Update from the CEO, Dr. Brian Ruff

 

In this inaugural newsletter, I would like to introduce PPO Serve to those who may not know about us and what we do and to share the latest news and developments to those of you who know and are familiar with what we do. PPO Serve was established in March 2015. We anticipated the key supply-side recommendations of the HMI and have successfully run three demonstrations of the clinical service products commercially branded as The Value Care Team®, The Birthing Team® and GP Care Cell®. We are rolling out all of them to scale in partnerships with non-governmental, public and private sector partners. At the local level, the product is provided by multi-disciplinary teams of healthcare professionals organized into commercial, privately-owned companies which hold the license to use the respective PPO Serve brand called Integrated Clinical Consortia® (ICC).

    • The Value Care Team®(TVCT) – the ICC is made up of general practitioners, physicians, care coordinators and allied healthcare professionals. We have demonstrated in our 2 projects that our model improves healthcare access and outcomes for an enrolled population within a particular geographic area. PPO Serve facilitated the first Value-Based Contract for population medicine for the Pretoria North TVCT®.
    • The Birthing Team® (TBT) – this is a maternity ICC comprising midwives, doctors (GPs and specialists) and allied professionals. They work in partnership with the local hospital management to deliver all-inclusive, end-to-end maternity care in private hospital facilities. To date, this product has mainly served women with limited or no healthcare insurance, but plans are afoot to introduce patients with conventional insurance through medical aid in early 2020. The maternity product is unique in that it is priced at a fixed global fee.
    • The GP Care Cell® (GPCC) – this project aims to expand access to antiretroviral treatment (ART) for uninsured people living with HIV (PLHIV) by leveraging the capacity of private general practitioners (GPs) to provide high-quality HIV Testing Services (HTS) and ART provision for free outside of public sector health facilities in a controlled manner. The programme is in three districts and large scale-up is on the cards with partners.

We have sought partnerships to access specialised skills to mature the analytic and systems assets we have had to develop in order to implement all our clinical products. These products have an independent potential from the clinical products for commercialisation in both the private and private sectors.

It’s also been a year of change at PPO Serve. Dr. Crisp resigned from our board to join the public sector and Eugene Jansen has joined the board replacing Dirk Wagener who has been on the board since 2016. At the executive level, Dr. Visegan Subrayen and Erin Magongo have joined me and Dr. Howard Manyonga in management following the anticipated departure of three executives earlier in the year. The changes at the board and executive and have refocused the company and our prospects for 2020 and beyond are looking better than they have ever been in our brief and eventful short life.

We look forward to interacting with you and will be glad to hear any feedback you might have. Have a prosperous festive season and gear up for exciting news from PPO Serve in 2020!

Kind regards
Brian Ruff

Visegan Subrayen, Head of The Value Care Team & GP Care Cell

 

The Value Care Team (TVCT), our manifestation of Value Based care in population medicine,  was launched in Pretoria North in September 2019 after conclusion of the first Value Based contract with GEMS.  The Pretoria North TVCT comprises general practitioners, a physician, paediatrician and allied workers and is accountable for a population made up of GEMS members within that area.  This team follows on a similar population medicine project PPO Serve ran for 3 years on the East Rand, from which we have now withdrawn due to the lack of funder support. The team itself  continues to be operational independent of PPO Serve.  We continue to mature the model with the   prospect of rolling out successive teams nationally to service the GEMS population of approximately 2 million people. We intend to expand to Pretoria West, the Western Cape and north of Durban in 2020, as well as new schemes.

PPO Serve has also created a private network of General Practitioners to provide HIV testing and ART initiation and ongoing management services for patients living with HIV. Our network organisation role includes the use of the PPO Serve ICS for patient protocol management,  facilitating laboratory testing and logistics for stock control. Funding for the GP consultation fees is from PEPFAR, in an arrangement actively supported by the South African Government.  The Department of Health provides funding for the ART medicines and blood tests from the NHLS. This is good template, and a base for contracting private providers in the  NHI.

