Health Market Inquiry – analysis of the private healthcare market

Health Market Inquiry – analysis of the private healthcare market

Brian Ruff, our founder presented to the Health Market Inquiry on 17 May 2016.   He presented an overall analysis of the private healthcare market in South Africa and PPO Serve’s vision for how it can be reformed to improve healthcare outcomes and efficiency.

He explained that a different narrative is necessary in order to ensure affordable and efficient healthcare delivery in South Africa. The current narrative largely ignores the poor performance of the healthcare system in terms of both its efficiency and healthcare outcomes.  The result of an under-regulated private healthcare system was ultimately high premiums for patients and lower than desirable quality of care.

An Article on Section 27 summarises the presentation:

Ruff continued to explain that although ultimately a “unified” healthcare system is necessary, the process of producing National Health Insurance (NHI) has thus far lead to a “regulatory vacuum” and effectively stifled some key regulators. Overall, PPO Serve, in the short term, is advocating for a “competitive solution” which will crucially require the stimulation of competition on the “supply side” (between healthcare providers) based on value and in a manner that is “accountable”.

 

PPO Serve’s suggested regionalised system would, according to Ruff, by operated through “branded healthcare systems” with “multidisciplinary teams” including a variety of healthcare professionals working together to produce the quality health outcomes. These teams and regional systems would be able to define value to sets of consumers accurately by taking into account 1) population need, 2) measured patient outcomes and 3) costs.

The full presentation can be found here: Competition Commission pres – 10May2016 – final2

New Position: Office Coordinator

LOCATION: Rosebank, Johannesburg

WHAT WE NEED

We are looking for an Office Coordinator to perform administrative and office support activities for multiple team members.  We need you to make our day to day activities efficient so that we can focus on the complex activities. If you are passionate about projects and show us your skills in organising, implementing, measuring and improving this role will allow you to develop further.

YOU MUST BE: Organised, proactive, socially conscious
YOU MUST WANT TO: Make the team more efficient, deliver exceptional work. Make a difference.  Help us change the health care system.  You must want to work in a start-up environment.  We work hard, but have fun.  If you don’t want to work hard, don’t apply. We are committed and passionate, are you?
 YOU MUST BE ABLE TO: Learn quickly, work fast, think big, deliver precisely, iterate, be lean, and prove yourself. Ideally you have been doing admin for years but need a change. You are comfortable with admin, self-sufficient, inquisitive, and energetic with an appetite to learn.  You write well.

WHAT WE NEED YOU TO DO:

Perform a variety of office and project administration duties including:

  • Coordinates schedules and activities of the overall team
  • Manages travel arrangements, including booking, check in, and changes
  • Conduct desktop research
  • Assist with preparation of documentation and project tools
  • Word processing, creating spreadsheets and presentations
  • Fielding telephone calls, receiving and directing visitors; respond to inquiries
  • Manage the filing, storage and security of documents
  • Place orders for supplies and services
  • Maintain the day to day financial, accounting, administrative and personnel services
  • Monthly reconciliation of the financial records

Qualifications and experience required:

  • Undergraduate degree preferable.
  • Postgraduate degree advantageous
  • 3-5 years office and/or project coordination
  • Extensive software skills (Word, Excel, PowerPoint), Internet research abilities
  • Excellent written communication skills

 WHAT TO DO NOW

Should you be interested in applying or know someone who meet these minimum requirements, don’t just send us your CV.  Be sure that you interested in our passion and then help us understand why we need you to be part of our team.

  1. Investigate Integrated Clinical Consortia (ICC™) on www.pposerve.co.za  Read about Accountable Care Organisations (ACO’s), PCMH, multidisciplinary teams and care coordination in Google. Do you want to help us change healthcare?
  2. Write us a paragraph about what you think about the South African private healthcare system.  What is good, what should be changed?
  3. Write us a paragraph telling us why you’ll be a good Office Coordinator
  4. Also send us your detailed CV
CONTACT US START DATE SALARY
Info@pposerve.co.za 1 June 2016 Market related

 

New Position: Data Analyst

LOCATION: Rosebank, Johannesburg

WHAT WE NEED

We are looking for a Data Analyst to support the business through the application of data science within the context of healthcare.  We are focused on using data in the pursuit of creating transformed health care systems that benefits patients.

YOU MUST BE: Organised, diligent, process orientated, proactive and socially conscious
YOU MUST WANT TO: Add value to the team by delivering exceptional work. Be inquisitive, ask questions, THINK and challenge your team mates. Make a difference. Help us to change the health care system. You must want to work in a start-up environment.  We work hard, but have fun.  If you don’t want to work hard, don’t apply. We are committed and passionate, are you?
YOU MUST BE ABLE TO: Learn quickly, work fast, think big, deliver precisely, iterate, be lean, and prove yourself. Ideally you dream about data all the time, and think about how data can be used as a catalyst for real change. Be completely comfortable with MSOffice and data extract tools. You can take raw data, add context to it and draw conclusions from it, and aid us in driving of the vision of making health care more affordable to all South Africans.

