Discovery Health's new Hospital Care helps you make informed decisions about your care and supports ongoing improvement in quality of care

For the first time in South Africa, you can now look up how your hospital performs against others on important measures of quality. "South Africa's doctors and private hospitals are considered to be among the best in the world" says Dr Ronald Whelan, Chief Commercial Officer at Discovery Health. "To continue to drive ongoing improvement in quality of care and clinical outcomes, we must have a standardised and reliable way to compare the performance of hospitals across the health system" adds Dr Whelan. With Discovery's Hospital Care rating doctors and hospital teams can compare their results with those of other hospitals, allowing them to continuously improve and to achieve standards of care that remain among the best in the world.

"Quality in health care and patient safety is best achieved through transparency, such as that provided by public reporting initiatives. We encourage Discovery members to use the Hospital Care rating to make empowered decisions about their care" says Leah F. Binder, President and CEO of The Leapfrog Group, a world-renowned NGO that, for more than a decade, has been publishing ratings on how hospitals in the US perform on safety and quality.

What is Hospital Care?

Consumers rely heavily on ratings when booking hotels, restaurants and even when deciding what movie to watch. These are proven to be powerful tools in supporting people make informed decisions about their day-to-day lives. With Discovery's new Hospital Care, members of medical aids administered by Discovery Health will now be able to make more informed decisions about their choice of hospital too. Based on a methodology developed by the US Centers for Medicare and Medicaid Services and underpinned by sophisticated analytics by Discovery Health, Hospital Care lets members view hospitals' performance based on how well they do across a range of clinical, patient experience and efficiency measurement that matter most to patients.

"We have the advantage of learning from the US system and adopting a claims data-based methodology that has been internationally verified and validated," says Dr Geraldine Timothy, Discovery Health's Head of Quality of Care. "Like with every other hospital rating initiative in the world, the main goal is to empower patients to make informed choices and to support hospitals and doctors in driving ongoing improvement in the quality of care delivered to patients and the overall experience in hospital" adds Dr Whelan.

Categories of Measurement:

Hospital Care is based on four standardised measures. These include readmission and mortality rates for specific conditions, patient experience and a hospital efficiency. The overall rating shows how individual general hospitals perform compared to all general hospitals to which Discovery members are admitted.

1. Mortality: Death is always a tragic consequence of illness; however, some deaths are preventable. Although deaths of individuals with conditions such as stroke, heart attack, cardiac surgery or hip fracture are a relatively small proportion of all hospital deaths, excess deaths in these categories (i.e., rates of death greater than the long-term average or in comparison to other facilities) may reflect problems in particular care pathways that could be addressed to improve patient care and clinical outcomes.
2. Readmission: In almost all instances it is not expected that a patient should return to hospital after being discharged, particularly if the patient's recovery has been effectively managed. High rates of repeat admission to hospital after receiving treatment for the same condition point to potential improvements required in overall quality of care, management of patient recovery and preparation for discharge from hospital.
3. Patient experience of care: Members of medical schemes administered by Discovery Health who have been admitted to hospital are routinely invited to complete a survey of their personal experience in relation to their admission to hospital and to provide feedback on any potential areas for improvement. The data collected from these surveys provides valuable information on how patients feel about the care they received and helps to identify areas for improvement. Examples of questions in the survey include how well their pain was managed and whether they were provided with information which they were able to understand regarding their medication.
4. Efficiency: The efficiency measure provides information on how well hospitals manage resources and costs. Wasteful expenditure in hospital such as unnecessary blood tests, radiology imaging and other procedures not only cause unnecessary harm to patients but also results in unnecessary costs. This, negatively impacts the overall affordability of healthcare, ultimately resulting in higher medical scheme contributions that are then required to cover the costs of this inefficiency.

Why is the Discovery Health Hospital Care important?

First, hospital ratings create transparency to the ultimate users of the healthcare system - patients and their families. "By being transparent about a hospital's performance, we are providing members with the opportunity to make more informed choices about their healthcare.," says Dr Geraldine Timothy.

Second, The Hospital Care is designed to spur productive discussion and debate, with the underlying intention of driving continuous improvement. "The rating is not intended to punish or be punitive," says Dr Timothy. It is intended to identify opportunities for improvement in quality of care, patient experience and efficiency of care delivery. With this knowledge the hospital and the healthcare team can focus on the specific areas and improve the overall quality of care. For example, in the five years that we have been publishing patient experience scores on the Discovery website, we have already observed an increase across many scores, including a 20% improvement in the quality of medication information provided to patients. Additionally, significant opportunity exists for learning from the practices of hospitals that have achieved better than expected performance in the Hospital Care rating.

Third, the 2019 Healthcare Market Inquiry report stressed the need for information about the quality of private healthcare to be made public. The report specifically emphasised that funders of care (i.e., medical schemes) should be implementing value-based care models, with greater emphasis of quality of care and clinical outcomes. Discovery Health believes strongly in the principles of value-based care in which all role-players work together for the benefit of the patients and overall cost-efficiency of the healthcare system. With this, the intention is that the measures included in the Hospital Care rating will also be used in value-based contracts between the Discovery medical schemes and hospitals going forward.

Understanding the ratings

Important points underscoring the rating:

Hospitals need to be compared fairly. This means that the data should be fully risk-adjusted so that hospitals that care for more sickly populations do not inadvertently receive poorer rating than hospitals who typically care for younger and healthier populations.

There must also be sufficient number of cases on which to report. Therefore, only hospitals with enough volume of data for three of the four categories are included in Discovery Hospital Care. For the 2019/2020 measurement period 146 hospitals had sufficient volumes of data to enable accurate rating. As admissions at these hospitals accounted for 76% of all Discovery Health admissions in hospital for that period, this provided a good view of Hospital Care ratings across the system.

Furthermore, the rating methodology covers selected conditions where there is not expected to be much variation in the quality of care one receives, such as pneumonia, heart attacks and hip and knee replacements. Dr Timothy clarifies, "The rating was not designed to evaluate everything that gets done at a hospital, however the measures selected are internationally used to represent the quality of care across a few diagnoses where there is typically low variability in the type of treatment required." "Each hospital is given an overall rating based on the aggregate rating across the four measures. The rating is based on an "expected score" which is similar to an average.

"A highly consultative process has been followed with hospitals and doctors across the healthcare system to ensure that there is full transparency in the underlying data and methodology used to compile Hospital Care" says Dr Timothy. Discovery Health also looks forward to working alongside hospitals and doctors to further refine the tool and, more importantly, drive ongoing improvement in quality of care across the healthcare system to the benefit of patients and members. Related to this, it is important to note that this rating does not identify the cause of poor performance and that it does not directly reflect on the care provided by the doctors in a specific hospital. The number of conditions measured are limited and as such there are some care teams which are not included in this rating.

Where to find the ratings?

The Hospital Care is displayed on the Discovery Hospital Care portal for members of medical schemes that Discovery Health administers. Healthcare providers can access the results on the Healthcare Professional Zone.

Discovery Health congratulates all hospitals and their teams for collaboratively working with us and for their ongoing commitment to excellence.