Better healthcare at lower cost? Here's how it's happening for you


"Value-based care is about providing access to high-quality affordable healthcare for medical scheme members", says Dr Noluthando Nematswerani, Head of the Centre for Clinical Excellence at Discovery Health. "Our range of exciting value-based care programmes aim to achieve this."

Value-based care: Tell us more?

"In a nutshell, value-based care is the next step in the ongoing evolution of health care," says Dr Nematswerani. "It's a move toward systems that bring costs down while improving the quality of care received, thus generating value for patients and the broader healthcare system. This contributes to patient satisfaction and positive outcomes. It encourages better co-ordination of care between patients and their healthcare providers who work far more closely in managing a condition than is normally the case. Healthcare providers are rewarded for good clinical outcomes.

"This means we are promoting what is really a global shift in healthcare. A shift away from a fee-for-service model, where doctors are paid when they see a patient regardless of how well the patient does, to a value-based care model, where doctors are incentivised to spend more time with medical scheme members."

So, what's in it for me?

"At Discovery Health, we've worked very hard to develop a number of value-based care programmes over the past few years with several goals in mind."

These programmes developed allow medical scheme members to:

  1. Proactively access more affordable, higher quality healthcare for their needs.
  2. Work alongside their dedicated network doctor in the holistic treatment of their condition. Read more about why having one dedicated primary care doctor to manage your health is so important.
  3. Access healthcare in new ways (such as those offered through Discovery Health's Hospital at Home programme, explained further on).
  4. Access additional benefits and cover linked to the value-based care programme.
  5. Become empowered to take control of the management of their condition in exciting new ways and reap the rewards of potentially better health and quality of life in the process.

Dr Nematswerani adds: "There is growing international evidence that active, informed patients who work in close partnership with doctors get better outcomes from their care than patients who are passive or less engaged."

"As a result, healthcare systems across the world are looking for ways to encourage patients to become well-informed healthcare consumers, and for health professionals to treat patients as true partners in the healthcare experience. At Discovery Health we've worked hard to achieve just this by implementing a number of innovative value-based care programmes that really revolutionise what it means to receive medical care for members of medical schemes we administer, such as Discovery Health Medical Scheme (DHMS)."

"The doctor they are working with to manage their condition is absolutely dedicated to their care"

Examples of some of Discovery Health's value-based care programmes are listed further on in this article, but here's one to kick us off:

"When scheme members are healthier through better control of a condition like diabetes because they have taken part in the Diabetes Care Programme, they experience lower healthcare costs and enjoy higher quality of life and health. They also know that the doctor they are working with to manage their condition is absolutely dedicated to their care and to seeing them succeed in managing their condition," explains Dr Nematswerani.

  • Read up on how participation in the Diabetes Care Programme supported Neil Packery after his foot amputation, and how this process helped Rakesh Mithal and Merlin Naidoo to regain their quality of life.

"Dedicated network doctors are paid more for achieving better clinical outcomes for medical scheme members," adds Dr Nematswerani.

"All in all, value-based care works to counter the rising (and unsustainably high) costs of healthcare, to ensure that both access to specialised care and medical scheme membership are affordable and provision of care is sustainable."

"Then, we have seen similarly excellent results in other similar programmes with all parties benefiting significantly - patients through improved quality of care, doctors through enhanced remuneration, and the medical scheme through lower claims. Ultimately, value-based care aligns perfectly with Discovery Health's shared-value approach to healthcare - which is discussed later."

Examples of cutting-edge value-based care programmes available to Discovery Health Medical Scheme (DHMS) members

The Hospital at Home Programme

The Hospital at Home Programme is the result of Discovery Health's reimagining the world of healthcare delivery to bring medical scheme members access to South Africa's largest virtual hospital. Using cutting-edge technology and supported by a highly skilled clinical team, this programme lets up to 750 patients receive hospital-level care in the comfort of their own home for several medical and surgical conditions that would otherwise require an admission to hospital. Watch our video on this programme.

"Overall, members are supported by a highly personalised care team with skilled clinical staff, clinical protocols and best clinical practices, and appropriate medical scheme benefits. Together, these benefits and services ensure a seamless healthcare experience for patients.

The Spinal Conservative Care Programme

The Spinal Conservative Care Programme is designed to help medical scheme members to manage back pain, a common medical condition experienced by scheme members, as best as possible. Appropriate out-of-hospital conservative management of back pain has proven to deliver good outcomes and could prevent the need for surgery. This programme will help you manage your condition with the support of a network of healthcare professionals who specialise in the treatment and rehabilitation of back and neck pain.

"We see it as an ecosystem, like in nature, that connects and benefits all participants - practitioners, hospitals, patients and the system itself"

"Discovery Health is deeply committed to value-based care, as it aligns perfectly with the broader shared-value ecosystem on which Discovery's business is built as a whole," adds Dr Nematswerani. "Applied to healthcare, shared-value helps to build healthier people, better healthcare at lower costs offering social benefits on a broader scale.

"When we talk about shared-value in healthcare, we see it as an ecosystem, like in nature, that connects and benefits all participants - practitioners, hospitals, patients and the system itself. It does this by placing the individual patient and his/her health at the centre of care. How? Basically by paying doctors and hospitals, not simply for delivering care, but for delivering better care that improves people's health."

"Applying shared-value to healthcare means collaborating with DHMS members and their doctors to improve efficiency and quality of healthcare throughout the system. This both makes members healthier and reduces claims significantly. This is in turn shared with members through richer benefits and lower insurance premiums, and with doctors through increased remuneration in return for improved quality of patient care. In this virtuous cycle, ongoing improvements continuously create additional value for all parties."

Interested in more details about implementing value based care?

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