Is it really possible to get better healthcare at a lower cost?

In business parlance, shared value is a ‘sustainable business model’, meaning it allows Discovery, as a business, to look beyond shareholder value and to actively benefit all participants in the healthcare system: members, doctors, patients, hospitals and even society at large. How does it do this? Mainly by creating a healthcare ‘ecosystem’ – an interconnected world of digital services and networked healthcare providers who are rewarded for delivering better healthcare (and improved patient health) at a lower cost.

Let’s look a little closer at how the shared value ecosystem makes healthcare not only better, but also cheaper…

What are we sharing?

In nature, an ecosystem is designed to benefit all participants in the system, and the system as a whole. So let’s start with the premise that the shared value ecosystem needs to do the same. Achieving this requires creating more ‘value’ and then sharing it among all participants in the healthcare system. What is this ‘value’? In a typical business, it would be profit, but in a regulated health insurance system – like South Africa’s, where medical schemes are not for profit – it has to be something else.

Let’s say you usually spend 100 units a year running a business. If everything is operating at peak efficiency, you might spend only 80 units – in which case you would have created a surplus of 20 units. In a commercial business, that would be profit; in a healthcare system, it would be surplus, which – in the shared value ecosystem – is then shared among the participants.

How does the shared value ecosystem manage to create this surplus? There are four main ways:

1. Increasing connections
2. Reducing waste
3. Using partnerships and scale to save on costs
4. Rewarding people for getting healthier, and doctors, hospitals and the entire healthcare system for giving better care that improves patient health.

1. Increasing connections

In the healthcare system, more connections mean that pracitioners can quickly find and share information, while patients can more easily access the care they need. This of course leads to time savings and cost savings that increase efficiency in the system as a whole.

The shared value ecosystem is made up of various efficiency-boosting connections. First, a digital ecosystem connects patients to care. Over and above the Discovery website and member app, a range of digital tools link people to the health information and practitioners they need. The DrConnect platform, for example, gives you access to free medical advice from a network of doctors and video-call consultations with practitioners you’ve previously seen. Added to this, an electronic ecosystem of health information and records called HealthID allows practitioners to use, view, share and manage patients’ history, test results, hospital admissions and progress all in one place. This means information is always available and in the right place to save time and ensure better care. 

2. Reducing waste

In any setting, less waste means greater efficiency. Without the right checks and balances, the healthcare system can generate a surprising amount of waste that siphons off funds needed for better care. Tests have to be repeated if results are lost. Less-than-ideal practice or hospital conditions lead to complications or repeat admissions. Then there is healthcare fraud – illegitimate claims constitute a massive waste stream of their own if they go undetected.

The shared value ecosytem is built to monitor and prevent waste. Health results, costs and feedback from member surveys are constantly monitored by a digitally enabled environment to assess what’s working and what needs to be improved. A team of analysts, investigators and software are also constantly assessing claims to detect and prevent fraud. An estimated R5.1 billion in possible fraudulent claims has so far been prevented – a saving that leads to something like a 15% reduction in the premiums members pay!

3. Using partnerships and scale to save on costs

As more people, practitioners and partners plug into the ecosystem and join Discovery’s networks, more cost savings are possible on health products and services (such as glasses, stem-cell banking and personal care). Discovery’s Medicine Unit is another system-monitoring tool that analyses and finds ways to manage the cost and inflation of medicines. This means that, within the shared value ecosystem, less is spent on day-to-day medication and more ‘surplus’ is available for cutting-edge, high-cost medicines, such as those used in oncology, when they’re needed.

4. Rewarding people for getting healthier, and the healthcare system for delivering better care

Shared value makes sure that members’ premiums flow into an ecosystem that doesn’t just pay for delivering care, but pays for better healthcare and improved patient health. Firstly, members themselves are rewarded for improving their health, but so are healthcare practitioners and institutions that help them get healthier.

Discovery’s networks of healthcare providers, hospitals and pharmacies function like ecosystems that actively ‘reward’ those who join for giving better care. This means they’re not paid simply for delivering care, but are in fact paid more for delivering better care that improves patients’ health. There are also chronic-condition care programmes like Diabetes Care, Cardio Care, Mental Health Care, HIV Care and Kidney Care, which work through a network of doctors, with the GP at the centre to coordinate care. The message is, when you use a practitioner within our network, you really do get better care at a lower cost.

Sharing the value

In a healthcare system, ‘efficiency’ means that individuals are healthier, and the healthcare professionals and hospitals on offer are providing better, higher-quality treatment, and more cost-effectively, thereby putting patients at lower risk.

By making people healthier and incentivising better care, the system liberates a surplus – and, instead of being held back as shareholder ‘profit’, that surplus is shared among participants. In this way it also benefits society at large. Like a natural ecosystem, everything is connected and influences everything else. We all share the value and everybody wins.

‘Shared value makes sure that members’ premiums flow into an ecosystem that doesn’t just pay for delivering care, but pays for better healthcare and improved patient health.’

‘In a healthcare system, “efficiency” means that individuals are healthier.’