Health technology assessment
Value-based healthcare is defined as outcomes that matter to our members relative to the cost of delivering those outcomes. We live in an age of innovation in healthcare where many advances in medical technology have significantly improved outcomes. However, some technologies add substantial cost without adding significant outcomes benefit (eg decreases the value of treatment).
As a not-for-profit, Friendly Society, it's important we have a clear process to approve coverage for new technologies that allows us to prioritise value. We have developed guidelines so that there is a clear and consistent process for our value-based approach to funding healthcare delivery.
Applications for assessment of health technologies are accepted for the following categories:
- new procedures / technologies
- eligibility criteria changes for an existing procedure
- incremental changes to existing technology / devices
- diagnostic tests and investigations.
Assessment guidelines and process
- Applications must be submitted by a registered medical specialist in New Zealand and include a registration number.
- Applications must be for conditions covered by Southern Cross policies.
- Applications must be approved by Medsafe.
- Applications will not be approved if developmental / experimental in nature.
Once an application is received, the procedure / technology will be placed on the Southern Cross Health Society unapproved healthcare services list until assessment is completed.
If you have any questions about the process or guidelines, please email [email protected] or write to Southern Cross Health Society, Private Bag 99934, Newmarket, Auckland 1149.
Top 5 tips for a complete submission
Use this checklist to help ensure your application can be reviewed without delays.
- Provide a clear clinical rationale
Explain the patient population, clinical need, and expected benefit. Include supporting evidence where available. - Include full episode of care costing
Provide a complete cost estimate covering all components, including hospital, specialists, diagnostics, consumables, and any devices. Attach supporting documentation where relevant. - Be specific about service delivery
Outline how and where the service will be delivered, including provider capability, equipment, and any requirements for delivery. - Estimate utilisation and impact
Include expected volumes and how the change may affect service use and cost. - Check all required sections are complete
Incomplete applications are the most common cause of delays. Use the form guidance and FAQs below to confirm everything is included before submitting.
Frequently asked questions
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What is changing in the HTAQ process?
We have updated the HTAQ application form to include a requirement for provision of all clinical, service and financial information needed to assess a proposal and, if approved, to move more seamlessly into contracting and implementation. The form now asks for clearer service context, provider capability and full episode of care costings, supported by relevant documentation.
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Why are you making these changes?
Previous applications have sometimes lacked key clinical and financial details. This has led to delays after an approval decision while we gather missing information and negotiate contracts, which can delay member access. The updated forms set clear expectations upfront and help decisions and implementation happen sooner.
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Does this change clinical decision making or my clinical autonomy?
No. Your clinical judgement remains essential. These changes are about how we assess and implement funding decisions, including having clear evidence and cost information to support fair, consistent decisions.
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Where can I get more information?
The For health professionals website page re health technology assessments will include the updated forms, step-by-step guidance and FAQs.
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Who do I contact if I need help?
Use the contact details on the For health professionals website page re health technology assessments. Your Partnership Manager can also help point you to the right resources.
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When do I need to start using the new forms?
From the published effective date on the website. Any new submissions from that date must be made using the updated HTAQ application form.
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Who can submit an HTAQ application change request?
Affiliated Providers with a valid NZMC number involved in delivering or proposing the technology or service can make a submission. If you are unsure if you can make a submission, contact us.
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Will you tell me the outcome of my submission?
We’ll acknowledge receipt and provide an update on the outcome or next steps through the contact details you provide. Some decisions may take time depending on evidence and governance cycles.
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My new healthcare service was approved, but it is still on the Unapproved healthcare services list. Why?
It will remain on our list of Unapproved healthcare services until the service is added to our health insurance policies as part of a policy update. After that, it will be removed from our list of Unapproved healthcare services. If you have an eligible patient for a newly approved healthcare technology, please contact your partnership manager.
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How long will the assessment take?
Time frames vary depending on the complexity of the proposal and evidence required. The website will provide indicative expectations. Completing the forms thoroughly upfront helps avoid delays.
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Is Southern Cross changing how it contracts for approved technologies?
The updated HTAQ form clarifies that, if a technology is approved, we expect to contract under Affiliated Provider arrangements at the price point submitted in the application. This is why accurate costing and supporting documentation are important.
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What about privacy and confidentiality of the information I provide?
The forms include consent statements explaining how information will be used for assessment purposes. We use the information to evaluate proposals and support contracting and implementation planning.