WHAT WE NEED YOU TO DO:

  •  Design and conduct analyses that identify opportunities to improve health care quality and reduce costs, support clinical transformation activities, and rapidly evaluate the effectiveness of interventions.
  • Produce high quality, action-oriented analytic outputs
    Contribute to the development of analytic strategy and infrastructure in a new, rapidly growing company
  • Financial modelling
  • Performance monitoring at provider, facility and consortia level
  • Adhoc analysis and investigations

Qualifications and experience required

  • Tertiary Qualification
    • Bachelor of Science degree (Statistics, Applied Mathematics)
    • Bachelor of Commerce (Business Science)
  • Postgraduate a definite advantage
  • 1-2 years Analytical work experience in the financial services industry desirable
  • Exposure to working with MS SQL (Advantageous)

WHAT TO DO NOW

Should you be interested in applying or know someone who meet these minimum requirements, don’t just send us your CV.  Be sure that you interested in our passion and then help us understand why we need you to be part of our team.

  1. Investigate Integrated Clinical Consortia (ICC™) on www.pposerve.co.za  Read about Accountable Care Organisations (ACO’s), PCMH, multidisciplinary teams and care coordination in Google. Do you want to help us change healthcare?
  2. Write us a paragraph about what you think about the South African private healthcare system.  What is good, what should be changed?
  3. Write us a paragraph telling us why you’ll be a good Data Analyst
  4. Also send us your detailed CV

CONTACT US

START DATE

SALARY

Info@pposerve.co.za

1 June 2016

Market related

 

New Position: Clinical Coordinator

LOCATION: Rosebank, Johannesburg

WHAT WE NEED  

We are looking for a Clinical Coordinator to support the Clinical Executive in the development of the Integrated Clinical Consortia and operational toolkit.  Additionally the Clinical Coordinator will assist in the management and operational roll out of projects that are transforming the private healthcare system.

YOU MUST BE: Proactive, organised, diligent, and socially conscious
YOU MUST WANT TO: Be inquisitive, ask questions, think broadly, and challenge your team mates. Make a difference. Help us to change the health care system using your clinical knowledge, data and understanding of best practice. You must want to work in a start-up environment.  We work hard, but have fun.  If you don’t want to work hard, don’t apply. We are committed and passionate, are you?
YOU MUST BE ABLE TO: Learn quickly, work fast, think big, deliver precisely, iterate, be lean, and prove yourself. Your clinical knowledge must be sound. In addition, you should have a broad range of skills, work hard and smart. You can find answers fast and enjoy the process of building something new.  You must be comfortable with Word, Excel and especially PowerPoint.

WHAT WE NEED YOU TO DO:

  1.  Make things happen!
    • Understanding clinical process and engage with clinical data in an effort to understand the issues and possible solutions health system related issues
    • Build teams in the healthcare industry
  2. Stakeholder engagement
    • Establish, coordinate and maintain relationships with valuable internal and external stakeholders, including, but not limited to, clinicians, society leaders and operational managers for the flawless execution of projects
    • Communicate effectively with team and external stakeholders – providing a clear vision of what determines success
  3. Project Management
    • Track and report on progress and compliance of current projects with regards to operational standards and service level agreements
    • Deploy training and change management in the projects
    • Ensure that all projects are delivered on-time, within scope and within budget
    • Arbitrate and resolve conflict and interface with problems in the projects
  4. Clinical toolkit development
    • Provide clinical input into broad range of clinical toolkit developmental work

Qualifications and experience required

  • Healthcare related degree essential (Medical Doctor, Pharmacist preferential)
  • Postgraduate a definite advantage
  • 2-5 years experience in the Healthcare environment

WHAT TO DO NOW

Should you be interested in applying or know someone who meet these minimum requirements, don’t just send us your CV.  Be sure that you interested in our passion and then help us understand why we need you to be part of our team.

  1. Investigate Integrated Clinical Consortia (ICC™) on www.pposerve.co.za  Read about Accountable Care Organisations (ACO’s), PCMH, multidisciplinary teams and care coordination in Google. Do you want to help us change healthcare?
  2. Write us a paragraph about what you think about the South African private healthcare system.  What is good, what should be changed?
  3. Write us a paragraph telling us why you’ll be a good Clinical Coordinator
  4. Also send us your detailed CV

CONTACT US

START DATE SALARY

Info@pposerve.co.za

1 June 2016

Market related

Creating health communities through hospital hubs

Creating health communities through hospital hubs

There have been a number of interesting articles we’ve read recently that promote the role of hospitals in integrated care systems originating from ‘Obamacare’ – the US reforms. These include community level clinical and social services for populations. Articles include:

And the US Federal Government has just launched:

This feels to us to be an extremely relevant approach to discuss because in the South African private healthcare sector environment there is a huge and growing dependence on hospitals and hospital beds.

Hospital services are used to address straightforward clinical problems and undertake the simplest of procedures. Weak community healthcare services are both a cause and a result of this arrangement.

Is it possible that hospitals can be part of the prudent solution where services are done in the appropriate site?

In addition, is there a model of population medicine built around the hospital that adds value to the community it serves and is also commercially profitable?  

