PPO Serve, a South African healthcare company, has been pioneering multi-disciplinary, value-based care for nearly a decade, closely aligning with the NHIâs vision of universal healthcare. At the recent Rural Health Alliance conference, Deputy CEO Lungile Kasapato highlighted their innovative model, which integrates GPs and clinical associates into holistic care teams. By focusing on primary care and outcome-based payments, PPO Serve aims to address inefficiencies in the current system and promote sustainable, patient-centred healthcare.
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By Chris Bateman
An innovative private South African healthcare company has been quietly implementing multi-disciplinary value-based care for nine years â and is poised to take the lead in South Africaâs fast shifting healthcare landscape. The unique approach to healthcare delivery closely imitates the NHI model currently being imposed with the aim of replacing private medical aids with a single funder universal model within some twenty years.
This emerged at the Rural Health Alliance conference last month where PPO Serve, who provide holistic, integrated primary health care for GEMS patients, also reported on how clinical associates have proven to be an âinvaluable resourceâ in their multi-disciplinary approach.
Ms Lungile Kasapato, a medical technologist and deputy CEO of the company, outlined how they were finding solutions to a âfragmented and inefficient systemâ by partnering with medical campuses to employ mid-level healthcare workers.
Sounding remarkably like NHI national deputy director, Dr Nicholas Crisp, in promoting her companyâs philosophy, Kasapato said the current fee-for-service approach was deeply flawed and would undermine rather than support the UNâs sustainable development goals, (SDGâs) to 2030.
âThe SDGâs include financial risk protection for health services, safe effective quality care and affordable medicine â a tall but brave and necessary order, especially in a country like ours with the worldâs worst Gini-coefficient,â she asserted.
Read more: The ANC has stirred up even tougher opposition to NHI: Katzenellenbogen
The company, started by Dr Brian Ruff and Reidwaan Jabaar in 2015, and co-funded by the Foundation for Professional Development, (FPD), was recently ranked in the top14 out of more than115 companies delivering Value Based Healthcare from more than twenty-seven countries by Value Based Healthcare Centre Europe in 2023.
Using care-coordinators, PPO Serve organises General Practitioners (GPs) in private practice into multi-disciplinary teams and pays global and outcome-based fees, integrating within the teamâs other partners like allied healthcare workers, social services, hospitals, and step-down facilities.
Said Kasapato, âthe most dangerous phrase in the English language is, âweâve always done it this way!â
She said their doctors were paid according to the effort involved and the outcome achieved, which was value-based-healthcare delivered outside of hospitals, in the primary health setting.
Clinical associates, (undervalued and underused in the public sector), performed extremely well during selection interviews. When they got into practice, they were âphenomenal.â
âBecause of the way theyâre trained theyâre very in line with what we need for care coordination. Weâre currently not part of the NHI, but we believe in universal healthcare,â she added.
Of their difficulties in trying to change the healthcare system, she said; âwe ran most of those eight years almost broke but survived because of men and women passionate about changing our healthcare systems,â she said.
This integrated care will expand our geographic reach but most importantly, weâre investing in changing the culture. Working culture is informed by the structure in which we work. If we change the structure, we must be intentional about changing the culture as well,â she asserted.
Her company provided a learning platform and boasted âan amazingâ IT system which, because of the focus on primary care, contributed to downstream savings which could then be reinvested upstream to promote healthy communities, with far less hospitalization.
âThis approach is a call for us to look at and do things differently. We need a major change in thinking â weâre far too comfortable with the way weâve been doing things. If you look at healthcare systems globally, profiteering is not wrong so long as youâre in line with why weâre here as healthcare workers. âWe need to provide patient value – and a buck,â she quipped.
She described South Africaâs private sector as costly, unproductive and producing sub-optimal outcomes.
âBecause itâs not coming from my pocket or the doctorâs pocket, we all agree that you get admitted to hospital with medical aid. We know the cost of the same procedure could be ten or twenty times higher at the hospital. Yet nobodyâs looking at venues or outcomes. Whether youâre a GP or specialist, the current way to make money is to do as much as possible, (fee for service). Thereâs unhealthy competition amongst healthcare workers. We must ask; should we be competing – or complementing one another?
She said the Health Market Inquiry findings were âshocking,â concluding that the healthcare system was dysfunctional, poorly organized, with doctors overservicing and South Africa having many more hospital beds than other countries with similar populations.
The cost of healthcare in South Africa was rising inexorably, unabated. Unless something was done, nothing would change Nearly nine percent of the countryâs GDP was spent on healthcare â almost double that of the WHO guideline of five percent â yet outcomes remained dismal when compared to similar countries that spent the same.
Incremental fixes like combatting fraud, reducing errors, enforcing practice guidelines, making patients âbetter consumers,â and implementing electronic medical records had not had much impact. What was needed was a fundamentally new strategy.
âWeâre failing, yet we have the resources. Itâs a clarion call to tell us that our healthcare system is not working â it needs to transform â we need a new rationale,â Kasapato said.
Half of the countryâs healthcare spend was on just under sixteen percent of the population, leaving the other half of the kitty to service eighty four percent of its citizens.
Kasapato said a framework for restructured healthcare should focus on achieving the best outcomes at the lowest cost and defined value-based healthcare as âequal to outcomes and patient experience, over value.â
Providers that failed to focus on value lacked the essential foundation for strategy and would become increasingly non-viable and irrelevant, she predicted.
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