By Fiona Wakelin
Championing Innovation, Digital Transformation and Value‑based Care at POLMED
POLMED is a restricted medical scheme dedicated to members of the South African Police Service and their dependents, providing comprehensive risk‑pooled medical cover. Its core offerings centre on two contribution options (Marine and Aquarium) tailored to different income levels and benefit needs, with in‑hospital, out‑of‑hospital, and preventative benefits.
Public sector employees, and police officials in particular, face a combination of physical risk, psychological stress and irregular working hours that heighten their vulnerability to both acute and chronic conditions. This manifests in higher incidence of musculoskeletal injuries, hypertension, diabetes, depression and substance‑related challenges compared to the general population.
Access barriers, especially in under‑resourced areas, also complicate continuity of care and follow‑up on treatment plans. Additionally, financial pressures and uncertainty around broader health system reforms create anxiety and may influence how employees engage with their benefits.
POLMED members have access to a contracted provider network of general practitioners, specialists, hospitals and allied health professionals, supported by disease management and chronic medicine programmes. The Scheme also offers targeted programmes in mental health, oncology and maternity, along with dedicated preventative care benefits such as screenings, vaccinations and wellness assessments.
Ms. Neo Khauoe, Principal Officer of POLMED, with over 25 years of experience in healthcare management, speaks to us about the challenges, rewards and benefits of providing affordable healthcare to the South African Police Service:
Working in the healthcare and medical schemes environment for more than two decades has taught me that sustainability and compassion must go hand in hand. Seeing the impact of well‑designed benefits on individual members and families has reinforced my belief in evidence‑based, member‑centric decision‑making.
I have also led teams through regulatory uncertainty and economic volatility, which has shaped a leadership style grounded in transparency, resilience and collaboration. Partnering with clinicians, unions, administrators, and regulators has shown me that complex healthcare challenges can only be solved through shared purpose and disciplined execution.
As CEO of POLMED, my primary responsibility is to safeguard the long‑term sustainability of the Scheme while ensuring that members continue to receive quality, affordable healthcare. This entails setting and executing the Scheme’s strategic direction, overseeing financial soundness, risk management and compliance with the regulatory framework governing medical schemes.
I am also accountable for building a high‑performing organisation, which includes leading the executive team, nurturing key stakeholder relationships with the Board, unions, regulators and administrators, and embedding a culture that is member‑centric and outcomes‑driven. An important part of my role is to champion innovation, digital transformation and value‑based care, so that POLMED can adapt to a rapidly evolving healthcare system.
I am energised by the opportunity to tangibly improve the health and well-being of those who serve and protect our country, often at great personal risk. Leading POLMED at this moment of profound change in healthcare allows me to help shape a more equitable, sustainable and outcomes‑driven system.
A Significant AHA Moment
A defining moment for me was seeing the early results from our integrated, data‑driven approach to managing high‑risk members. When we combined claims data, clinical risk profiling, wellness participation and targeted nurse or case‑manager outreach, we saw measurable reductions in avoidable claims and hospital admissions and improved adherence to treatment in a short period.
This demonstrated that relatively small, well‑designed interventions -such as proactive check‑ins, coordinated specialist care and better use of prevention- can significantly shift outcomes and costs. It reinforced my conviction that investing in data, relationships and prevention is not a “nice to have”, but central to our sustainability.
The rapid evolution of data, technology and clinical science means we can continually re‑imagine how we support members across their life journeys. Being able to translate these innovations into practical solutions for police officials and their families is deeply rewarding.
My vision is to be the trusted healthcare partner of every police official and their family, enabling healthier, safer communities through accessible, high‑quality care. This vision has translated into a strategy built on three pillars: scheme sustainability, quality healthcare for beneficiaries, and strong stakeholder relationships.
Strategically, we are shifting from a purely volume‑based funding model towards value‑based care, where success is measured by health outcomes and member experience. We are also investing in digital capabilities, advanced analytics and integrated care models to better understand member needs, intervene earlier and manage the burden of disease more proactively.
Significant Advances In The Sector
Over the last 25 years, one of the most profound shifts has been the move towards evidence‑based, value‑driven healthcare, where clinical protocols, outcomes measurement and data analytics underpin benefit design. The growth of disease management, particularly for chronic conditions such as diabetes, hypertension and HIV, has significantly improved quality of life and reduced avoidable hospitalisation.
