Agility Health

What Agility Health does

Agility Health, founded in 1995 and headquartered in Centurion, South Africa, is a private managed care administrator and clinical risk management services provider serving open medical schemes in South Africa. The company positions itself as one of the ten largest open medical scheme administrators in the country and operates as a subsidiary of diversified group Agility Holdings. Its operating model is B2B and boutique: direct, key-executive engagement with medical scheme boards on multi-year administration contracts, supplemented by a contracted provider network and a dedicated self-serve portal for healthcare providers.

The core product is an integrated administration and risk management platform that unifies claims administration, pre-authorisation, member services, hospital management, pharmacy benefit management, and disease management on a single technology stack. Proprietary components include the Patient Driven Care™ (PDC™) clinical risk management framework with Personal Health Coordinator workflow allocation, the PharmacyPower™ PBM offering with real-time rules processing and Drug Utilisation Review, and a proactive Hospital Management system featuring 24/7 pre-authorisation and automated e-authorisation. The platform reports 85%+ of pre-authorisation requests resolved online in real-time without human intervention.

Agility Health monetises through managed services contracts with medical schemes (per-scheme administration fees and managed care fees), with pricing negotiated privately on a per-scheme basis. Its named customer base includes HEALTH SQUARED, with additional reach into healthcare providers and, indirectly, employer groups that fund medical scheme benefits. The company is accredited by the South African Council for Medical Schemes, TRACE International, and is a UN Global Compact signatory, and pursues thought-leadership distribution via Quarterly Health Review industry events and a newsroom function.

Name

Agility Health

Legal name

Agility Health

Website

https://agilityhealth.co.za

Company type

Private

Founded year

1995

Operating status

Operating

Headcount range

251–500 employees

Short description

Agility Health is a South African managed care administrator and clinical risk management provider, delivering integrated administration, PDC™ risk management, hospital management, and PharmacyPower™ PBM services to open medical schemes as one of the country's ten largest open scheme administrators.

Ownership category

akta.pro rank

Product category

Healthcare Administration & Managed Care Services

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821), Custom Computer Programming Services (541511)

SIC

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro industry

PRIMARYHLACAIAB

Healthcare Master Data Management (MDM) & Patient/Provider Identity Data

Healthcare & Life Sciences/Digital Health & Health IT/Healthcare Data Platforms, Warehousing & Governance

Keywords

• Medical scheme administration
• Managed care services
• Healthcare risk management
• Pharmacy benefit management
• Clinical risk management

Headquarters

HQ city

Gauteng

HQ country

South Africa

HQ region

Africa

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Medical Scheme Administration Services: Integrated administration services for open medical schemes in South Africa, providing back-office processing, claims management, pre-authorisation, and member services through their proprietary technology platform.
2. Managed Care and Risk Management: Clinical risk management services including disease management, hospital management, and pharmaceutical benefit management delivered through the Patient Driven Care™ programme.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

Agility Health provides integrated administration and risk management services to open medical schemes in South Africa. Its offering combines highly automated intelligent processing for claims, pre-authorisation, and member services with clinical risk management programmes centred on the proprietary Patient Driven Care™ (PDC™) framework. The company also delivers PharmacyPower™ pharmacy benefit management, proactive hospital management, and disease management through a single unified technology platform accessed by healthcare providers via the Agility Providers Portal.

Product overview

Agility Health offers a unified platform-based approach to medical scheme administration and risk management, consisting of an integrated administration system at its core, complemented by the proprietary Patient Driven Care™ (PDC™) clinical risk management framework. The product portfolio includes Hospital Management for proactive authorisation, PharmacyPower™ for pharmacy benefit management, and Disease Management for coordinated patient care. These components share a common technology platform with embedded algorithms and protocols, and are accessed through the Agility Providers Portal by healthcare providers. The end-to-end system enables medical schemes to achieve risk management objectives while providing members timeous access to effective care.

Differentiator

Problem solved

Functional benefit

Brands

• Patient Driven Care™ (PDC™): Proprietary clinical risk management framework that places the patient at the centre of every intervention, identifying risk in the insured population and focusing on high-risk patients for intensive management to improve clinical outcomes and reduce costs.
• PharmacyPower™

Products and services

• Integrated Administration and Risk Management Core administration service for open medical schemes that integrates back-office administration with risk management programmes, combining highly automated intelligent processing, clinical risk management, and high-quality reporting on a single platform.
• Patient Driven Care™ (PDC™) Proprietary clinical risk management framework that places the patient at the centre of every intervention, using embedded algorithms and protocols to risk-rate members, identify at-risk individuals, and coordinate care through Personal Health Coordinators.
• Hospital Management

Quantifiable outcome

• 85%+ of pre-authorisation requests resolved online in real-time without human intervention
• +2 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

One partnership is on record.

• Agility HoldingscoreOthersParent company of Agility Health. Agility Health is a subsidiary of Agility Holdings. The parent company's global footprint includes investments in healthcare, technology solutions, and financial services across multiple continents.

Scale indicators5 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Discovery Health: South Africa's largest medical scheme administrator and managed care provider, part of Discovery Group. Directly comparable to Agility Health as a third-party administrator offering administration, managed care, and integrated risk management to open medical schemes, but at materially larger scale.
• Medscheme (AfroCentric Group): One of South Africa's largest medical scheme administrators, part of AfroCentric Health. Offers administration, managed care, and disease management services to multiple open and restricted schemes, directly competing with Agility Health for scheme contracts and provider networks.
• Old Mutual Health Solutions: Health administration arm of Old Mutual in South Africa offering medical scheme administration and managed-care services. Competes with Agility Health in the open medical scheme segment with a similar integrated admin + clinical risk model.
• Momentum Health Solutions: South African health administration and managed care business within Momentum Metropolitan, providing scheme administration, wellness, and clinical risk management. Directly comparable business model and target customer base to Agility Health.

Peers

• Metropolitan Health (MMI Holdings / Momentum Metropolitan):

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks4 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/agility-holdings

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Agility Health