GEMS strives to build strong, lasting relationships with healthcare professionals who provide care to our growing scheme of more than 1.8 million beneficiaries. The GEMS Network was implemented in January 2010 to ensure that members have optimal access to cost-effective healthcare services.
The aim of the network is to support individual participating healthcare service providers to deliver rational and appropriate care that is beneficial to the Scheme, the member and the provider. This is the key to addressing the cost and quality challenges of the South African healthcare industry.
Why join the GEMS Network?
GEMS is committed to providing equitable access to excellent and affordable healthcare. Further to our current member base, there are still an additional 400 000 Public Service employees who are eligible to access GEMS benefits. As a GEMS Network participant, you will enjoy access to this growing member and patient base. The GEMS Network is actively marketed to our members.
Key features of the GEMS Network
1. The use of healthcare service providers on the Sapphire and Beryl network is compulsory for members on these options. Members on the Ruby, Emerald and Onyx options may consult providers who are not on the GEMS Network.
2. Members are guided to GPs: extensive member communication is issued and members are encouraged to use the network providers as a means to stretch their benefits.
3. Specialist referral management: GPs are the coordinators of care and this is especially true on the Sapphire and Beryl options. Members are required to consult with their network GP before they can be referred to a specialist.
4. Peer consultation: We are committed to consulting with professional leadership structures in order to better understand and identify the issues experienced by healthcare service providers.
5. Participating GPs on the Ruby, Emerald and Onyx network will be paid according to a tiered reimbursement structure for consultations where certain criteria are met. These criteria tell us how the GP is performing against certain targets.
6. Enhanced fees: GPs on the Ruby, Emerald and Onyx network are profiled and those practices that achieve a category 1 status will receive an enhanced consultation fee (GP management fee) in addition to the normal consultation fee.
To ensure optimal functioning and management of the GEMS Network we have appointed Medscheme to manage all our GP networks.