Service Offering

Enablemed employs the services of highly qualified clinicians, who through the management and support activities of the organisation, seek to make a difference to how medicine is practiced in the population of patients entrusted to them. Enablemed strives towards restoring a more direct and ongoing relationship between doctor and patient in the primary care setting. Our philosophy is premised on the fact that the General Practitioner is the best point of access to the health care system. International research over many years has proven that this is the most efficient and effective point of access for the integration of healthcare services

Enablemed’s vast experience in low-income product development and benefit management of primary care, as well as its contractual relationships with other specialist service providers, enables it to deliver the following service offering:

 

  • General Practitioners – Managed via the 24 hour call centre
  • Dentistry Management – DENIS
  • Specialist Network – Managed via Enablemed 24 hour call centre
  • Pharmacy Management – Mediscor  per formulary
  • Optical Management – Managed via Enablemed 24 hour call centre
  • ICON Oncology Services – Managed via Enablemed 24 hour call centre
  • Hospital Network – Managed via 24 hour call centre and contracting with various hospital groups to meet the schemes/clients requirements

Our approach is different in that:

  • Members have the freedom of choice to nominate their own General Practitioner;
  • Dependants can similarly nominate their own GP, independently from the principal member;
  • Enablemed`s GP footprint is nationwide;
  • Enablemed has its own 24 hour call centre used for pre-authorisation and to ensure our members receive personal attention 24 hours a day;
  • Clinical management expertise ensure members are not denied access for medically necessary treatments;
  • Clinical protocols have been developed according to clinical guidelines and evidence based outcomes;
  • Active intervention and ongoing clinical management by the full Clinical Committee monitors and follows up on every high cost case or utilisation by members and providers;
  • Comprehensive health benefits;
  • Downstream costs are contained by our pre-authorisation process and hands on approach to ongoing clinical monitoring;
  • All Primary Care services offer unlimited benefits within the network;
  • Members belonging to Enablemed managed options have consistently enjoyed rich benefits when compared to other options;
  • Annual increases in options managed by Enablemed have been consistently below market average without reducing benefits;
  • Enablemed has proven to be one of the lowest cost health providers in the industry based on analysis from the CMS annual report over the past 5 years.