Chief Medical Officer at Discovery Health, Dr Maurice Goodman, talks about the importance of a shared purpose among stakeholders of better patient care and how technology can enable that collaboration.
Tell us about Discovery’s strategy to forge collaboration with healthcare professionals.
We appreciate the great doctors and healthcare professionals we have in South Africa and Discovery Health’s vision is to become a valued partner with health practitioners in improving the system, not just a payer of plans.
So we work hard to get and stay close to treating clinicians, and that’s a deceptively hard task to do. Internationally, there’s typically always friction between clinicians and healthcare funders – be it the government or public sector, like the NHS in the UK or private sector funders, like in the US. But we believe that due to certain circumstances in South Africa, like the relatively small number of practising GPs and specialists, we can actually buck that trend and turn it around.
One of the critical factors hindering success around the world is that people often get mired in the current problems. In South Africa, there are undeniable problems with costs and quality combined with other long-standing problems in the healthcare system, but it’s difficult to get stakeholders motivated to fix them.
What we need to do is sketch a compelling view of the future so that all roleplayesr in the healthcare system are motivated to work through the current problems. There has to be a shared purpose of improved patient care. We’ve been working to engage doctors, society and GP groupings in meetings to discuss this vision. What doctors get excited about is ultimately that their patients get better care and get better as a result. And frankly, that is also why we come to work every day: to make sure that we have a healthcare system that delivers better care to everyone using it.
How does technology fit into Discovery’s objective to closely align with medical professionals?
Part of the Discovery Health model is that we believe we need to be a disruptor, a force for positive change in society and not just a company delivering a product. Internationally, there’s a dramatic change underway around technology in general and eHealth and digital platforms in particular. By making sure we understand best-of-breed international technologies and by bringing those technologies and advances into our current local healthcare systems, we can add real value.
We’re seeing three main streams maturing around technology. The first is in regard to advances in medical technologies, drugs and devices. They all bring huge value. Unfortunately, they also bring huge costs. So, how does one access the value without bankrupting the system and making access unaffordable? There’s a whole discussion around that to try and introduce the technology in an affordable, sustainable way.
Then there is the digital ecosystem that empowers patients, doctors, and the industry as a whole to perform better. Information is much more ubiquitous and available to everybody. Doctors are facing a situation where patients may know more about the latest cancer drug, for example, than they do. That can be threatening; on the other hand it can also be enabling. So the question for all of us is: How do we embrace that trend and harness its benefits?
The third stream within health technology is all about wearable devices, which links to our wellness and Vitality strategy. It points to an important shift in patients becoming much more empowered as more and more people are living with chronic diseases, including cancer, diabetes, and hypertension. Enabling doctors to “prescribe wellness” to patients who are motivated to comply will be very powerful in combatting the growing burden of these non-communicable diseases.
What is the foundation for building a connected national health system and realising continuity of care for patients?
One of the problems in our healthcare system, especially within the private sector, is that the system is fragmented and everyone works in silos. The result is a lot of wastage, a lot repetition and often poor quality care. For example, a patient goes to a GP, has a set of blood tests and is then referred to a specialist a couple of weeks later. The specialist is not sure what has or has not been done and repeats the whole set of tests. For the patient, that’s bad quality care and it costs a lot of money.
Broadly speaking, we need a basic digital platform for communication that’s accessible to all players across a complex system. The platform needs to be focused on the patient and the patient’s health record. This in itself could be a useful platform in uniting everyone from doctors and hospitals to other suppliers.
Do you think that a single, national EHR platform should be managed by one entity?
In our view, one national system would be ideal. However, it may not be practical. Defining basic components that would facilitate interoperability is probably the way it will go. Public, private and national systems are definitely going to become more and more important as we migrate towards NHI – where conceptually you’ll have patients moving between public and private providers. Certainly it would be best to have one system that cuts across all those different entities, but enabling solutions to talk to each other might be a more feasible approach.
A lot of the doctors who are still practicing started off as family doctors serving a single community. In terms of their evolving role, who is the doctor now?
Today’s doctors are operating in a much more complex environment. In addition to being excellent clinicians, they have to be astute business people. They have to understand how to manage finance and technology, and how to operate in a complicated and fast-paced environment.
