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Managed care - critical for the future of healthcare

21 September 2020 Bonitas Medical Fund

One of the biggest lessons learned during this global pandemic is the impact lifestyle diseases and comorbidities have on Covid-19 patients. These include high blood pressure, diabetes and obesity - or a combination of any of these conditions - which increases the risk significantly of getting seriously ill with Covid-19.

‘Even without the pandemic, we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions. This is why Managed Care is key. It’s about encouraging and empowering members to take charge of their health and to support them on their path to wellness,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund.

The role chronic conditions play
It is undisputed that comorbidities affect the outcome of patients who contract Covid-19. ‘When Covid-19 became a reality, our first step was to identify our high risk members, which is around 30%. We then put interventions and communications in place to ensure they understood the importance of sticking to the protocols, maintaining their medication regime and eliminating as much risk as possible. We also ensured chronic medication was delivered to member’s homes,’ says Callakoppen.

The Covid-19 hub
The hub on the Bonitas website allows members to access the most updated, relevant, reliable information and statistics. This includes a specific call centre with registered nurses ready to respond to any questions or concerns, provide support and give members updated clinical information from credible resources.

WhatsApp self-help
A WhatsApp self-help platform was also launched, with a specific Covid-19 option that provides information on everything from symptoms through to treatment, recovery, transmission, costs covered by your medical aid, frequently asked questions, updated statistics on active cases, recoveries, deaths and a self-screening test.

To ensure access to quality healthcare during lockdown, our Managed Care model had to be intensified, such as:

• Reducing Covid-19 out-of-pocket expenditure for members
• Enhancing funding approaches to various services such as pathology testing and negotiating reduced costs for those tests
• Proactively engaging with hospitals to ensure members would be accommodated in private facilities and have access to the best private healthcare when required
• Assisting members in need when they had medical requirements over and above the standard benefits
• Engaging with providers and facilities in terms of PPE (Personal Protection Equipment)
• Ensuring member co-payments/shortfalls were either reduced or eliminated
• Introducing free virtual care to provide uninterrupted healthcare, while safeguarding members

Free virtual consultations
‘As part of our commitment to serving the whole of society, we offered the virtual consultations to all South Africans, taking the GP into their home – free of charge. Covid-19 is not about protecting the individual, it is about the collective survival,’ explains Callakoppen.

Comorbidities and physical examinations
‘Face to face consultations have begun again but providers and patients must be prudent – the risk is still there. But there is a need for people who have not had their necessary annual check-ups, particularly our high risk members, to see their doctors.’

These include: Those patients who feel they are no longer responsive to their medication, are concerned about general matters relating to their health or have received a specialist referral from their GP to obtain the next level of care.’

What does the future hold?
‘The changes in healthcare as a result of Covid-19 are likely to revolve around preventative care and sustaining well-being as opposed to responding to illness. The management of health is critical to containing lifestyle risks and keeping South Africans healthier.

‘We have many mechanisms of ensuring affordability, availability, accessibility and quality care. The future will see everyone involved in healthcare being more agile and adapting to ever-changing needs of all role players: Providers, members, local government/the Department of Health, through to the procurement of equipment, medicine supply management, use of day surgeries and acute hospitals as well as alternative reimbursement models.

‘Technology will also play an ever increasing role, virtual care will remain a viable option and we hope to see public/private partnerships going forward so that we ensure more equitable care for all,’ says Callakoppen.

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