared with us. Whether it has stemmed from dissatisfaction with the level of service received from our call centre, or difficulties in processing claims, we have taken cognisance of the fact that we had room for improvement.”

According to Mfenyana, South African healthcare consumers have become increasingly cynical of endless service promises, and tend to disregard these until they see demonstrable action. Consumers are becoming more selective, they no longer remain loyal to service providers if service is not forthcoming.

“The healthcare industry should be leading the groundswell toward better, more customer-centric service in order to ensure that the needs of medical scheme members are anticipated and exceeded at every opportunity,” she asserts.

When the Government Employees Medical Scheme (GEMS) first opened its doors for business in 2006, few expected it to be the success that it turned out to be.

“With the aid of a rigorous tender process and watertight contractual agreements, we have contracted with the best-of-breed service providers who are providing the appropriate infrastructure and skills to serve the needs of our members,” Mfenyana adds.

We conducted extensive research for the development of an innovative product range, with options specifically designed to suit members’ medical usage patterns. In-house campaigns focused on an ethos unique to GEMS, boosting staff morale and rewarding productivity.

“The results have been encouragingly positive but we are always looking for avenues for improvement. We conduct regular surveys to assess our service on an on-going basis. We research the opinions of each individual Government department, members and service providers, and, generally speaking, the results have been encouraging.”

“The important thing is that these research results are not simply filed away. We take active measures to address each issue that is red-flagged as problematic or potentially challenging.

“Despite much progress, we have not yet attained levels of service that receive a ‘Wow’ reaction from members – and we remain committed to this elusive goal.

For the present, we are making great strides towards meeting and exceeding each and every member need. There are four tenets to the GEMS service philosophy that we are at concentrating on:

  • Getting it right first time – so that members are not sent from pillar to post to have their queries resolved;
  • Taking ownership – not passing the buck but doing our utmost to solve the problems that land on our desk;
  • Keeping promises – not just promising to deliver, but delivering on promises;
  • Service, service, service – ensuring our members feel valued, building relationships, and going the extra mile.

Value for money – first and foremost

“We fully appreciate that the health and wellbeing of our members and their loved ones is their most precious asset. That is why the monthly amount that they contribute towards their healthcare cover is one of the most important investments they will ever make.

“It is up to us at GEMS to ensure that our members will always get the very best value for money when it comes to healthcare services, and more specifically their healthcare benefits,” she notes.

Sometimes cost alone will determine what scheme and option a member will choose to belong to. GEMS has always made an effort to deliver the finest possible healthcare benefits at the most affordable rates to its members. Contribution rates on GEMS benefit option plans are maintained at 19% below those of similar benefit plans offered by other medical schemes, while offering similar or better benefits.

Snapshot of recently introduced customer-centric innovations from GEMS

  • A recent advance in our continuous efforts to enhance our service saw the introduction of GEMS Self-help Kiosks. This interactive tool provides personalised service to members and prospective members at the touch of a button. With a dedicated GEMS ambassador on hand to assist, members can access a range of services, including logging of queries and requests, viewing their claims and benefits, and printing their GEMS documentation.
  • In a bid to help protect members against lifestyle diseases and proactively promote health and productivity, the GEMS Fitness Programme was piloted late last year and implemented at the beginning of 2016. This initiative offers members guidance and support on exercise and nutrition, as well as access to the GEMS Fitness Journey portal, which allows them to measure their progress and challenge their colleag
  • GEMS has introduced a number of client liaison officers (CLOs) to serve members throughout South Africa, including those residing in remote areas. The specially trained CLOs serve as a vital link between the Scheme, the service provider network and the members, whom they are able to assist in the language of the member’s choice.

“Although GEMS has made some positive advances, the management of the Scheme has no intention of resting on its laurels. We also know that if we put your members at the heart of everything we do and focus on making a difference in their lives, this is the best possible endorsement. When existing members are impressed with service, they become our brand ambassadors and this belief is at the core of everything GEMS stands for,” she concludes.