Another major advance has been the rise of digital health –from electronic health records to telemedicine and app‑based engagement– which has made care more convenient and opened new channels to support members. Finally, there is a stronger focus on preventative and wellness‑oriented benefits across schemes, recognising that early detection and healthy lifestyles are essential for sustainability.
Providing Quality Healthcare Cover Despite Increased Fiscal Pressure
Public sector wage constraints and broader fiscal pressures mean contribution growth must remain responsible while healthcare costs continue to rise above inflation. To stay sustainable, we are focusing on rigorous risk management, including contribution income optimisation, benefit design reviews and targeted cost‑containment without compromising essential cover.
We are deepening managed care interventions, strengthening network arrangements and using data to identify high‑risk members early so that we can intervene before conditions escalate. In parallel, we are pursuing operational efficiencies and exploring vertical integration opportunities in the healthcare value chain to capture savings and reinvest them into benefits.
A Strategic Refresh
In recent years, POLMED has embarked on a strategic refresh that prioritises wellness, prevention, and digital enablement as key levers for better member outcomes. We are enhancing our digital ecosystem to improve self‑service, strengthen communication and enable more personalised health interventions. This includes delivering through vertical integration, one of the current initiatives includes a mobile diagnostic and treatment centre.
We are also working with delivery partners to pilot and expand value‑based reimbursement models, particularly in high‑cost areas such as mental health, oncology and selected chronic conditions. These models incentivise providers to focus on outcomes and coordinated care rather than isolated fee‑for‑service events.
Digital health is central to how we intend to serve members going forward. We are building a more integrated digital platform that allows members to access benefits information, pre‑authorisations, wellness tools and provider networks conveniently via online channels.
By investing in data analytics, we can stratify risk, monitor the impact of interventions in near real‑time and support clinicians with better insights. Over time, this will enable more predictive, personalised care pathways and open the door for expanded use of telehealth and remote monitoring, especially for members in remote or high‑risk policing environments.
Preventative Healthcare
Preventative care is at the heart of our benefit design, with dedicated benefits for screenings, immunisations and wellness assessments that are not depleted from day‑to‑day savings. We actively communicate these benefits to members and encourage annual health checks to identify risk factors early.
We are also expanding wellness programmes that promote physical activity, healthy nutrition, mental resilience and responsible use of healthcare services. For a high‑stress profession like policing, we place particular emphasis on mental health support, stress management and access to counselling as pillars of holistic wellbeing.
Looking Forward
Over the next five years, our priorities are anchored in the Scheme’s strategic outlook for 2024–2028. First, we will intensify our focus on scheme sustainability through prudent pricing, robust risk management, vertical integration where appropriate and ongoing efficiency gains.
Second, we will deepen our commitment to quality, evidence‑based healthcare by expanding value‑based care initiatives, enhancing networks and improving outcomes measurement. Third, we will accelerate the development of a digital health ecosystem that enables data‑driven decisions, smoother member journeys and closer integration with our partners across the care value chain.
The finalisation of the NHI framework signals a fundamental restructuring of South Africa’s health financing architecture. While implementation will be phased over many years, we are actively analysing the implications for a restricted scheme like POLMED and engaging constructively with policymakers and industry bodies.
Our approach is to remain agile: ensuring compliance with emerging regulations, protecting members’ rights, and aligning our benefit design and contracting models so that we can co‑exist with the NHI in a way that enhances access to care. For the foreseeable future, medical schemes are expected to continue funding a wide range of services alongside the NHI, and we are planning for multiple scenarios to manage this transition responsibly.
A Message To All Members and Stakeholders
To every member and stakeholder, my message is that POLMED remains unwaveringly committed to your health, your dignity and your financial protection in times of need. We recognise the extraordinary sacrifices made by police officials and their families, and we see it as our responsibility to honour that service through dependable, evolving healthcare cover.
As the healthcare landscape changes, we will continue to innovate, listen and partner with you to build a more sustainable, preventative and person‑centred Scheme. I invite you to use your benefits proactively, participate in wellness initiatives and walk with us on this journey towards healthier members and safer communities.
