Medihelp’s care ‘superpower’: Future-fit healthcare that’s compassionate, well managed, and sustainable

At Medihelp, care management is the difference between paying claims and actively improving health outcomes. It’s also the difference between short-term affordability and long-term sustainability (according to the latest Council for Medical Schemes report, the number of medical schemes has declined from 144 in 2000 to 71 in 2024) – for members today and for generations to come.

This year, Medihelp is celebrating its 120th year of existence – a testament to its resilience, sound stewardship, and unwavering commitment to serving members through every season of life.

The superpower, explained: better care for members, stronger sustainability for the fund

Medihelp’s approach to care management is powerful because it delivers on two priorities at the same time:

• We support members to manage their own health and care – through guidance, clinical support, and structured programmes that empower people to make informed, confident decisions.

• We make sure Medihelp will be here for years to come to support our members – by enabling appropriate care, preventing avoidable costs, and ensuring contributions remain as manageable as possible without compromising quality.

This balance is what makes Medihelp future-fit: a scheme designed not only to meet today’s needs, but to remain resilient in a healthcare environment that will keep evolving.

Evidence in the numbers that matter

Medihelp’s care management strength is measurable – and it shows in real-world impact:

• Readmissions prevented: Through proactive clinical intervention and coordinated support, Medihelp helped to prevent unnecessary hospital readmissions – improving recovery and reducing disruption for members and their families. In 2025, Medihelp’s re-admission rate for the 30 days after hospital care dropped by 42%.

• Compassionate Care Programme reach: Our Compassionate Care Programme provided hands-on support to over 100 members who needed it most, helping them navigate complex palliative care health journeys with dignity, empathy, and practical care coordination.

• Through our Intense Care Support Programme focussed on members in ICU who needed us most, we saved millions of Rands, resulting in a balanced 2026 contribution increase.

• Claims cost management: Medihelp’s disciplined approach to managing claims costs is reflected in the latest Council for Medical Schemes (CMS) report, demonstrating how we compare favourably in claims cost management relative to other schemes – without losing sight of the human being behind every claim.

• CE Index: Medihelp took first place in the Client Care Centre category of South Africa’s medical aid industry, and second place in the overall industry ranking.

Compassionate by design. Managed with discipline. Built for the future.

Medihelp’s care management philosophy is rooted in a simple truth: members are not line items. They are people – with goals, families, and futures. That’s why our model brings compassion and accountability together:

• Compassion, because healthcare is personal.
  
• Discipline, because sustainability is essential.
  
• Innovation, because tomorrow’s healthcare demands smarter ways of delivering value.

A sustainable scheme is one that manages care well

Healthcare funding must be sustainable to be meaningful. When care is managed responsibly, members benefit through better outcomes and support, and the fund benefits through stronger long-term stability. That is the Medihelp differentiator.

Our care 'superpower' means we are positioned to continue delivering reassurance, reliability, and value – not just for the next year, but for the next generation.

Why this matters to employers

• Health outcomes you can measure: Fewer preventable readmissions signal better post-hospital support – helping employees recover properly and get back to work sooner.

• Less disruption, more productivity: Proactive care management reduces repeat crises and “stop-start” absenteeism, protecting team continuity and performance.

• A better employee experience (with less HR escalation): Compassionate care support helps employees navigate serious or complex health journeys – reducing frustration, complaints, and admin burden.

• More predictable costs: Strong claims cost management is a practical indicator of contribution stability and long-term affordability – vital for payroll planning and workforce budgeting.

• Sustainability you can count on: In a consolidating medical schemes market, the ability to manage care well is a key marker of a scheme that’s future-fit, resilient, and built to support employees for the long haul.