In a year in which the Gross Domestic Product (GDP) grew by only 2.3%, net sales of Central Nacional Unimed, sixth largest provider of health care plans in Brazil, it increased by 28%. They were ten percentage points higher than the 17.2% average increase of the market (comparative data of the third quarters of 2013 and 2012), according to the latest information released by Agência Nacional de Saúde Suplementar (ANS – Supplementary National Health Agency).
The revenue exceeded the goal set in the strategic planning of the service provider – R$2.1 billion – an increase of more than 141,000 lives in the clients portfolio, exceeding 1.4 million beneficiaries (+11% on 2012) approached Central Nacional Unimed of one of its main goals for the coming years: the leadership of the health insurance market.
The control of the administrative costs and the adjustments on the profitability of contracts also positively impacted the balance. But they did not distract the attention of leaders and managers of the service provider from the biggest challenge they have been facing in recent years. The high claims rate (cost of health care) was around 91% in 2013.
“We could only celebrate these numbers, because they were obtained in a difficult period of the Brazilian economy. We are mindful, however, to inflation of medicine, which far exceeds the official rates, and the effects of the excessive legalization and regulation of our activities,” observes Mohamad Akl, CEO of Central Nacional Unimed. This cost pressure has resulted in the decrease in net income (surplus available from the Shareholders’ Meeting (AGM) to R$35.3 million). The claims also stem from issues that are beyond the scope of the service provider. One of them is the multiplication of provisions, besides the imposition of dozens of new procedures every two years, in the Docket defined by ANS. In practice, the service providers have to expand the procedures covered without passing the additional costs to customers.
In addition, beneficiaries go to court, often successfully, to obtain treatments and surgeries not covered in the contract. “We calculate the monthly payments on the basis of actuarial studies that cross age profiles and diseases, but the contracts are breached unilaterally, by judicial decision,” laments Akl.
Adjusting revenue and costs is one of the priorities of the company. The Strategic Committee of Claims was created, built by the vice-presidency of the service provider and the areas of preventive medicine, business and medical audit. “We are developing new forms of monitoring care spending without jeopardizing the quality of care,” says vice president Humberto Jorge Isaac.
Increasing competitiveness in buying Orthotics, Prosthetics and Special Materials (OPMEs) is another strategic objective. The solution has been collective buying these products, most often used in surgical procedures.
An example of this was the partnership agreed by the Federation of Unimeds of the Brazilian State of São Paulo (FESP) and Central Nacional Unimed, which has already saved millions of reais in acquisitions of OPMEs.
“The balance has several positive indicators as a result of modern, transparent and cooperative management of Central Nacional Unimed. Our member cooperatives help us administer the service provider and serve our customers in their regions, which expands our penetration and reputation of the Unimed brand,” explains Akl.
For this, the service provider has the Administrative, Technical and Operational Board (CATO), consisting of 18 Unimed cooperatives, which have consultative and deliberative power. It is supported, moreover, by the Supervisory Board, also formed by representatives of the members.
The Board of Directors is elected for four years by the Shareholders’ Meeting (AGM), with the broad participation of members. Annually, members assess and approve the balance of the previous year and determine the use of the remains (profit), and other measures.
There are weekly meetings between company departments and the Board of Directors. Committees and subcommittees – such as Project, Risks, Internal Communications, Market and Preventive Medicine – also support the management. There are regular meetings of managers and the Board of Directors, including participating employees from various areas, linked to the topics under discussion. The more than one thousand employees have other ways to participate in management decisions. For such are informed of the goals of the annual strategic planning. They have free access to management and the Board of Directors, and are encouraged to contribute ideas to the program, which rewards the best suggestions for cost reduction and process improvement.
About Central Nacional Unimed
It is the national service provider of Unimed business health plans. It was created to ensure the competitiveness of the Unimed system to the demands of the market and the regulation of the health insurance companies in 1998. Its 324 members are Unimed cooperatives, which are preferred to serve nearly 1.5 million customers in Central Nacional Unimed. The contracted parties of the national service provider are companies engaged in three or more states, with at least 300 lives in portfolio. In some situations, however, the Central Nacional Unimed also serves individuals and small and medium enterprises, in line with Unimed System.
Today this takes place in São Luís (MA), Salvador (BA), Brasília (DF) and in São Paulo (SP). In these regions, branches were installed and accredited networks were established to serve the customers of the service provider and other Unimed cooperatives.
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