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INTEGRATED REPORT 2017
Non-communicable diseases
• Asthma/COPD*/Bronchiectasis
• Cardiac failure/cardiomyopathy/dysrhythmias
• Diabetes (type 1 and 2)
• Hyperlipidemia
• Hypertension
• Depression/Bipolar
• Cancer
• Chronic renal failure
• Epilepsy
• Hyperthyroidism
• Musculo-skeletal disorder
Managing patients with chronic conditions has become
especially challenging in recent times, because of, among
other things:
• rushed practitioners not following guidelines;
• lack of care coordination;
• lack of follow-up; and
• patients who are inadequately coached for self-
management.
* Chronic obstructive pulmonary disease.
VALUE CHAIN OPTIMISATION
Value chain optimisation is the process of analysing and
increasing the value of every Rand spent on medical aid.
It identifies opportunities for collaboration and negotiating on
prices with healthcare providers. The outcomes are to drive
value, lower costs and make medical aid affordable again,
so that our clients can expand their membership.
We have leveraged our clinical, actuarial, data analytics and
health intelligence capabilities to identify irregularities and
negotiate affordable prices on unregulated components,
such as medical consumables and surgical devices.
Initiatives that improve healthcare while lowering its cost,
include the Documentation Based Care (“DBC”) back and
neck rehabilitation programme, our pharmaceutical courier
distribution services to patients and more recently, the
Integrated Chronic Care Model (“ICCM”).
INTEGRATED CHRONIC CARE MODEL
Medscheme’s ICCM was implemented on 1 May 2017, and
aims to decrease costs for our client schemes while improving
the healthcare for our scheme’s beneficiaries.
Chronic diseases have become more prevalent across the
world, the majority being caused by non-communicable
diseases (“NCDs”). NCDs now spread faster in developing
countries such as South Africa than in high-income countries,
and, as chronic illnesses account for over 50% of healthcare
costs, it is imperative that we combat them. Over the past five
years, the number of Medscheme’s scheme members with
three or more chronic diseases has increased by 50%, both as
a result of an increased incidence of lifestyle related diseases
and more proactive identification of at-risk patients.