SAMA Conference| Using a “Shared Value” model to support the … · 2018-08-31 · Building a person centred shared value healthcare system Healthcare Professionals Increased

SAMA Conference| Using a “Shared Value” model to support the delivery of Person Centred Care

Phomelelo Moshapo 18 August 2018Health Profession Relations, Discovery Health

Agenda

2

The drive to Person CentredCare

1

Discovery Health’s approach to Person Centred Care2

Global Focus on Person Centred Care

Growing local focus on Person Centred Care

Sources: Medical Chronicle, 2017 , SAMJ,2014, Discovery HP Newsletter 2018

by H Manyonga - 2014

A PCC focus will help to address many of the major challenges facing the SA healthcare system

Inefficiencies and wastage

Resource distribution

Lack of data

Declining Expenditure Fragmented Health

System

Disease BurdenSouth Africa faces a quadruple burden of disease

The health system is fragmented

• Public Sector – management, delivery and capacity challenges

• Private Sector – escalating costs and clinical governance challengesLack of a comprehensive

health information system

The distribution of health, administrative and management skills is skewed

Per capita spend on health is under pressure and declining

Source: IHME Global Disease Burden Database6

SA’s overall disease burden is structurally different and higher than other countries due to high HIV prevalence

South Africa’s quadruple burden of disease

3,703 1,578 1,040

22,017

11,594 27,093

1,388 1,387

434

229 46

3,374

1,500

19,021

38 136

4,290

2,834

2,121

2,709

4,197

6,360

1,784 2,949

19,218

21,020 26,297

15,542

19,644

18,699

23,191 24,337

Brazil China Germany Ghana India South Africa United Kingdom United States

Country

Disease burden (DALY rate per 100 000 people)Communicable HIV/AIDS Injuries Non-communicable

Highly fragmented system

GP

GP

specialistSurgeon

Pharmacy

Hospital/ER

Patient

Investigations

The sickest patients:• are the most exposed to system

fragmentation• further increasing cost and

reducing quality of care

Variable quality of care

8**The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf 2013

43 million injuries per year resulting from 7 types of in-hospital adverseevents + 23 million Disability-adjusted life years (DALYS) lost per year frommedical harm**

*Refers to HIV screening conducted in the same year as the delivery

38% HIV screening during pregnancy*

37%KeyCare Diabetic patients without a single HBA1C measurement

32% Mammogram coverage (50-74y) in preceding 2 years

64% Ischaemic Heart Patients on aspirin

24% Cardiac Failure patients admitted once

Global challengesSouth African Mortality Rates for Acute

Myocardial Infarction(2013-2015)

DHMS Experience(2016)

SA average = 10.3%

EU average = 5.5 - 7.8%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59

Risk adj mortality rate for Acute Myocardial Infarction

2013 - 2015 (59 hospitals with more than 25 admissions)

SA average = 10.3%

The HMI also stresses the need to measure outcomes and quality and communicate this to the public

The way forward lies in true partnerships that share value between all stakeholders

Shared value partnership

• Increased volumes and earnings for doctors

• Better quality of care

• Sustainable healthcare system

• Reduced administrative burden

FunderHealthcare

professionals

Patients

Sustainable partnership

System designed for providers, not patients

Convergence of macro trends

Consumer affordability under threat

Doctors under increasing pressure

Poor coordination; waste; Variation in quality of care

Tipping point

Agenda

10

Discovery Health’s approach to Person Centred Care2

11

Shift focus to value for patients

Value = max Cost

lowest

Qualitybest

Measure outcomes and costs

2Move to bundled payments

3

Integrate practice units & delivery systems

1

4

Building a person centred shared value healthcare system

Healthcare Professionals Increased revenues

Reduced administrative burdenImproved productivity and job

satisfaction

PatientsBetter health, more value through lower premiums and richer benefits

FunderHealthier membersLower claimsIncreased surplus and sustainability

Making doctors and patients

healthier

12

Our food supply system is not only affecting our planet but our people too …

2.1 billion (~33% global population) people are overweight globally

So what?It’s affecting our health …

Which in turn is affecting our wealth …

Health concerns linked to obesity:

Type 2 Diabetes, Cardiovascular disease, Cancer, reproductive issues, increased stress on bones, emotional distress etc.