There is a basic lack of training within the undergraduate medical curriculum in small business management, and management as a whole. Medical students go to medical school and come out as excellent doctors. If they go into private practice, they’re running a small business straight away and in the public sector, they quickly end up in a management position running a department. However, many of them have never even heard of VAT and other business principles. There’s a big gap in our undergraduate curriculum in enabling doctors to function as managers. It’s a gap that medical schools are moving towards closing.
Medicine in itself has also become more complex, more specialised and sub-specialised. If you go back a few years, a specialist, like a paediatrician, would be at the pinnacle of the triangle. Now, within that specialty you have sub-specialties, for example, paediatric cardiologists and paediatric gastroenterologists.
What we’ve lost through specialisation, commercialisation and industrialisation is the GP or primary care doctor coordinating the care of the patient. This mainly impacts patients with chronic conditions in terms of quality and costs. If a patient comes in for an acute twist to the ankle, or a cough or cold it’s relatively quick and easy to manage and treat. Patients with chronic health conditions, who might need to move between different doctors and specialists, are a much more complex challenge in the current system. It makes it difficult for a single doctor to coordinate their care.
Doctors are central to the adoption and use of eHealth. What would Discovery say to a doctor resisting the use of technology?
Not unexpectedly, we experienced a fair amount of resistance when we initially rolled out Discovery HealthID, and it was a classic textbook case that you’d find anywhere. Generally, younger doctors are the early adopters. Interestingly enough, we found that age was not the primary reason for resistance.
The sustainable use of technology relies on its ability to demonstrate real, tangible benefits within the realities of the doctor’s practice. In the early days of the launch of HealthID, if there was a problem with connectivity, for example, we had to understand those challenges and be able to overcome them.
The second factor is being able to demonstrate that, ultimately, the patient is going to benefit from better care as a result of better communication between the doctors or a comprehensive, single patient record as a reference to guide care decisions.
Lastly, it takes time to learn to use the new technology – at first, if it takes the doctor five minutes longer for each patient when using the technology, they’ll end up seeing fewer patients. It’s important to make sure they are adequately reimbursed for that time spent learning, so a financial incentive can aid in getting doctors on board. This has been clearly demonstrated in many countries around the world. We believe we are through the teething problems and currently there are over 4,600 doctors using Discovery HealthID.
Outside of working closely with medical professionals, you also have a lot of influence over the health decisions your members are making. Talk us through your use of technology to engage with patients?
In any medical funding population you tend to get about 80% of people who are well, healthy and claim less than they contribute. That cross subsidisation is necessary to fund the remaining 20% who are consuming a lot more health services. Vitality plays a critical role in getting the right information and the right incentives to that 80% of the population to make sure that they stay informed, healthy and motivated to make the right choices for their health and wellbeing. That engagement hinges on technology to make sure that information is credible and readily available, it’s personalised and accessible on their chosen device.
If we move to the population that needs to access the health system, technology has revolutionised the way they navigate the system. For example, finding the nearest hospital or doctor is commonplace and available to almost anyone.
So, access to information through technology is fairly straight forward. On the other hand; however, healthcare plans can be quite complex. You have a greater choice of tailored cover with different plans, but with those choices come complexity. How do patients really understand what they have bought and what they haven’t bought? Often people are exercising different parts of their brain when they are a well. Healthy consumers purchasing a plan as opposed to sick consumers will make different decisions and adhere to the plan they’ve chosen. It’s important that consumers know upfront what they have or haven’t bought so that when they access the plan, they can easily navigate through it.
Increasingly, there are various networks that give patients access to a certain hospital or certain doctors with or without co-payments. Technology plays a critical role in providing patients with the ability to navigate this system and to access medical information. That could be at a fairly simple level, like a reminder to get your flu vaccination at the beginning of the flu season, through to more complex issues like receiving information about the latest oncology treatments if you are living with cancer.
The healthcare system has many stakeholders with varying needs and responsibilities. When placing the patient at the centre of the system and focusing on quality care, the healthcare system as a whole will benefit. Our shared purpose is to ensure access to a healthcare system where patients are empowered and can benefit from improved health outcomes enabled by collaboration between healthcare professionals, funders and other key players.