New Discovery Health Diabetes Shared-value programme supports healthcare professionals to curb SA’s diabetes pandemic

Clinical trials and real-world data show that for people who live with diabetes, improving glycaemic (blood sugar) control slows down the rate at which the disease progresses, prevents the onset of serious complications and reduces the overall healthcare cost associated with the condition. Also, according to analysis of data emanating from Discovery Health Medical Scheme (DHMS), members living with diabetes who keep their glycated haemoglobin (HbA1C) levels in-range have 4% to 9% lower healthcare claims than members who do not achieve this. Similarly, scheme members with less advanced diabetes have significantly fewer hospital admissions. Overall, better blood sugar control is directly linked to better health outcomes for scheme members and lower healthcare costs across the board.

These important insights have for the past few years defined Discovery Health’s investment in supporting both medical scheme members and healthcare providers to achieve optimal diabetes management through the Diabetes Care programme.

Now, Discovery Health has taken these efforts a step further and launched an ambitious new program – the Diabetes Shared-value Programme. This programme recognises the passion and commitment shown by the many dedicated healthcare providers who treat Discovery Health Medical Scheme members who are living with diabetes and help them to achieve improved outcomes and better diabetes management.

Diabetes Shared-value Programme gives true meaning to value-based healthcare

“Value-based healthcare is a critical element in healthcare transformation as it aligns reimbursement of healthcare professionals to patients’ clinical outcomes,” says Dr Ryan Noach, CEO of Discovery Health.

“The new Diabetes Shared-value Programme rewards value-based care by aligning a healthcare provider’s payment with the degree to which their patients who live with diabetes (type 1 or 2 diabetes) achieve and sustain HbA1C control (a marker of average blood sugar levels over a two-to-three-month period) and, thereby, delay the progression of disease,” adds Dr Noach.

Remunerating doctors for achieving outcomes that really matter to their patients

Participating healthcare professionals receive payment for each member allocated to their practice who achieves an 'in-range' HbA1C for the year. They also receive a separate amount for each member whose disease stage has remained stable or has improved over the course of the year. These fees are paid in addition to the standard service fee for medical scheme patient care.

“The goal of the new program is to remunerate doctors for the value created when patient outcomes improve as a result of the doctor’s clinical treatment protocols and dedication to bettering the patient’s health,” says Dr Noach.

“In this way, the model moves us from a fee-for-service approach, or one that remunerates quantity of care, to a value-based care approach which rewards the quality of care and consequently improved clinical outcomes. Importantly these are healthcare outcomes that matter to patients – that really have an impact on the patient’s quality of health and life.”

Enrolment of patients on the Shared-value Programme

Doctors on the Premier Plus network are encouraged to enrol all scheme member patients on the Diabetes Care programme as a starting point to their joining the Diabetes Shared-value programme. Eligible scheme members are those registered on the Chronic Illness Benefit (for type 1 or 2 diabetes) and enrolled on the Diabetes Care programme for a minimum of four months in 2021. “Where needed, Discovery Health can assist doctors to identify eligible patients through analysis of patient population disease stage and HbA1c data,” adds Dr Noach.

It is also important to point out that participating doctors are not penalised where patients enrolled on the programme lack progress or develop complications. This is an upside-only arrangement.

Patient-provider partnership key to success

“We maintain our stance that as much as doctors need support in caring for patients with diabetes, that patients must also be empowered to take responsibly for the daily management of their condition,” adds Dr Noluthando Nematswerani, Head of Discovery’s Centre for Clinical Excellence. “This self-management is a crucial component of achieving and maintaining in-range measurements, condition stability and improved health outcomes.”

To this end, DHMS has updated the relevant benefits so that scheme members on the Diabetes Care programme have access to extended time with their doctor, regular visits with other healthcare providers within their Diabetes Care team including optometrists, diabetic nurse educators and podiatrists.

Furthermore, qualifying scheme members have cover for continuous glucose monitoring (CGM) sensors – technology linked to improved glucose control and lower risk of hypoglycaemic events. These elements are fundamental to optimising the management of diabetes and empowering patients who use CGM to far better understand and control their condition. The CGM also allows for remote monitoring of patients by their healthcare providers for improved patient care.

- Cover depends on a member’s health plan and is subject to limits.

Through the Vitality platform and member support services, all members on the Diabetes Care programme have access to coaching services and incentivised health goals, including treatment reminders and remuneration for attaining fitness and other lifestyle goals.