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CareWorks for Medical Schemes


CareWorks provides proactive disease management and treatment to scheme members with ongoing counselling and adherence support; linkages to doctors within provider networks; claims management and reporting. We also implement demand creation programmes that focus on enhancing preventative care through increased member education and uptake of screening benefits with linkages to appropriate care.

Our multi-lingual, outbound contact centre provides members with psycho-social and logistical support that ensures follow up appointments are being attended and that treatment is being received.

Care coordination is available for chronic diseases of lifestyle such as HIV, Diabetes, Asthma, COPD, Hypertension, Cardiac Failure, HIV, Depression, Bipolar Disorder and Substance Abuse, aimed at reducing “lost to follow up” rates of high-risk members as well as absenteeism rates.

  • Preventative communications and education programmes, online health assessments, member profiling with targeted screening and linkages to care programmes

  • Experienced case managers, counsellors and clinicians enhancing member engagement and optimising outcomes


  • Telephonic reminders for appointments (pathology/radiology/GP, etc) ensures compliance and reduces complications that may arise (such as drug resistance)


  • Retrieval of blood results for disease management monitoring followed by calls to members providing results and ongoing support/education


  • Inbound advice and support line for issues such as service provider/doctor enquiries; medicine deliveries; drug side-effects and any other relevant information needed


  • Service authorisations and claims management for all members ensuring streamlined service access and provider payments

  • Task driven data systems enables efficient disease management achieving 90%+ adherence rates


  • Increase appropriate utilisation of preventative care benefits


  • Ongoing member/counsellor interactions creates a confidential and trusting basis to access help and advice with issues impacting wellbeing


  • Proactive prevention, care and disease management reduces chronic disease costs including hospitalisation and specialist claims


  • Healthy outcomes for members resulting in reduced absenteeism and a more functional workforce



CareWorks’ proactive disease management and treatment services equips members and provides them with the knowledge and support to best manage and control their condition.

Our prevention programmes empowers members to prioritise their health with an emphasis on early detection and linking to care of any health issues.

High adherence rates reduce costs to the medical schemes as well as absenteeism in the workplace whilst increasing healthy outcomes.

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