PSMAS Head of Managed Care division on health and wellness in medical insurance

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Premier Service Medical Aid Society Head of Managed Care Division Dr Munyaradzi Mujuru
Premier Service Medical Aid Society Head of Managed Care Division Dr Munyaradzi Mujuru

Q1. What is Managed Care?

“Managed care” is a term you may have heard before, but perhaps weren’t sure what it meant. It’s pretty simple really. Traditionally managed care has been about contracting healthcare providers and medical facilities to provide care at a reduced cost for medically insured populations.  However, at PSMAS we have taken this concept further to make it better to serve our members by focusing on both prevention and care management. This in turn helps to produce better patient outcomes and healthier lives.

When we then zero in on the Preventive aspect of Care, that then leads to the Concept of Wellness

Q2. How do you define wellness?

Wellness is an active process of becoming aware of and making choices towards a healthy and fulfilling life. Wellness is more than being free from illness, especially because of deliberate effort. It focuses on preventing illness and prolonging life as an actively pursued goal. The aim of wellness is to prevent exposure to risk factors, prevention of diseases/conditions, minimize the likelihood of getting diseases, prolonged life, early detection and management of diseases. There are eight dimensions of wellness, which are:

o             Intellectual – recognizing creative abilities and finding ways to expand knowledge and skills

o             Career – creating personal satisfaction and enrichment from work

o             Physical – recognizing the need for physical activity, healthy foods and sleep

o             Social- developing a sense of connection, belonging and a well-developed support system

o             Spiritual – expanding a sense of purpose and meaning in life

o             Emotional – coping effectively with life and creating satisfying relationships

o             Environmental – occupying pleasant environment, stimulating environments that support wellbeing.

o             Financial – feeling satisfied with current and future financial situations

Q3 What are the PSMAS Lifestyle Wellness Program offerings?

Premier Lifestyle is a wellness program that was initiated by Premier Service Medical Aid Society in 2017. The goal is to promote lifestyle modification among our members. Premier Lifestyle’s main objective is to influence behaviour change that protects our members from diseases through employing a lifestyle that is health conscious. The program is an added benefit to all members with PSMAS and it comes at no extra cost. The program offers health risk assessment and screening. Members are checked for BP, Blood Sugar, BMI, weight, body fat, and pulse rate among other parameters. These parameters determine the risk of an individual in relation to monitored Non-Communicable Diseases. The assessment collects member information, their demographics, and medical, family and social history in relation to listed conditions. The initial stage is to complete your HRAQ (Health Risk Assessment Questionnaire) virtually or at any PSMAS branch office, PSMI clinic or any of the network wellness providers. The HRAQ is important for identifying potential risk factors.  The HRAQ is a questionnaire used to uncover lifestyle trends and health issues. It is an effective tool to identify risk, and to track population health trends over time.

Q4. What is the next step after screening?

a). All screened members are given health education based on their screening results. The screening results are colour coded to show the risk levels of each parameter. Based on the risk factors members are identified and enrolled for Health Risk Management programs. Currently Premier Lifestyle is implementing the following eight care programs which are:

o             Physical exercise

o             Nutrition , diet & weight management

o             Stress & resilience management program

o             Back & neck care program

o             Substance use management program

o             Interpersonal relationship management program

o             Sleep management program

o             General wellness program

Members are enrolled on the above care programs based on the health risk assessment results. The care program providers will provide extra assessment and implement intensive care management and offer health coaching for members to achieve set targets.

b). Premier Lifestyle is conducting a Pulse Wearable Health Device pilot project which is running for three months from June 2021. It is a first of its kind in Zimbabwe. The digital device monitors the following:

  • Number of steps
  • Distance covered
  • Calories burned
  • Heart rate/Pulse

1005 members were enrolled into the pilot phase and these were selected according to the screening and profiling results. The success of the pilot phase will lead to full roll out to all PSMAS members.

Q5. What are the benefits of engaging in some of the listed care programs?

5.1 Physical exercise

Exercise strengthens your heart and improves your blood circulation. The increased blood flow raises the oxygen levels in your body. This helps lower your risk of heart diseases such as high cholesterol, coronary artery disease, and heart attack. Regular exercise can also lower your blood pressure and triglyceride levels

5.2 Nutrition, Diet & Weight Management

Maintaining a healthy weight is important for health. In addition to lowering the risk of heart disease, stroke, diabetes, and high blood pressure, it can also lower the risk of many different cancers.

5.3 Stress and Resilience Management

Effectively managing stress often leads to improved health. Stress management programs are drug-free. Most importantly, stress management programs put you in charge and give you a sense of control, which leads to enhanced self-esteem, less likelihood of depression and an overall improvement in quality of life.

Q6. If I enroll for wellness, should I stop my medication?

For many conditions, a medication can only do so much. Lifestyle changes are important even if you take medication. Healthy lifestyle habits can improve the chances that a medication will be effective. In fact, it may be even more important for those who were prescribed medications, because if their conditions were severe enough to warrant a prescription, they may be at higher risk for complications (such as heart attack or stroke) than those able to avoid medications. Medication and lifestyle changes work hand in hand.

Q7. Which Providers is PSMAS currently working with for screening and care programs?

We have established a wide network of service providers across the country for each of the wellness domains. Members can get in touch with our in-house wellness and care experts on the contact details below for appropriate referral.

Q8. What is my role in wellness?

As defined earlier on, wellness is a proactive process and an individual has to make deliberate efforts to lead a healthy lifestyle.

  1. Avail time to enroll and get screened under the Premier Lifestyle Program
  2. Know your health risk
  3. Set wellness goals for self
  4. Actively pursue set goals

For further information, please visit your nearest PSMAS branch office, Our Facebook page, Twitter page, PSMAS website or email us on [email protected]

 

 

 

 

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