Dear Family Practitioner
GEMS Sapphire and Beryl (SB) Family Practitioner (FP) Network: General Communication on GEMS and Subsequent Network Agreement
Tariff changes for 2017
An increase of 5% in professional fees for doctors participating in the GEMS FP network.
Kindly note that with effect from 1 January 2017, the following fees and tariffs will be applicable to Sapphire and Beryl network doctors:
Level 1 / R349.10 / R263.00 / After 6th visit within network
Level 2 / R335.10 / R263.00 / After 6th visit within network
Level 3 / R305.30 / R244.50 / After 6th visit within network
Continuation of Agreement
Changes for 2017
We are pleased to be able to share important information with you in preparation for 2017. The purpose of this communication is to update you on the following:
The GEMS care coordination strategy;
The GEMS Network Agreement; and
Changes to the GEMS Family Practitioner (FP) tariff for 2017.
We remain optimistic about the future of healthcare in South Africa and would like to thank you for participating in the GEMS FP Network. We continuously strive to
extend access to high quality, cost effective care to our members. Sustained growth in our Networks will ensure equitable access to comprehensive healthcare
services for our members. It is pleasing to note that we currently provide healthcare cover to more than 663 000 principal members. This represents over 1, 74
million beneficiaries.
1. The GEMS Care Coordination Strategy
GEMS supports care coordination and considers the Family Practitioner (FP) to be at the heart of this process. Fragmented healthcare has resulted in inefficient,
costly treatment for our members, whereas care coordination by an FP has been shown to improve the quality of healthcare and lower overall health expenditure.
The key interventions that will impact FPs are indicated below:
1.1. GEMS encourages beneficiaries to nominate their treating Network FP to coordinate their care. This can be done by contacting the GEMS call centre on
1.2. The process to access Specialist care has remained unchanged for 2017. Sapphire and Beryl beneficiaries will require a referral from their nominated Family
0860 004 367. Practitioner by calling the GEMS Call Centre on 0860 436 777.
2. Network Agreement
The GEMS Standard SB Network agreement has not changed for 2017.
2.1. Our focus areas for 2017 are diabetic care, hypertension and cardiac care. In order to assist family practitioners with the appropriate management of these
conditions, we support seven quality measures. These were developed in collaboration with the Independent Practice Association (IPA) Leadership. Participating
network family practitioners will be profiled against benchmarks for each of the quality measures shown below. This profiling will not influence your network
practice score for 2017, but we encourage the appropriate management of SB patients with these diseases.
HbA1c coverage - Percentage of registered diabetics who have an annual HbA1C test. / Stable diabetics should have at least 2 HbA1C tests annually.
LDL coverage in diabetics - Percentage of registered diabetics who have an annual LDL test. / Stable diabetics should have at least one LDL test annually.
Monitoring diabetic nephropathy - Patients registered with diabetes who have an annual random urine albumin: creatinine ratio test / One urine albumin: creatinine ratio test in registered diabetics per annum.
Statin coverage in type 2 diabetics - Percentage of registered diabetics who are on a statin. / All registered type 2 diabetics should be on a statin.
Diabetes related hospital admission rate - Admission rate of registered diabetics with diabetes related complications. / Ideally well controlled diabetics should not require hospitalisation for diabetes related complications.
LDL coverage - Percentage of patients registered with ischaemic heart disease (IHD) and hyperlipidaemia who have had an annual LDL test. / At least one LDL test in stable beneficiaries with hyperlipidaemia or IHD per annum.
Monitoring hypertensive nephropathy - Patients registered with hypertension who have an annual random urine albumin: creatinine ratio test. / One urine albumin: creatinine ratio test in registered hypertensive patients per annum.
3. Tariff changes for 2017
Please be advised of the following changes for 2017:
An increase of 5% in professional fees for doctors participating in the GEMS FP network.
Kindly note that with effect from 1 January 2017, the following fees and tariffs will be applicable to Sapphire and Beryl network doctors:
Level 1 / R349.10 / R263.00 / After 6th visit within network
Level 2 / R335.10 / R263.00 / After 6th visit within network
Level 3 / R305.30 / R244.50 / After 6th visit within network
Continuation of Agreement
You do not need to sign or return the Agreement. Should you have any objections to anything contained in this communication, you are required to inform us in
writing. The objection must reach us on or before Wednesday, 28 December 2016, failing which, it shall be deemed that you agree to the contents hereof, and
shall be legally bound thereto as a GEMS SB Network Provider.
Thank you for your continued support and cooperation and we look forward to a long and prosperous future together. If you have any further queries, kindly call
the GEMS Call Centre on 0860 436 777 or email on .
Kind Regards,
GEMS Network Management