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HMO Model

It is our pleasure to introduce the Health Plans of KGMD Healthcare Limited to you.

Our Health Plans have evolved to fill the gap that exists in the Managed Healthcare market to deliver great quality healthcare that meet the customers’ expectation. Our ability to provide quality care rests mainly in our unique model of Health Maintenance Organization called an IPA or Independent Providers Association. We are the first to implement the IPA model of HMO in Nigeria.

 

KGMD HMO Model



One of the greatest challenges of Managed Care in Nigeria, which negatively impact the quality of care received, is the lack of proper alignment of the needs and expectations of the provider network (i.e. hospitals and clinics through which the HMO provide care) with that of the Health Maintenance Organization thus creating a dichotomy for which the enrollees and the payers pay dearly for in poor quality service and the attendant danger to lives.

The IPA on the other hand creates a seamless flow of service from the HMO to the network of providers. This is made possible essentially because of the shared ownership of the network and the HMO.

The Independent Providers Association or IPA is an association of Healthcare professionals of diverse training and skills who work together under an administrative umbrella to deliver health services to enrolled members in a coordinative manner. KGMD Healthcare Ltd., which is a pioneer IPA in Nigeria thus contract with employer and other groups and individuals.

The key advantage of our model is the seamless cooperation that exists in the network and between the network and the central office of the HMO.

 



Quality Assurance
Quality standards are defined by a standing Quality Assurance Committee comprising Care Managers of the HMO and a joint committee of providers and KGMD Healthcare Ltd. The later committee, referred to as the Joint Quality Group comprises Medical Directors and senior clinicians of Providers in the KGMD Healthcare Ltd. Read More
 
Provider Operations
Provider Managers, who are nurses and doctors run this unit. They map the provider Network and admit providers into KGMD Healthcare Ltd. Read More
 
Customer Service Centre (Call Centre)
The call centre in central to the operations of KGMD Healthcare Ltd. The centre obtains feedback from our clients, enrollees and providers, resolves issues through the use of IT enabled protocols and guidelines and also links other operations units of the HMO using a triaging system. Read More
 
Members Operations
This is organized around functions to make operations faster. Two groups exist in this unit
 
Marketing Operations
The Marketing department is organized into groups or teams around markets as opposed to products, for focus and efficiency, since many products are sold into more than one market.
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