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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

New healthcare management system delivers savings for pressurised industry

16 February 2016 Agility Global Health Solutions

Study reveals pleasing drop of 15.2% in hospitalisations for chronic illness.

A personalised disease management intervention, based on clinical and statistical insights, has reduced the number of hospitalisation episodes for patients living with high risk chronic illnesses by 15.2%, a recent study by Agility Global Health Solutions [Africa] (Agility Africa) has revealed.

“We found that, overall, hospital events decreased 15.2% for chronic patients following the implementation of our disease management initiative, Patient Driven Care™(PDC™). The reduction in costs that this represents is a welcome development for these patients, their employers, and medical schemes,” says director of product development at Agility Africa, Dr Jacques Snyman.

The managed healthcare arm of Agility Africa implemented the intervention in February 2014 for patients living with chronic illnesses. Their progress following the disease management intervention was measured between February and June 2014, and juxtaposed with seasonally comparable baseline data for the same individuals.

“This intervention was aimed at improving the wellbeing of medical scheme members with chronic illnesses. As the evaluation research revealed, it also had the effect of yielding pleasing financial savings for medical schemes under the administration and managed care of Agility Africa.”

“In the case of patients suffering hypertension, for example, the study reveals that medical schemes saved 26.3% overall, relative to the period prior to the implementation of PDC™,” Dr Snyman explains. “These savings include a 13.5% reduction on general practitioner expenditure, a 2.2% saving on pharmacy costs and an exceptional 14.3% saving on hospital costs for hypertension patients. This should be seen against the background of higher adherence to prescribed medicines, which increases chronic medicine expenditure. Well controlled patients receive fewer addition medicines.”

Recently appointed chief executive officer of Agility Africa, Patrick Masobe, says the intervention has shown marked benefits for both members with chronic illnesses and the organisations funding their healthcare.

“This is evidence of the efficacy of our clinically- and statistically-derived approach to the care of patients with chronic conditions. These members are experiencing improved wellness, thereby tangibly reducing the expenditure incurred in GP visits, pharmacy costs and hospital events for medical schemes under our administration,” Masobe notes.

“The 15.2% decrease in the number of hospital events following the implementation of PDC™ represents sizable savings in financial terms, giving credence to our unique selling proposition which promises ‘More Care, Less Risk’.”

The concept of PDC™ segregates risk in the medically insured segment of the population, through a risk-rating framework based on clinical input data. Quality intelligence is also garnered throughout the underwriting, authorisation and the claims processes.

Patients gain access to benefits based on individual disease clusters, the history of medicines used and healthcare events (such as hospitalisation), achievement of their treatment goals and patterns of resource use.

All high-risk patients flagged through an exception reporting system are monitored on a daily basis by Agility Africa’s personal health coordinators, who are privy to the patients’ clinical data and individual circumstances. This ensures that the individual member is assigned the appropriate benefit allocation in time.

“Thanks to the system-embedded intelligence that assists our personal health coordinators, combined with the individualised approach of PDC™, potential risks can be identified earlier and hence managed timeously and effectively.

“I believe this is the most conclusive evidence to date in terms of the benefits that can be yielded by well-informed, highly personalised patient intervention programmes. In a private healthcare industry characterised by rampant inflation and run-away costs, this augurs well for the future,” notes Masobe.

“In terms of the wider South African healthcare landscape, it speaks to the more effective and judicious management of the increasingly valuable yet threatened resources of the country. With National Health Insurance (NHI) on the cards, and increasing numbers of South Africans entering the healthcare system, a more intelligent, better informed approach to healthcare management is clearly a priority,” concludes Masobe.

 

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