About

Health Financing Specialist with +10 years of experience in operational and strategic management in Health Insurance and Healthcare service delivery management. Practical understanding of challenges facing health systems in emerging markets and the opportunities available for sustainable solutions. Solid experience in Strategic Purchasing, Benefit Package Design, Provider Payment Reforms and Pharmaceutical systems design and policy. Strong process understanding of the operational and service practicalities that make health systems and service work. Entrepreneurial individual who seeks to bring transformation within healthcare systems through application of commercial approaches and health economics tools. Possess comprehensive knowledge in Global Health emerging trends, Healthcare Pricing, Health Policy Analysis and Healthcare Market Shaping. A firm believer of Universal Health Coverage and Value Based Healthcare with interest in enhancing access to healthcare and improving efficiency in healthcare systems.

Skills

  • Healthcare
  • Health Insurance
    9

Experience

wilfred zvarevashe

Education
  • February, 2023 - November, 2024
  • Fulltime
  • Health Economics with more focus on Economic Evaluations and Strategic Purchasing and how they contribute towards Universal Health Coverage.

wilfred zvarevashe

Work experience
  • Provide technical leadership in utilizing a range of quantitative and qualitative techniques to conduct comprehensive health financing core analytics, which involves analyzing, assessing and identifying improvement opportunities for various aspects of the healthcare strategic purchasing system of the medical scheme with 1 million beneficiaries.
  • Provide technical leadership in the formulation and implementation of the organizations Strategic Purchasing Plan.
  • Spearheaded the introduction of new Benefit Management Programs that included Diagnostics and Pathology Benefit Program, Dental Benefit Management Program and Maternity Benefit Program. The programs provided a reduction in claims costs by 3% in the first 3 months of implementation and enhanced strategic purchasing capability of the medical scheme.
  • Developed a Negotiation based Pricing model with service providers that created savings for the fund of 7% of the total costs of claims upon implementation and it enhanced affordability of healthcare services to clients by eliminating and reducing out of pocket payments.
  • Led a team of experts in conducting Activity Based Costing for Hemodialysis services, the output of the exercise reduce the episode cost of Hemodialysis by 22% thus improving affordability to the fund and improving efficiency with Service Providers.
  • Led the implementation of a Case Based Bundled payment Model as an alternative reimbursement model for surgical procedures with specialty hospital. The Cases were built around Diagnostic Related Groups. The pilot phase demonstrated a reduction in costs of surgical procedures by 30% and improved patient satisfaction through ensuring affordability of the healthcare services and quality outcomes.
  • Led a team of Analysts to develop framework for Capitation of Primary Healthcare. Piloted the Capitation Model with 2 local authorities with focus on Primary Care with 300 members enrolled in the pilot.
  • Monitors the utilization of healthcare services in the fund through Claims Analytics identifying gaps in healthcare and potential bottlenecks on access to healthcare.
  • Prepare periodic reports (Monthly, Quarterly and annually) outlining the utilization trends of healthcare, benefits paid and pricing of healthcare services.
  • Improved Reporting of utilization management through introduction of new indicators that provided deeper insights for the purpose of monitoring, evaluation and learning within the Medical scheme.

wilfred zvarevashe

Work experience
  • November, 2021 - October, 2022
  • Fulltime
  • Facilitated the formulation of the organizations Strategy for 2022-2024.
  • Worked with Third Party Consultants to develop the Strategy Activity Map of the 2022-2024 Strategy for implementation.
  • Led a team of Analysts to develop a proto-type micro health product based on a voucher system.
  • Led the team of Analysts in the development of a medical aid product for Traditional Leaders, the product was successfully launched and successfully enrolled +30 000 principal members in the first six months of its launch.
  • Led the review of the organizations benefit package design which led to a new product structure.
  • Led the formulation of the organization’s Innovation Policy and its roll out.
  • Advised the Managing Director on performance issues highlighting variances and emerging risks for the business

wilfred zvarevashe

Work experience
  • Researched into activities of major players in healthcare services industry, new products or services, market shares of competitors, growth prospects and profitability, performance indicators, subscription rates and key success factors.
  • Conducted desk research and literature reviews to inform Benefit Package Design.
  • Led the market research to inform Product Development for an Informal Sector Health Insurance product. The research informed the development of a Proto-type for the Micro Health Insurance Product.
  • Conducted desk research and literature reviews to understand best practices in the Reimbursement of Service Providers globally and provided recommendations on how the organization can transition to alternative reimbursement models.
  • Provided research findings into the strategy formulation process, implementation and review in order to ensure achievement of business goals.
  • Compiled research protocols and design data collection tools for both qualitative and quantitative methods.
  • Identifying and developing business proposals for new growth opportunities that can enhance existing products, either development of new markets or improvement of existing business model for increased customer satisfaction.
  • Compile Concept Notes, Business Cases, Business Plans and proposals for new opportunities and maintain the Business Development calendar tracking their progress.

wilfred zvarevashe

Work experience
  • Led the adjudication, reimbursement and pricing of Pharmaceutical claims in line with the Society’s strategy and fund rules.
  • Led Claims operations in creation of bespoke clinical and funding rules to enable authorization and adjudication in line with benefit design.
  • Conducted Drug Utilization Evaluations and analysis of pharmaceutical claims for the fund.
  • Contributed to the claims management strategy quarterly and annually.
  • Provided periodical impact analysis reports of effectiveness of pricing policy.
  • Led research and analysis of pharmaceuticals pricing in line with local and regional trends.
  • Project management-Participated in the implementation of a Claims management system as a Technical Specialist for Pharmaceutical Claims. My responsibility included preparing Business Requirements Specifications for Pharmaceutical Claims to be implemented by system developers.

wilfred zvarevashe

Education
  • Public Health with a focus on Health Policy

wilfred zvarevashe

Education
  • Pharmacy

Related persons