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Healthcare cost management

Ascoma has completed its brokerage network with the creation in 2003 of an Ascoma healthcare division (the Pactilis network) specializing in the management of mutual funds and healthcare costs for companies. Ascoma Santé/Pactilis provides businesses with a unique service in sub-Saharan Africa based on access to care through a large third-party healthcare network, constant advice and technical assistance, and the audit, analysis and monitoring of healthcare plans. Ascoma Santé/Pactilis ensures perfect management and control of costs.


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Access to Ascoma's network of Medical Providers 

Ascoma has set up a large network of medical providers equipped with a dedicated and computerized reception allowing access to care for all:

PRIMARY AND AMBULATORY SPECIALIZED CARE

This includes general and specialized medical consultations, routine examinations (biology and radiography), and dispensing of medicines. Primary and ambulatory specialized care should be provided as a matter of priority or prescribed by the subscriber's internal medicine centres, if they exist, as well as by Ascoma`s healthcare centre network. These structures offer agreed tariffs, allowing for a significant reduction in costs and contributing in large measure to the stability of the insurance budget.

HOSPITAL CARE

In case of hospitalization of an insured, a certificate of care is automatically issued by Ascoma and delivered directly to the receiving hospital. Each hospitalized patient is visited by a medical adviser who verifies their insured status, the quality of the reception they have received and the ability of the hospital to treat their pathology (this service is optional).

THE THIRD PARTY

Ascoma offers a generalized third-party payment system that allows users to avoid paying costs in advance and relieves companies of the management of reimbursement files. This third-party payment system is accessible in most centres of Ascoma`s care network.

Control of healthcare costs

To ensure better monitoring and social protection adapted to all, it is essential to control healthcare costs. This control revolves around several stages: 

  • Verification of rights in healthcare centres
  • Regular visits to all insured patients
  • Automatic control of all invoices
  • Request for informed consent for certain medical acts
  • Establishment of unique fee schedules with medical providers and insurers for each medical procedure

Analysis and monitoring of health plans

To control and analyze costs, Ascoma offers efficient and reliable analysis tools.

These tools enable clients to control their healthcare costs effectively by fighting against overconsumption, over-prescription, fraud and overcharging, thus making for successful policies and limiting falsified contributions.

TYPICAL OR "CUSTOMIZED" PERIODIC STATISTICS

The system makes it possible to carry out global analyses through, among others, services, status of beneficiaries, high schools, ailments, geographical areas, beneficiaries or families and through healthcare centres and providers.

EXPENDITURE ANALYSIS MEETINGS 

Monitoring committees can be organized in the presence of company managers and staff representatives to analyze the results of the system and to consider, if necessary, corrections and changes to be made.

The international card

Adapted particularly to policyholders who travel frequently, the international card ensures the continuity of third-party payments abroad (hospitalization and outpatient care) and under the same conditions as those of the country of residence. Beneficiaries carry a health card with a barcode readable by an optical scanner. Healthcare centres will be able instantly to verify the patient's eligibility, a necessary condition for accessing the third-party payment system.

Third-party payment allows users to avoid paying fees in advance and relieves companies and insurers of the management of reimbursement files.

Did you know? Only Ascoma Health offers this service in Africa.

Ascoma Health in numbers

  • More than 500,000 beneficiaries.
  • More than 70 Ascoma doctors (teachers, surgeons, specialists, generalists, dentists, etc.)
  • 3,000 healthcare providers (all specialties offering third-party payment)

The Ascoma Group is particularly sensitive to issues related to the healthcare system on the African continent. Our employees in Europe and Africa work together in partnership with local insurance companies to offer innovative solutions.