POLMED - An Agile and Compassionate Approach To Service | Cover Story

Neo Khauoe , Principal Officer, POLMED

My journey in healthcare is one built on a foundation of compassion and clinical understanding. I began my career over 30 years ago as a nurse at Baragwanath Hospital. This experience instilled in me a deep connection to patient care and the needs of our communities. This clinical background provided a crucial perspective when I transitioned into the medical schemes industry, starting as a customer services consultant at Medscheme .

My career path has been rich and varied, encompassing positions such as Client Relationship Manager at Alexander Forbes and Sizwe Medical Services, Scheme Executive, and General Manager. A significant milestone was being instrumental in managing the Administration and Managed Care contract that contributed to POLMED’s early success. In 2014, I joined Sizwe Medical Fund as a Principal Officer with the challenge of spearheading the strategic management of the Scheme out of curatorship. I executed this role with exception, successfully stabilising the scheme and leaving it with a positive financial outlook. These diverse roles have equipped me with highlevel strategic, administrative, and stakeholder management skills, all of which I now apply with pride in my current role as Principal Officer of POLMED.

I then took the helm at POLMED in 2017, following an intervention by the Council for Medical Schemes (CMS) to exit the previous executives and trustees, a period that required steady and immediate leadership to restore stability and trust.

As the Principal Officer, I am the Accounting Officer for the Scheme, bearing statutory and administrative responsibility for its proper functioning. My key duties include ensuring compliance with all regulatory requirements, supervising the Scheme's staff, and managing the collection and accounting of all monies. I am responsible for maintaining accurate and complete records of all financial transactions, assets, and liabilities, and for ensuring that the annual financial statements are prepared in accordance with statutory requirements.

A critical part of my role is the effective management of the Scheme's investments and assets to ensure sustainability. I am responsible for protecting the confidentiality of members' medical records. Ultimately, my role is to steer the organisation towards achieving its strategic goals of sustainability, quality healthcare, and robust stakeholder relationships.

Key Products and Services Offered By POLMED

POLMED provides comprehensive healthcare services and cover for active and retired SAPS employees and their dependants. Our core offerings are delivered through two primary benefit options: the Aquarium and Marine plans.

The Marine plan is our flagship programme, offering benefits that significantly exceed the Prescribed Minimum Benefits (PMBs), including an open hospital network, chronic and specialised medication, continuous glucose monitoring devices, and extensive specialised dentistry. Beyond these core plans, we are transitioning from a traditional claims-paying model to an integrated wellness organisation.

This includes preventive initiatives such as annual health risk assessments, full immunisation schedules, and wellness programmes for weight loss, smoking cessation and encouraging physical activities. We also provide mental health support crucial for officers dealing with trauma, ensuring comprehensive care for our members' specific physical and mental health needs.

Membership Growth and Trends

POLMED has demonstrated significant and consistent growth. Since registering as a closed medical scheme in 2000 with 235 940 insured lives, we have expanded to cover 492 508 lives, representing an increase of approximately 108.8%. This growth trajectory has been robust in recent years, making POLMED the fourth largest medical scheme in South Africa. This growth is a testament to the value we offer, even in a challenging economic environment.

Our consistent increase in principal members is a key indicator of the Scheme's health and the trust placed in us by the South African Police Service (SAPS) community. This growth has been achieved while maintaining cost-effective contributions and comprehensive benefits, underscoring our commitment to accessibility and sustainability.

Partnerships and ESD

We maintain strategic partnerships that are crucial to our operations. We work closely with the South African Police Service (SAPS) and labour unions, including POPCRU and SAPU, to understand the realities of police work and ensure we meet our members' needs. We also engage in extensive tariff negotiations with healthcare providers.

