At Discovery Health we share the common purpose of improved quality care for patients
Together we can add value by collaborating on Shared Value Initiatives. These initiatives aim to enhance patient outcomes by facilitating coordination of care, as well as the use of digital health tools that improve access to critical information. Over the past few years, we have been actively engaging with a number of specialist societies to collaborate on various Shared Value Initiatives. The Coronary Artery Disease (CAD) Care Project forms part of these initiatives.
About the CAD Care Project
Discovery Health, in collaboration with the South African Society of Cardiovascular Intervention (SASCI), invites you to participate in a care delivery project to demonstrate that a partnership with joint learning and data sharing can improve the healthcare quality and cost outcomes for patients diagnosed with coronary artery disease syndromes. Cardiologists who choose to participate can benefit from access to more flexible funding, a more efficient benefit reimbursement process as well as enhanced professional remuneration. The CAD Care Project excludes patients on the KeyCare plans.
Scope of the CAD Care Project
- This initiative is open to any willing cardiologist who is a member of SASCI (or who is willing to join SASCI). You can confirm your participation by signing an agreement document.
- As part of the CAD Care Project, participating cardiologists agree to a peer review and mentoring process by an elected SASCI peer review committee. SASCI peer review will address complex cases and trends not accommodated for on the CAD Care Project.
Participating cardiologists will be reimbursed per episode trigger including any or all of the following:
- Positive stress ECG
- Rising cardiac enzymes
- Chest pain in the context of high-risk factors, i.e. where there is either high probability or confirmed CAD syndrome
- Where the cardiologist needs further investigation (CTCA or angiogram) to confirm or exclude diagnosis.
Patient benefits from the CAD Care Project
- Participating in this initiative will ensure the financial impact on the member is removed. In addition the doctor has enhanced autonomy in deciding the clinically appropriate treatment plan for the patient, as the costs of medical treatment or cardiac intervention have been considered in the episode fee.
- The episode fee is inclusive of all professional costs due to the treating cardiologist, namely the consultation, ECG, ECHO and if clinically appropriate, the review of CT angiogram, performing of the angiogram, as well as angioplasty or stenting.
- Where the cardiologist considers a CTCA investigation is clinically appropriate, the existing co-payment will be waivered and will be paid from the risk benefits, ensuring that members are not left out-of-pocket.
CAD Care PROGRAMME OUTCOMES