About Discovery Health

Globally, governments and private healthcare funders are grappling with the complex problem of maintaining a fragile balance between access to healthcare, cost and quality. Most healthcare systems face a common set of challenges that contribute to healthcare costs escalating faster than general inflation, making it increasingly difficult to provide access to the high-quality healthcare our society increasingly expects.

Private healthcare financing provided by medical schemes inherently benefits society by protecting individuals and organisations from adverse events. Discovery Health’s vision is to amplify the benefits by delivering an integrated value-driven healthcare system, which is centred on meeting the needs of its members and delivering access to the best quality care at outstanding value for all key stakeholders. This vision is realised through a pioneering shared value healthcare model that incentivises people to be healthier, which generates lower claims and higher surpluses for client schemes, and incentivises healthcare professionals through value-based contracting, leading to a healthier society and more members and clients selecting Discovery Health.

The patient

The patient is at the centre of any healthcare system built on shared value principles. This approach empowers patients, places them at the centre of decision making and delivers the best value to them in terms of financial and health outcomes.

Healthcare funders

Governments and private healthcare funders such as insurers and medical schemes who pay for healthcare are critical to governance and financial liquidity of the shared value system. Discovery Health is a pioneer and champion of this model in South Africa and intends to further improve on gains made to benefit members and the Scheme.

Providers of healthcare services

This includes doctors, specialists, hospitals, pharmaceutical companies, pharmacies and manufacturers of medical equipment. Discovery Health has made major strides in moving away from a traditional fee-for-service model to value-based payment models that focus on the quality of care and patient outcomes. We have developed and implemented several value- based contracts with health professionals, and are continually engaging with relevant parties to set up favourable value-based remuneration incentives, drive a cost-effective medicine strategy and use technology effectively to improve patient experience and reduce cost of care.

Ensuring higher quality healthcare

Discovery Health continuously strives to improve the quality of healthcare available to DHMS members by maintaining a cohesive system in which healthcare professionals work in integrated teams and are paid using innovative alternative reimbursement models based on shared value principles.

Over the years, Discovery Health has also developed comprehensive, best-in-class disease management and care coordination programmes to improve member’s access and quality of care, while also lowering the overall cost of healthcare. These include chronic disease programmes for diabetes, renal failure, HIV, mental health, and care coordination programmes aimed at complex patients with multiple conditions. Some examples of these programmes include:

Home Care

Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Diabetes Care

Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Read more

CAD Care

Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Read more

Kidney Care

Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Read more

Mental Health Care

Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Read more

Improving wellness

Vitality is Discovery’s world leading, internationally recognised science-based wellness programme that incentivises and rewards a healthy lifestyle.

Substantial, peer-reviewed evidence has been published in leading international and local journals that shows the significant impact on health status, health claims and health outcomes of engagement in the Vitality programme. In short, members’ health, hospital admissions, and mortality rates improve as they engage more with Vitality. As a result, DHMS benefits significantly from long-term healthcare cost savings and improvements in the Scheme’s risk profiles, and associated employers also benefit from improved health status, wellbeing and higher productivity of their employees who engage with Vitality.

Vitality has had a significant impact on DHMS

Vitality has achieved savings for DHMS of R11.5 billion between 2008 and 2016. The total Vitality savings are quantified in four components:

Positive member demographics

Vitality enables DHMS to attract and retain younger, healthier members.

Initial engagement selection and behaviour maintenance

Vitality also enables DHMS to attract and retain people that exercise more when compared to non-Vitality members. It is estimated that this initial and ongoing engagement selection resulted in savings of R3.8 billion for DHMS between 2008 and 2016.

Behaviour change

Vitality encourages members to increase engagement in healthy behaviour, which results in further savings for DHMS as claims are lower for members who increase their level of engagement with wellness activities.

Attracting new members

Vitality provides a substantial competitive advantage to DHMS and contributes to attracting a strong flow of new members. As new members tend to claim significantly less than existing members, any net new membership growth improves the Scheme’s financial position.

To provide access to quality, cost-effective healthcare, Discovery Health works closely with healthcare providers and their professional societies. Discovery Health is shifting away from a traditional fee-for-service model in favour of value-based payment models that are focused on quality of care and patient outcomes. Several value-based contracts with doctors have been developed and implemented, and there is continued engagement with the industry to identify additional methods of reducing healthcare costs.

1 DHMS members have voluntary access to Vitality membership. Vitality is administered by Discovery Vitality (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider.
2 2017 figures not available at the time of publication.

In addition, Discovery Health continues to grow and maintain provider networks that are efficient, drive adoption of evidence-based and cost-effective generic medicines, and incorporate technology into the healthcare system; together, these measures help to counteract medical inflation without compromising access to and quality of healthcare.

Discovery Health’s managed care processes and interventions have resulted in significant savings for DHMS and have had a clear impact on the Scheme’s loss ratio and operating surplus.

Medicine savings

Discovery Health’s medicines strategy spans the entire medicines value chain, from price negotiations with manufacturers and agents, to dispensing and claims reimbursement. Key components of this strategy include risk management, provider contracting, claims processing, pharmacy reporting, supply chain integration, clinical database optimisation and legal and regulatory compliance.

Forensics

Discovery Health applies advanced data science techniques to proactively detect healthcare fraud and abuse. In addition, the forensics and analytics units have developed various tools and reports for the ongoing detection of potential fraud and abuse against the Scheme, which has led to the recovery of millions of Rands a year.

Alternative reimbursement models

Discovery Health has negotiated a number of alternative reimbursement models with hospital groups and suppliers of surgical items, generating further savings.

Risk management savings are generated through tariff and medicine savings, funding policies, forensics, alternative reimbursement models and surgical item management. The total managed care savings per year, from these interventions, after allowing for inflation, are:

Enabling personalised healthcare and service benefits through technology

• HealthID
• DrConnect
• Discovery member app
• Smart series

Maintaining world-class service levels

In 2017, Discovery Health continued to push service excellence in the delivery of quality healthcare in an environment of high medical inflation. In comparison with international benchmarks, Discovery Health’s service metrics exceed international best practice benchmarks.

Future focus areas

• Collaboration with the South African Society of Obstetricians and Gynaecologists to better manage safe deliveries, early elective C-sections and the high rates of admissions to neonatal intensive care units.
• Enhance public reporting of the hospital experience of patients. The Discovery Health Patient Survey Score will be updated to include reporting on mortality rates and re-admission rates.