Managed Healthcare

Managed healthcare is defined as any effort to promote the rational, cost-effective and appropriate use of healthcare resources. The philosophy of TopMed is to work with members and service providers in achieving these aims.
TopMed’s managed healthcare programmes use clinical funding guidelines and best practice protocols in respect of certain services and supplies for which TopMed allows benefits. Beneficiaries will only qualify for benefits in respect of those services and supplies if the guidelines and protocols have been complied with.

Disease Management

Disease Management is a holistic approach that focuses on the patient’s disease or condition, using all the cost elements involved. The intervention takes place by means of patient counselling and education, behaviour modification, therapeutic guidelines, incentives and penalties and case management. If a beneficiary, however, does not co-operate with the programme, TopMed may refuse to allow further benefits insofar as it is related to the specific disease/condition. Or alternatively, TopMed may decide to only allow benefits for a lower level of service. For more information, contact TopMed’s Disease Management Programme on 0860 00 21 58