For the hospital to be well aligned with the needs of its client population, it must get rewarded for being part of the integrated care systems. If the hospital remains dependant only on its current volume derived income rather than its population medicine mandate, the contradictions of supporting effective community services are hard to resolve.

There a quantum leap is needed, a major rearrangement of the organisational and financial relationships compared to the current.

The organisation of a system where the hospital is the hub is characterised by clinical service lines designed for identified segments of patient demand (adult chronic medicine; maternity care etc.) that extend from households in the community and free standing clinics to hospital polyclinics and then into wards and theatres and ICUs and back again – continually. The teams that service these channels are made up of multiple disciplines and are focused around the needs of each patient. As a result, each patient can move seamlessly in the integrated system, which is also supported by Care Coordinators and an IT systems to make this work.

Financial arrangements for teamwork need shared recognition and basic remuneration so that individual clinicians get rewards for the success of the team. The upside rewards are measured against the requirements of the population that they serve. This disqualifies the current ‘fee for service’ (FFS) tariff because it rewards an excess of services rather than the minimum and prudent treatment option and is therefore not in the best interests of the community.

In general, this means long term population linked fees for consulting disciplines (GPs; Physicians; Gynaes etc.) and bundled or episode fees for therapies with a well-defined beginning and end, such as elective surgery, and a mixture in between.

All of this is very relevant to the current debate about employing doctors in SA.

Proscribing the employment of doctors is blamed for some of our systems inefficiencies. We believe that simply lifting the block and allowing hospitals to put them on a salaried payroll may not be the right or only answer. If fragmented single practice is the problem, and teamwork is the answer, then a better answer may be the creation of commercially independent and autonomous teams of clinicians who work and earn together and can enter into contracts or joint ventures with both medical schemes and hospitals.

PPO Serve Integrated Clinical Consortia™ are the answer. Joint ventures between them and their hosting hospitals completes the model.

 

Don’t want to read the full articles? Here are summaries of the important points:

Hospitals as Hubs to Create Health Communities: Lessons from Washington Adventist Hospital

Hospitals as hubs in community services can bring effective care to people and populations:www_brookings_edu___media_research_files_papers_2015_09_health-neighborhood_hospitals-as-hubs-to-create-health-communities_pdf

They are in a position to also begin to address social determinants, which we know that when ignored invariably negate clinical gains:

  • They build community networks linked to the hospital services, which facilitate integrated clinical care and bring services closer to the home.
  • The hospital has programs which aggressively enrol discharged patients in community support initiatives.
  • They undertake specific ‘hot spot’ programmes i.e. programmes that deal with specific community or locale issues that cause healthcare problems that can be addressed if the system has a population view and mandate

They get population related rewards. This means a population related budget system with rewards related to population based performance. There are penalties for avoidable readmissions. There is a useful new US funding program called the Community Health Needs Assessment (CHNA) that provides additional financial incentives to hospitals to collect addition data upon which to base intervention programs

Clinical data sharing is key – this arrangement permits full population data exchange i.e. record of all activities that the patient experiences is available from an integrated database. This also includes non-clinical data. In addition to aiding better individual patient care, the data is used to identify and address ‘hot spots’ for management; and for risk stratification of the patients in the community in order to design and channel them to appropriate services and interventions.

Multidisciplinary team is key – clinicians and support staff work together on joint care plans and hold regular reviews of individual patients and system processes.

 

Can hospitals help create healthy neighbourhoods? 

Cursor_and_JAMA_Forum__Can_Hospitals_Help_Create_Healthy_Neighborhoods__–_news_JAMASome hospitals are rethink their roles in healthcare systems, not just focusing on resolving acute problems and providing emergency care. ‘Hotspot’ strategies that successfully affect local communities and initiatives to address social determinants of health are prodding the rethink.

There are also now US financial and regulatory nudges too, such as penalties for high 30 day readmission rates. The CHNA (above) requires non-profit hospitals (the vast majority in the USA) to report on their communities social needs and develop strategies.

Difficulties include information sharing because of different data systems, as well as privacy restrictions. Critically, there is a ‘wrong pocket’ problem – hospitals that invest in community partnerships can work against its own bottom line even as the community is rewarded.

Silo budgets are another issue – in SA a medical scheme cannot invest in social services that might reduce the need for hospitalisation and improve longevity that is in the interests of life insurers, even for the same lives….

The authors suggests 4 steps to achieve this reform:

  • Develop metrics to measure the social and economic benefits of hospital community work
  • Make data sharing easy
  • Blend funding pools
  • New forms of investment capital

 

The Accountable Health Communities Model – a CMS Innovation Center pilot project to test improving patient’s health by addressing their social needs

Cursor_and_HHS_govThis is a new funding programme for screening people about their health related social needs and related referrals can improve quality and affordability.

Many of these issues – housing instability; hunger, interpersonal violence, transport problems – aren’t revealed in the normal clinical encounter but nonetheless have significant impact on the individual’s use of the healthcare services.

The programme aims to at ‘bridge’ organisations that align clinical and community services by connecting the identified patients to services and assessing the impact that has on their use of healthcare services, especially emergency room use, readmission rates and total healthcare costs.