Nicolette Dirk,finance writer, justmoney.co.za
Liberty Medical scheme has introduced their General Practitioners (GP) networks to cut medical costs for their members.
Using an incentive system, the scheme pays doctors 15% more than those who don’t belong to the network.
Liberty Medical Scheme’s executive principal officer, Andrew Edwards, said medical schemes should look at innovative programmes that make GPs co-ordinators of care to bring down healthcare costs.
“Employing doctors in the private sector – whether it is hospitals or medical schemes - is likely to introduce another layer of administration and costs. The question should be: how do we shift the health system so that GPs are empowered in their traditional roles as primary care givers and co-ordinators of care,” said Edwards.
Heidi Kruger, head of corporate communications for the board of healthcare funders of Southern Africa, said this type of network helps cut down on downstream costs and also ensures that patients get the right type of care at that level without necessarily having to see a specialist.
How Liberty’s network came about
Edwards said they started out by working with the GP leadership and finding ways to work together, without GPs feeling like they were being told how to treat their patients. Liberty also wanted to come up with a way to reward quality care and prevent poor quality outcomes.
Since then 2 400 GPs have signed up with Liberty Medical Scheme’s preferred GP network. Doctors have to be invited to belong and undertake to be reviewed by their peers each year.
“It does open them up to more oversight, but in many cases, doctors enjoy this as it gives them feedback about their work and enables them to feel part of a community of other doctors, as well as giving them access to the latest information about treatments and technology,” said Edwards.
Who benefits the most?
According to Edwards, the initiative has seen most success with members with chronic illnesses. Although chronic diseases such as asthma, diabetes and hypertension affect only about 20% of the medical scheme’s population, they account for roughly 80% of the costs.
Through disease management programmes, members with chronic illnesses are identified and the scheme works with doctors to ensure they are given the necessary screening tests, go for regular check-ups and are compliant with their medication. The result has been fewer, expensive hospitalisations and complications.
Kruger added that managing chronic diseases through disease management programmes or GP networks can prevent expensive and painful complications , for instance in the case of diabetes where complications can be serious. “By working with GPS, we’ve seen that focusing on primary care keeps people out of hospital and costs down.
This simple intervention saves the schemes hundreds of thousands of rand each year. In addition, the scheme pays for GP visits from the risk portion of a person’s medical cover, rather than their savings account. We found that members are more likely to take care of themselves proactively, if they don’t have to worry about running down their savings account,” said Edwards.
How are network doctors chosen?
Doctors invited onto the Liberty Medical Scheme preferred GP network are chosen based on their accessibility.
“We look at which doctors most members are using and we’ve made sure that 91% of our members are within a 10km radius of a doctor on our GP network,” said Edwards.
He added that on lower cost options, medical schemes are also introducing referral management, which means members may not bypass the GP and see a specialist directly. Kruger said a similar system is used in the United States.
“One of the biggest cost drivers in this country is that members go directly to a specialist who often requires more expensive tests, such as radiography and scans, which may not always be necessary. The key to bringing down costs is to empower GPs to be the first port of call and to treat patients holistically using good quality primary care,” said Edwards.