Enterprise and Supplier Development (ESD) is deeply embedded in our business model as part of our ESG commitments. As a non-profit, our social responsibility is paramount. We actively empower black-owned enterprises, with a specific focus on black women-owned businesses within our supply chain. This is not an add-on but a core principle, integrated through procurement programmes aimed at promoting economic participation and correcting historical gender and racial imbalances, reflecting our commitment to social sustainability. Internally, almost 70% of our workforce is female. This focus on inclusivity and correcting social imbalances is a core part of who we are.

SAPS Support

Our support for SAPS extends far beyond processing claims. Our very vision - "healthy members for a safer South Africa" - captures this essence. We recognise that a healthy police service is a more effective police service. We have championed specific initiatives for SAPS, such as during the COVID-19 pandemic, where we secured exclusive quarantine sites and isolation sites for members and successfully advocated for their vaccination at their workstations. We also provided multivitamins to boost their immunity. POLMED also invested in the long-term health and holistic well-being of each officer, which directly benefits the entire SAPS force and, by extension, the nation's security through wellness events, health symposiums, and targeted programmes for weight loss and smoking cessation.

We also advocated for relief to over 100 members and their families affected by the KZN floods. Our internship opportunities for the children of 'Fallen Heroes'—SAPS members who have died in the line of duty—demonstrate a deep, enduring commitment to the SAPS family, ensuring we support their well-being in times of both health and crisis.

Dolphins On The Logo

The dolphins in our logo are a powerful symbol of our core values, our identity and mission. Dolphins are universally recognised as intelligent, social, and protective creatures, often seen as guardians of the sea. They represent our commitment to guiding our members through the complexities of healthcare, working collaboratively (or in a pod-like structure), and providing a protective shield for the well-being of the police community. They symbolise our agile and compassionate approach to service.

POLMED Wellness Events

The purpose of our wellness events is to centre our strategy on prevention and early intervention. We aim to keep members healthier for longer, extend their productive lives, and reduce long-term reliance on the Scheme, which ultimately leads to lower contribution increase - a win-win for all. These events, which include our health symposiums and specific programmes like weight loss and smoking cessation, are designed to educate, empower, and equip members to take an active role in managing their health. They are very well-attended and have been instrumental in fostering a direct, engaging relationship with our members, moving beyond a transactional model to one of genuine partnership in their health journey.

Impact of Tech

Technology has profoundly impacted our offerings. Clinically, it has introduced life-changing treatments, turning once-fatal diseases like HIV into manageable chronic conditions. We now cover advanced devices, such as continuous glucose monitors and implantable defibrillators. Operationally, our website's provider search tool improves access to care. Looking forward, technology integration is a strategic priority.

We are developing towards a central data portal to facilitate collaboration among beneficiaries, providers, and the Scheme. The Scheme has rolled out its App, POLMED Connect, which, in its entirety, will enable us to monitor healthcare outcomes, facilitate reimbursement models based on results, and make early adjustments to interventions. Our members are becoming partners in the healthcare value chain by leveraging technology to collect data, which is crucial for delivering future-focused, high-quality healthcare.

We also recognise the dual nature of innovation; while AI presents opportunities for efficiency, it also introduces risks, such as more sophisticated false claims, which we must vigilantly guard against.

Measuring Success At POLMED

We measure success through a multi-faceted lens that goes beyond mere financial metrics. While a strong solvency ratio and prudent financial management are nonnegotiable for sustainability, true success is also reflected in member satisfaction in a challenging market. Financially, our ability to keep member contributions increases below medical inflation, along with our exceptionally low non-healthcare expenses, which contribute to this. Member growth is a key metric, with our increase to over 492 000 lives without solvency reduction signalling a sound financial base.

Operationally, success is seen in the improvement of stakeholder relations, from tumultuous general meetings to successfully hosted AGMs. Most importantly, we measure health outcomes, namely the success of our wellness programmes in preventing disease, the effectiveness of our member education, and the positive feedback from members whose complex medical issues we resolve.

