Discovery Health actively works to improve the quality of

healthcare available to the members of our client medical

schemes. By enabling a cohesive system in which healthcare

professionals work in integrated teams, they are better able

to share patient information to better coordinate care, and

are paid using innovative alternatives to current fee-for-

service models, such as value-based reimbursement models.

Our data shows that the hospital costs of members during the last

12 months of life are four times more and increase up to 10 times

more in their last month of life, typically due to intensive hospital

care in the final weeks. Over 60% of these medical scheme

members pass away in hospital, often in a high-care or an

intensive-care unit, in line with the international norm. But

research shows that more than 80% of people want to die at

home. To address this, Discovery Health developed the Advanced

Illness Benefit (AIB), which gives members with advanced stages

of cancer access to a comprehensive palliative care programme,

which includes Discovery HomeCare – a care solution provided by

professionally trained Discovery nurses at home. With unlimited

benefits, access to home-based care and a care coordinator, the

service has had a significant impact on patients and their families,

with over 70% of medical scheme members in this programme

electing to spend their last weeks at home with their families.

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In response to one of the most prevalent diseases, Discovery

Health developed Diabetes

Care

with the shared-value model

embedded in the programme. Diabetes

Care

, together with a

Premier Plus GP (a network family doctor who has contracted with

us on quality-based metrics), helps patients to actively manage

their condition. These doctors receive higher remuneration linked

to the clinical outcomes of their patients. Patients are empowered

and encouraged to manage their condition through access to

personalised tracking tools in Vitality, as well as tips and advice to

manage their condition, and can also access other related

healthcare providers like dietitians and biokineticists. More than

22 000 medical scheme members have joined personal health

programmes, and more than 1 200 healthcare professionals have

enrolled in GP Premier Practice. Besides the high uptake, we have

seen initial positive health outcomes.

Diabetes

Care

Measuring quality of care has been

demonstrated internationally to be

effective in improving both quality and

patient experience of care. In 2015,

Discovery Health started an initiative to

measure the patient experience of care

provided by private hospitals. Since its

publication on the website, the Patient

Satisfaction Score (PaSS) has been viewed

more than 36 500 times and the PaSS

score has increased from 56% in 2013 to

59% in 2016 in response to sharing results

with hospitals. We intend to extend these

measures of hospital experience to

include specific clinical outcomes such as

mortality and infection rates, and to

further extend the methodology to

include visits with a GP.

All of these investments are aimed at

creating an increasingly integrated,

shared-value healthcare system that gives

access to the highest quality healthcare at

the lowest possible costs.

As part of the future focus on improving

the quality of healthcare, we are planning

on introducing centres of excellence for

major joint replacements and in-hospital

psychiatry. International evidence shows

that clinical outcomes (mortality and

readmission rates) are improved

significantly where there is a higher

volume of cases, due to the skills and

experience healthcare teams develop.

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EXAMPLES OF DISCOVERY HEALTH’S DISEASE MANAGEMENT

AND CARE-COORDINATION PROGRAMMES

Discovery Health has developed disease management and

care-coordination programmes to improve members’ access

to and quality of care, while also lowering the overall cost of

healthcare. These include programmes for diabetes,

renal failure, HIV and mental health, and care-coordination

programmes aimed at patients with multiple conditions,

such as the ElderCare programme.