Decreased productivity

Increased absenteeism

Increased medical spend

Increased everyday expenses

That’s 2.5 times the number of under-nourished people globally

50% of the population is expected

to be obese by 2030

1 in 2 S o u t h

A f r i c a n a d u l t s

O v e r w e i g h t o r c l i n i c a l l y

o b e s e

5x G r e a t e r

r i s k

R i s k o f c h r o n i c

d i s e a s e s

50%R e d u c t i o n

i n d i a b e t e s r i s k

1 0 % w e i g h t l o s sIn South

Africa

Physical activity triggers a healthy lifestyle

Source: Vitality Points data

Did not exercise Started exercising

Buy more HealthyFood

Undertake preventative

measures

Undergo screenings

Do more online

assessments

Uplift in overall

engagement

+16%23% 26%

43%

Improvement in health participation after becoming physically active

79%

Impact of wellness programmes

15Source: Internal Discovery Analysis

80%

85%

90%

95%

100%

Inactive Lowengaged

Mediumengaged

Highengaged

Not registered

Lower admission rates

80%

85%

90%

95%

100%

105%

Inactive Lowengaged

Mediumengaged

Highengaged

Not registered

Lower healthcare costs

60%

70%

80%

90%

100%

Inactive Lowengaged

Mediumengaged

Highengaged

Not registered

Shorter hospital stays Reduced mortality

0

0.001

0.002

0.003

0.004

0.005

0.006

0.007

0.008

0.009

30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69

Axis

Title

Axis Title

None Blue Bronze

Silver Gold

Doctor wellness| the missing quality link

Healthier doctors are more productive

Healthier doctors are more effective in prescribing wellness

Healthier doctors deliver better quality care

When physicians are unwell, theperformance of the health-care systems canbe suboptimum. Physician wellness mightnot only benefit the individual physician, itcould also be vital to the delivery of high-quality health care.

Lemair, Wallance & William, Lancet 2009; 374: 1714-21

Vitality Active Rewards

1 Download the Discovery App

2 Achieve your exercise goal 3 Get Rewarded

Activate VAR

Personalised

Dynamic

Any exercise

Weekly Core rewards

For Doctors

Boosted Doctor Rewards

18

VARD

Vitality - all15%

20%

25%

30%

35%

1

2

3

4

Prop

orti

on o

f mem

bers

Number of goals per month

Distribution of goals achieved in an average month

VARD Vitality - all

VARD Initial Results| Doctors are more engaged than the general Vitality population




satisfaction



Tools to make your patients

healthier

Evidence based research demonstrates that screening picks up conditions earlier and reduces costs of treatment

39%

57%

69%

Blue Bronze Silver + No screen Screen

-9%R62 300

R57 000

58% 64%

No Screen Screen

42% 36% Stage 2,3 & 4

Stage 1

Average cost per cancer caseProportion of members undertaking screening Cancer stage at diagnosis

Health Checks| A range of five quick checks

21

Body Mass Index (BMI)

Blood pressure Blood pressure Signing of a non-smoker’s declaration

Cholesterol/lipogram

Health Checks| Doctors helping members to identify possible health concerns

22

> 6000 VHCs

performed by Drs

156173 176

236

271

227240

0

50

100

150

200

250

300

Jan Feb Mar Apr May Jun Jul

Thou

sand

s

~R 1,5M paid to Doctors for VHC Jan-July 2018




satisfaction



Shared Value initiatives23

24

Complexity

Evolution1 Fee for service

Fees charged at individual procedure level

Fixed feeSet price for defined discrete procedure, typically involving one Doctor or Surgeon

Bundled feeSet payment for a clinically defined episode involving a number of health care services / clinical disciplines

Value based contractAnnual or monthly fee paid to a doctor in respect of each individual patient

