Can value-based health care be turned into a real business model in South Africa?

Can value-based health care be turned into a real business model in South Africa?

At PPO Serve we believe the shift from service based to value based health care is inevitable because it is the answer the question of achieving the Triple Aim – improving the patient experience of care (including quality and satisfaction); improving the health of populations; and. reducing the per capita cost of health care. It is being rapidly adopted by many countries and in particular the USA market. Locally, though, there has been just a few and very tentative steps. We would like to change that.

The biggest impediment to change invariably is the shift from fee for service to value based reimbursement because performing and billing less services has the potential to erode short term revenue of providers. Nonetheless, there is a great need for innovators embracing this change are greatly needed in our sector. In fact, there are many major and well know innovators in the USA and other markets that embrace the model of value not as an act of charity but as a strategic imperative, and gain clear advantages for taking these steps.

According to an article in the Harvard Business Review, the rationale for their innovative strategies:Sustainability for all; Experience in Managing Risk; and long term Relationship Building. They see no real alternative.

These major healthcare innovators share specific strategic elements:

 “The provider organization(s) used process improvements to boost quality of care for patients: better outcomes, an enhanced care experience, lower anxiety, less wasted time, and fewer health risks. When the results became clear, each effort also fostered pride and teamwork, thereby reducing employee turnover.

 

Second, the organizations decided that improving value was more important than short-term fee-for-service profit. They made investments — and often disrupted the habits of their staff — because they recognized that a business plan based on value was the right kind for their patients.

 

Third, they decided not to game the system by targeting only patients in contracts that would yield financial rewards. Instead, they understood that care redesign had to be of value for all patients, or it wouldn’t happen reliably for any. They traded losses in some contracts for potential defection of some patients to other providers, greater professional pride, and a forward-looking strategy.”

 

We believe that value based market competition will reward early adopters with recognition and discerning patient choice.

In South Africa, we need supply side innovators in our sector that embrace value contracting and start designing care delivery for all the patients who they serve.  Are you one of them?