The initial GP Care Cell programme was launched in the City of Tshwane in November 2017 by the former Gauteng MEC of Health Dr Gwen Ramokgopa.  PPO Serve is subcontracted by the Foundation for Professional Development to provide the service in City of Tshwane & Ekuhuruleni and is now exploring commencement in Johannesburg with a different district support partner.

Howard Manyonga, Head of The Birthing Team

 

The first PPO Serve maternity ICC™ was launched in mid-2017, trading as The Birthing Team (TBT). The team provides midwife led maternity care for a global fee, in partnership with a hospital group. To date, there are 4 teams across RSA in 2 hospital groups. The teams have enrolled more than 2500 patients and conducted more than 1200 births in the cash market! This product was specifically designed for the gap market and has secured contracts with insurance providers. The product has performed beyond our expectations in this segment, producing very good results, outperforming any other competing set ups in the market. TBT was recognised a leader and was selected as the national winner for the best Healthcare Tech Startup and was a finalist in Southern African Global Start Up Awards category.  The midwife-led programme has huge potential in a market desperately in need of quality, affordable maternity services.  Indeed, we are now concluding negotiations to add scheme patients to the programme from February 2020.

The Future

The reorganisation of the supply side takes time and consistent commitment to change the way clinicians work, moving from an individual focus to a team-based approach and PPO Serve has invested significant time and effort in change management.

Erin Magongo, Head of Operations

The company has developed 3 ‘backbone’ support tools and services to enable us to expand or replicate our products rapidly, which puts PPO Serve at an advantage in the market. Below is a short description of these IT and analytic tools.

  • The Intelligent Care System (ICS)

This is our bespoke work flow system developed with our IT partner that enables the team to provide patient centric care. Care plans loaded onto the ICS detail the evidence-based clinical and psychosocial tasks the team members must perform in order to provide  optimal care. The system has been designed to provide some real time decision support. All data generated in the process of patient care  is incorporated into  the ICS structured clinical database where it is summarised and formatted into reports that are pushed back to the clinical providers. The ICS also tracks task compliance. Using this system, we can guide patients better throughout the different levels of care which, in turn,  will alleviate the system of its current pressures and will enable better manage budget management.

  • Business System and Contracting

The core business of PPO Serve is setting up multidisciplinary healthcare teams, called Integrated Clinical Consortia (ICC™s). Each team is set up as a local (PTY) LTD (commercial company) owned by the clinicians who work in it through structured shareholding.  This structure is compliant with all applicable regulatory and HPCSA guidelines. PPO Serve supports the clinical providers and the management of the ICC to maintain a focus on efficient and coordinated care. The multi-disciplinary approach ensures the team can meet the aims of value based care and facilitates the seamless contributions of different providers and patient navigation of the complex, and fragmented health care system.  The contractual arrangements ensure that the gains in production and improved clinical outcomes are recognised, and rewarded by the funder through  the value-based contract facilitated by PPO Serve. The PPO Serve ICC ™ is the first of its kind in RSA and the only set up which has secured value-based contracts with funders.

  • Episode Grouper (EPG)

The Episode grouper is an analytic tool that gives insight into the status of a patient by analysing their medical history and treatments. The grouper is applicable to individual and defined patients populations. Used with the PPO Serve geographic mapping tool, the EPG provides actionable insights to funders and providers, creating competitive advantage from better resource planning and proactive intervention, both important elements in achieving value-based care.  The target market for this software product is any funder or provider entity that has a large set of clinical data to analyse and understand. Consequently, this is generating significant interest from a variety of different interested parties. We envisage that a key deliverable for SAG prior to NHI is the creation of a ‘case mix task force’ that could provide extensive insight into clinical data required for proper budgeting and standardisation of outcomes. The EPG is a useful tool for this endeavour.

Over the last 4 years we learned some valuable lessons regarding potential risks and the mitigation thereof. To that end, we will continue to develop and mature a variety of  assets and tools required to support our clients, the ICC™’s to remain competitive in a rapidly changing health care environment. The tools enable the growing PPO Serve team to  effectively roll out  our clinical products nationally.