2

3

4QualityMeasurement

Partnership

FFS VBC

Over servicing

Cost efficiency

*

*Under-servicing mitigated by peer review

Shared Value Intrinsic to Person Centred Care

Care Coordination Programme improves quality of care for highly complex patients

0.9

1.1

1.3

1.5

3 6 9 12

34%

Month since intervention

Lower cost per event

Decreased hospital admissions

Home

Acute hospital

Care coordinator

Home-based care

Sub-acute unit

Normal Patient

50%33%

CCP Patient

Normal Patient

CCP Patient

Impact of care coordination programme

12%15%

6%

10%

Preventable admission rate Readmission rate

Voluntary programme designed to coordinate the long-term care for the sickest members

16

Member driven

Doctor driven

Unlock special doctor-specific benefits

Receive increased remuneration and

high volumes

Track patients’ management score via Dashboard

Track patients’ compliance via Discovery’s HealthID EHR

START…

Provider eligibility:• Practice size>=50

Diabetic members• Affiliation with

existing centers of excellence e.g. CDE

• Cost (efficiencies) and Quality (PQI’s) metrics

• Digitally engaged

DiabetesCare|Disease Management ProgrammeProviding doctors with tools to effectively manage their diabetic members

Premier Plus Eligibility| Practices can become a DSP by joining a disease management program

Member driven

Doctor driven

Demonstrate an efficient practice profile

Receive increased remuneration and

high volumes

To remain on the network complete 40 diabetes visits

(just over 3 visits per month) over the next 12 months on

any plan

Digitally engaged to be able to interact with the disease

management program platform

START…Premier Plus Network eligibility:• Join CDE as a

contracted practice

• Discovery Health Premier Plus Network

2727

Leveraging incentives and technology to change patient and doctor behaviour

KidneyCare programme DiabetesCare programme

Detailed monitoring of

key dialysis metrics

100% of dialysis centres and

patients enrolled

Admission rateLength of stay per admission

Detailed reporting and

feedback

% diabetics who have had an HbA1c test

% diabetics with medication compliance

All admissions Renal relatedadmissions

All LoS Renal related LoS

2013

2013

2017

2017

2013

2013

2017

2017

-4.1% 0.6%-18.2% -11.7%

DiabetesCare Non-DiabetesCare

+30% -1%

DiabetesCare Non-DiabetesCare

+14% +1%

2016

2016

2017

2017

2016

2016

2017

2017

Enrollment unlocks

additional risk benefits

Access to high quality

coordinated care

Using digital maternity records to support doctor drivenpatient centric care programmes

28

Ongoing substantial investment in digital tools and big data to improve quality of service and member experience

DIGITAL TOOLS AND SERVICES

HealthID Member app DrConnect Website Wearable devices Electronic health records

TelemetryVirtual Consults Smart Plan Wellness Experience

Medicines ServicingMaps

12

HIGH LEVEL TRENDS

Measuring patient reported experience (PREMS)

• Sent: 146,851

• Received: 26,049

• Response Rate: 17.8%

• Doctors involved: 5,510

89.8% of GPs were rated 8 or higher for the survey period

82.4% of members would recommend their GP

Net Promoter Score of 70%

GP PATIENT SURVEY MEASURES

6%

3%

6%

40%

7%

23%

9%

20%

23%

15%

71%

88%

73%

37%

78%

0% 20% 40% 60% 80% 100%

Doctor availability

Doctor's communication with patient

Professionalsm of office staff

Doctors discuss medication

Continuity of care

Never/Sometimes Usually Always

17


Healthcare Providers

DHMSCompetitors

MEMBERS

Health Insurer

Increased Growth & Sustainability

Lower Premiums

Lower Claims

Better Health

Increased revenues

Fewer hospital admissions

80%

85%

90%

95%

100%

Inactive Lowengaged

Mediumengaged

Highengaged

Reserves: R16.4bn Solvency: 27.45%

Increase in membership: 2.1%

Heart disease: -41% Diabetes: -53% Lung Diseases: -50%

+R100mPaid in quality incentives

since Aug 2012

Shared value is intrinsic to the Person Centred Care

-16.2%

SAMA Conference| Using a “Shared Value” model to support the delivery of Person Centred Care

Phomelelo Moshapo 18 August 2018Health Profession Relations, Discovery Health

Documents

SAMA Conference| Using a “Shared Value” model to support the … · 2018-08-31 · Building a person centred shared value healthcare system Healthcare Professionals Increased