Value-based healthcare emphasizes the importance of collaboration, communication, and coordination among healthcare professionals to ensure patients receive comprehensive and personalised care that meets their specific needs. This approach recognises that healthcare is a complex system and that addressing patients’ physical, mental, and social needs holistically leads to better outcomes and overall well-being.

“In the current private healthcare system, doctors and hospitals are mostly reimbursed for the volume of patients they see or procedures they do,” says André Joseph, funder relations and health policy executive at Life Healthcare.

“Value-based care shifts the focus from volume of services to quality and value. Value based care encourages healthcare providers to prioritise preventative care, early interventions, and evidence-based practices. This has resulted in better management of chronic conditions, reduced hospital admissions, and improved overall health outcomes. Value is created through the enhancement of the patient experience and improvement of quality of care and patient outcomes,” states André.

How do patients benefit from integrated care and funder network deals?

“Navigating the healthcare system is a complex exercise for patients,” says André. “They need to interact with multiple fragmented providers offering multiple services, often at different locations, and at different price points. In private healthcare, patients are faced with complex medical aid benefit structures, often with little understanding on how to utilise their benefits optimally, and no certainty whether their healthcare will be funded.”

“An integrated care pathway, such as Life Healthcare’s most recent integrated care programme for renal patients, eliminates the current fragmentation in care. The patient is given clearer information about their care experience and journey, which healthcare practitioners they will interact with at defined points in their care journey, and what their care is likely to cost.”

“Additionally, value-based care models often prioritise patient engagement and shared decision making, empowering patients to actively participate in their own healthcare decisions – improving their overall experience.

At Life Healthcare, we work closely with funders (medical schemes and administrators) to ensure they understand our integrated care programmes which include enhancing the patient journey, clinical disease management programmes, multi-disciplinary healthcare teams and data and technology.  In our engagement we aim to secure reimbursement arrangements (a better pricing structure on medical scheme tariffs). This allows us to contribute to increasing access to quality healthcare to more South Africans.

How does integrated care reduce costs?

“Cost reduction is achieved through eliminating the vast variations in the delivery of care and entrenching the use of evidence-based standardised care plans,” explains André. An important aspect of value-based care is the opportunity it provides the patient to comment on the outcome of the procedure. The various providers also undergo constant measurement to identify areas for improvement.”

Although every patient is unique and should be treated as such, through an understanding of the costs at a patient level, it is possible to group similar patients with similar health conditions of a similar complexity.

“These patient groups are then assigned defined care plans, which are delivered by the appropriate care team aligned to their clinical challenges,” he says.

Patients are guided through their specific care experience and care plan by a clinical-care coordinator, who is responsible for ensuring communication between the care team and patient.”

“The standardisation of patient care plans allows for bundling of services at a lower and fixed cost while maintaining high quality of care and outcomes,” added André.

Overall, value-based care has the potential to significantly improve patient outcomes and experiences by promoting a more patient centred, coordinated, and holistic approach to health care delivery.

Life Healthcare’s funder network deals 2023

‘Life Healthcare recognises the enormous challenges presented to patients and funders by the increasing burden of various disease conditions. We are committed to transforming care by engaging with funders and providers to advance the clinical product and alternative reimbursement model that promotes better outcomes, patient experience, cost efficiency, and value creation for the healthcare system,” added André.

Learn more about why most medical schemes have chosen Life Healthcare as their anchor provider for their members on network plans.

Five value-based care  programmes at Life Healthcare

Life Healthcare currently offers five integrated healthcare products being rolled-out to units:

1. Renal dialysis integrated care programme

Through the success of Life Healthcare’s integrated renal care programme piloted in 2022, Life Healthcare has successfully negotiated its first renal value-based care contract with a leading medical scheme. This contract promotes improved patient outcomes and shared value, while providing the patient with the financial structure for the holistic care that they require.

The renal integrated care programme focuses on giving patients with chronic-kidney disease (CKD) a better understanding of their condition, and their treatment, ensuring they do not feel alone on their renal dialysis journey. The programme’s care coordinators are assigned to Life Renal Dialysis facilities, to share information, provide guidance and ensure patients get emotional support if needed, with the understanding that patients living with chronic kidney disease require more than just their treatment of dialysis. These coordinators create a collective understanding between the patient and the clinicians involved in the patient’s care.

What are patients saying?

• “My care coordinator has helped me understand my renal journey and made it seem far less overwhelming,”
• “My care coordinator, Sister Asme, has really helped me, especially with my wound care journey.”
• “My kidney condition affected my circulation, and my foot almost had gangrene. But, she (my care coordinator) referred me to the wound clinic and now my foot has healed completely.”

 Read more about Life Healthcare’s renal integrated care programme here.

2. Stroke Restore

The focus of Stroke Restore is to guide the patient that experienced a stroke through a defined pathway, from emergency care to stabilisation in the ward, all the way to step-down care in rehabilitation. The rehabilitation component prepares the patient for reintegration into society by teaching skills such as eating and speech – functions that are often affected by a stroke.

3. Major Joints for Life

Major Joints for Life is focused on joint-replacement surgery (hip and knee replacement) delivered by a multi-disciplinary team. A fixed bundled fee is charged, which includes costs of the orthopaedic surgeon, anaesthetist, physiotherapy, hospitalisation and prosthesis. The patient will be contacted telephonically six months after discharge to provide feedback on factors such as the ability to flex the joint and pain levels. Learn more here.

4. Little Life: Maternity

The Little Life: Maternity programme is a collaboration between obstetricians and midwives journeying on defined-care pathways for  pregnancies, from the antenatal period through delivery to the post-partum phase.

5. Critical Care Re-engineered

This is a multidisciplinary team approach to the management of a patient in the Intensive Care Unit, with leadership and oversight of specific ICUs by an intensivist (an intensive care specialist) or a lead physician.

 

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE. Life Healthcare Group Ltd does not accept any responsibility for any loss or damage suffered by the reader as a result of the information provided.