An independent actuarial analysis has identified POLMED as the most cost-effective in the country, serving as a definitive mark of success. We also gauge member satisfaction through their direct survey feedback and participation in our programmes. We also measure the success of our health outcomes through data analytics, tracking the effectiveness of our preventative initiatives in reducing long-term illness and managing costs.

What Do You Enjoy Most About Your Role?

What I enjoy most is the profound sense of purpose. My drive has always been a love and compassion for people, and in this role, I have the privilege of translating that into tangible benefits for those who protect our nation. Seeing how our police officers work tirelessly makes it an honour to be responsible for their health benefits. Resolving complex medical issues and leaving members delighted is incredibly elating - I often wish for 36 hours in a day to do more. It is deeply gratifying to lead a non-profit scheme that creates immense value for stakeholders without a profit motive, yet still achieves impressive growth. Balancing the unique risks police face with access, cost, and affordability is a challenging but fascinating and rewarding aspect of my role.

I am also deeply passionate about talent management; identifying and honing the skills of our employees is one of my most rewarding endeavours.

What Have Been Some of Your Most Memorable Successes?

One of the most notable successes was improving POLMED's stakeholder relations. When I joined in 2017, the Scheme had tumultuous general meetings and faced potential curatorship. Through studious effort, we improved relationships across the board and now host successful AGMs. Our COVID-19 response was another highlight where we successfully championed member vaccinations, provided exclusive quarantine sites, and supplied multivitamins, directly easing the burden on our members and their families.

Achieving consistent financial stability despite membership growth and lower than-inflation contribution increases is a significant success. Initiatives such as providing flood relief in KZN and implementing wellness programmes demonstrate our commitment to holistic member care, making these milestones both personally and professionally rewarding.

The health indicators from members who participate in the wellness programme over the 2024 and 2025 period have shown encouragingly reduced claims. This also reflects on health outcomes.

And Greatest Challenges?

Initially, one of the most significant challenges was the resistance often faced by women in leadership, where typical management traits are viewed differently. I overcame this through consistency, honesty, and assertiveness, supported by self motivation and the skills gained from my MBA. From an organisational perspective, POLMED faced severe stakeholder relationship issues and the threat of curatorship upon my arrival.

Navigating the deteriorating general health profile of South Africans, the unique SAPS health risks, the burden of disease, and the constant pressure of rising healthcare costs, while levying affordable premiums, remains an ongoing challenge. Externally, policy uncertainties, such as the NHI, create industry-wide uncertainty, requiring strategic foresight to ensure the Scheme's long-term sustainability and role.

What Are You Looking Forward To In The Coming Year?

In the coming year, I am looking forward to advancing our key strategic priorities. This includes enhancing our research and data analytics capabilities and acquiring tools to automate the monitoring of healthcare outcomes. A significant focus is on entrenching our investment in health facilities and running parallel systems for services identified for insourcing, a key step in our transition towards a model that incorporates Health Maintenance Organisation (HMO) aspects. I am also excited to see the continued impact of our new, highly qualified, and driven employees as we implement our new operating model. Lastly, we look forward to collaborating more with our regulator, which will be crucial for our future growth and stability.

A Message Of Inspiration

My message is always to cultivate a curious and inquisitive mind. Do not simply accept the status quo; challenge it. For us to progress and stretch our potential, we must endeavour for constant, innovative improvement. This requires minds that are determined to ask "why" and "what if," driving the change we wish to see. Embrace every opportunity, especially those that come when you doubt yourself, and be open to encouragement from others. Never stop learning, and never hesitate to seek help when you need it. It is through this relentless curiosity and collaborative spirit that we can overcome challenges, achieve personal effectiveness, and collectively contribute to a better, safer, and healthier future for all.

Contact Information

• Tel: 0860 765 633 or 0860 POLMED Email: polmed@medscheme.co.za

• Fax: 0860 104 114

• Physical Address - POLMED Client Service Centre: Nedbank Plaza, C/o Stanza Bopape and Steve Biko Streets, Arcadia, 0083

• Website: www.polmed.co.za