Empowering GPs key to bringing down healthcare costs

"Employing doctors in the private sector – whether it is hospitals or medical schemes - is likely to introduce another layer of administration and costs,” says Edwards. "Rather, the question should be: how do we shift the health system so that GPs are empowered in their traditional roles as primary care givers and co-ordinators of care?”

Edwards says Liberty Medical Scheme has introduced GP networks which empower GPs to take more responsibility for their patients and incentivise quality outcomes by paying them 15% more than those doctors who do not belong to the network. "We started out by working with the GP leadership and finding ways that we could all work together, without GPs feeling like they were being told how to treat their patients,” says Edwards. "We also wanted to come up with a way to reward good quality care and prevent poor quality outcomes.”

The result has been that 2 400 GPs have signed up with Liberty Medical Scheme’s preferred GP network. Doctors have to be invited to belong and undertake to be reviewed by their peers each year.

 

"It does open them up to more oversight, but in many cases, doctors enjoy this as it gives them feedback about their work and enables them to feel part of a community of other doctors, as well as giving them access to the latest information about treatments and technology,” says Edwards.

The initiative has seen most success with members with chronic illnesses. Although chronic diseases such as asthma, diabetes and hypertension affect only about 20% of the medical scheme’s population, they account for roughly 80% of the costs. Through dedicated disease management programmes, members with chronic illnesses are identified and the scheme works with doctors to ensure they are given the necessary screening tests, go for regular check-ups and are compliant with their medication. The result has been fewer, expensive hospitalisations and complications.

"By working with GPS, we’ve seen that focusing on primary care keeps people out of hospital and costs down,” says Edwards. "Through this simple intervention, it saves the schemes hundreds of thousands of rand each year.” In addition, the scheme pays for GP visits from the risk portion of a person’s medical cover, rather than their savings account. Edwards adds: "We find that members are more likely to take care of themselves proactively, if they don’t have to worry about running down their savings account.”

Edwards says that the average age of a GP in South Africa is 52 years old. "Many of these doctors enjoy running their practices independently and have a wealth of experience. You have to respect that.”

Doctors invited onto the Liberty Medical Scheme preferred GP network are also chosen based on their accessibility. We look at which doctors most members are using and we’ve made sure that 91% of our members are within a 10km radius of a doctor on our GP network,” says Edwards.

The programme is also based on quality outcomes, with annual peer reviews held to look at how a doctor has performed. "This is not a punitive process, rather it’s collegiate and aims to support doctors to practice the best medicine they can,” says Edwards. For example, if, after analysing the types of drugs a doctor prescribes, it is found that they are over-prescribing pain killers, sleeping pills or antibiotics, the peer review system may help them see that this is a sub-standard way of practicing medicine. The penalty is that they may be asked to leave the network if they do not improve their outcomes.

Edwards says that on lower cost options, medical schemes are also introducing referral management, which means members may not bypass the GP and see a specialist directly.

"One of the biggest cost drivers in this country is that members go directly to a specialist who often requires more expensive tests, such as radiography and scans, which may not always be necessary,” says Edwards. "The key to bringing down costs is to empower GPs to be the first port of call and to treat patients holistically using good quality primary care.”