Discovery Health awarded prestigious Johns Hopkins University Starfield Award for second time

Authors:
Lizelle Steenkamp (Head of Risk Intelligence, Discovery Health), Matthew Zylstra (Senior Actuary, Risk Intelligence, Discovery Health) and Zack Shan (Actuary, Risk Intelligence, Discovery Health)

Who is Professor Barbara Starfield, and how does the Starfield award honour her legacy?

Prof Barbara Starfield was a Johns Hopkins University distinguished Professor and co-developer of the Johns Hopkins ACG System. She is globally recognised as an expert in primary care, case mix methodologies, and promotion of equity in health. Her career was dedicated to showing the pivotal role of primary care in the provision of healthcare. Although Prof. Starfield passed away in 2011, her worldwide public health legacy lives on.

According to Johns Hopkins University:

- One of Prof Starfield's most important insights was how systems of care that are organised around individual diseases are not the best for patients, especially those who are chronically ill.
- Research by Prof Starfield and her colleagues in the early 1980s showed that children who used the majority of healthcare resources were not those affected by single chronic illnesses. Instead, these children were those who had multiple, seemingly unrelated conditions. She extended these findings to patients of all ages. She ultimately showed that the clustering of morbidity (where people have multiple medical conditions) is a better predictor of the extent to which people will use healthcare resources than the presence of specific diseases.
- Her focus on clustered illnesses in a patient or patterns of morbidity formed the basis of Johns Hopkins' University's ACG System - a leading population health analytics software for predictive modelling around individual and population health, to forecast healthcare utilisation and more.

The university's Starfield Award honours Prof Barbara Starfield, co-developer of the Prof Johns Hopkins ACG System, and recognises work focusing on three major aspects of Prof Barbara Starfield's work:

1. Addressing multi-morbidity in patients and populations
2. Reducing disparities in the delivery of primary healthcare
3. Improving population health.
   It is awarded biennially (once every two years) and presented at the ACG International User Conference.

Discovery wins 2020 Starfield award

Discovery Health has won the Johns Hopkins University 2020 Starfield Award for a project entitled Reducing disparities in the delivery of primary health care - by reducing unnecessary emergency department visits.

The paper makes the business case that, "A closer relationship with your primary healthcare provider leads to a reduction in emergency department visits and subsequent admissions from the emergency department resulting in better patient outcomes and lower healthcare costs."

- Read the award-winning paper

"We began our model workings as early as 2018 and submitted the award entry study in 2020," explains study author Lizelle Steenkamp, head of Risk Intelligence at Discovery Health. "The award winners were announced last year, but the award was delivered this year given that the biennial ACG conference last year was cancelled due to the COVID-19 pandemic."

"Our work focused on "Reducing disparities in the delivery of primary health care," which was one of three areas outlined in the award criteria," adds Steenkamp.

"Discovery Health's core purpose is to make people healthier and enhance and protect their lives. In order to achieve this purpose, Discovery Health seeks to ensure that high quality, cost-effective care is available to all of its members."

Discovery Health provides administration and managed care services to over three million beneficiaries throughout South Africa. "Our data had shown a significant increase of 32% in emergency department visits over the past eight years (from 2010 to 2018). Further analysis showed the need for better primary care delivery. In this absence of this access, unnecessary emergency department visits increased," says Steenkamp.

The award-winning research effectively used the emergency department classification system and other ACG System variables to increase access to primary care for medical scheme members and reduce unnecessary emergency department visits.

Steenkamp adds, "Through sophisticated machine learning models and leveraging components of the Johns Hopkins University's ACG risk classification system, we were able to demonstrate the importance of a strong relationship between medical scheme members and their primary care providers. Members who have stronger relationships with their primary care providers - measured through claims data - tend to be admitted to hospital through the emergency department far less than those who do not. When admissions did occur, these tended to be for medical issues and not treatable through primary care interventions."

Summary of the 2020 paper's findings

The research submitted showed the importance of a strong relationship with a primary care provider in managing downstream costs, leading to improved patient outcomes and lower healthcare costs. The findings support the following:

1. The new benefit design path that Discovery Health has embarked on by creating lower cost benefit options where the entry point for members into the healthcare system has to be a primary care provider.
2. Creation of more network-based options which channels medical scheme members to more efficient hospitals. These types of hospitals are those that are both most cost-effective when treating patients, but also more considered in their decision to admit a patient through their emergency department.

This is not the first time Discovery Health has been awarded a Starfield award

In 2016, Lizelle Steenkamp (currently Head of Risk Intelligence at Discovery Health) and Sharon Naidoo, received this award on behalf of Discovery in recognition of their use of the Johns Hopkins ACG System in their project entitled "Improving Patient Coordination Through Effective Primary Care Management". This work was presented at the 2016 ACG System International Conference in San Diego. Discovery Limited used the Johns Hopkins ACG System to investigate the impact of care coordination on healthcare costs and patient health outcomes

Primary care sits at the centre of all strong healthcare systems

"Reducing disparities in the delivery of primary healthcare is pivotal in this transformation as effective primary care forms the foundation of all strong healthcare systems", adds Steenkamp. "Primary care sits at the centre of all strong healthcare systems and this is why Discovery Health has focused substantial energy over the years in understanding its primary healthcare system and identifying opportunities for partnerships and potential network opportunities which can help strengthen primary care."

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