MANAGED HEALTHCARE

Health Window has received accreditation from the Council of Medical Schemes (CMS) for active disease management for Type 1 and Type 2 Diabetes Mellitus. 

The current approach to management of chronic lifestyle diseases is less than satisfactory. Telephonic surveys to pharmacy patients highlighted the market’s general failure to manage chronic disease effectively. The patients  surveyed reported an average HbA1c of 9.5%, hinting towards most people with diabetes being poorly controlled. There is clear scope for improving how diabetes is managed if the population average from a random sample highlights poor disease control levels averaging 9.5%.

 

In addition, dispense data shows that poor adherence is a major issue and a possible contributor to poor levels of disease control. The same datasets also demonstrate that care fragmentation is prevalent, and that care coordination does not take place within prevailing practice.  It follows that a percentage of patients are likely not familiar with the need to correctly treat their condition. Self-care and self-coordination fail dismally, resulting in haphazard and fragmented care.

Patients with poor disease control and poor lifestyle habits are at a very high risk for unnecessary doctor visits and costly hospitalization. This is where interventions are most needed and where there is the greatest opportunity to generate savings.  A curative medicine model and event-based practice only creates the opportunity for future expenditure. By being reactive and responding only to established diagnoses or disease complications, we are driving up healthcare costs while also bypassing a significant portion of the market. A focus on prevention can help to decrease the high costs of hospitalisation. This requires a vision and desire to change from the old paradigms of disease management that did not deliver population level disease control. The focus should be to make a long-term, substantial and sustainable difference, rather than look only at short-term gains. Furthermore, should we have an opportunity to intervene at a point where costs are still low, prior to significant disease progression and the need for expensive interventions, we create a scenario where everybody wins.

 

Health Window sees a way to manage disease where merely reacting to complications related to chronic disease is no longer the status quo.

THE HEALTH WINDOW APPROACH

Our offering can be simplified using the ABCD model:

A   → Adherence Management: We will ensure that patients adhere to the treatment regimens prescribed by their health care providers. Monitor for non-adherence and escalate with a virtual nurse to identify and understand obstacles of treatment and help to overcome them.

 

B   → Broker data: between relevant HCPs, funders and the patient themselves. The Health Window platform will provide “one view” of the patient’s health profile and disease management progress, and this data view will be made available at the right time to the right health care provider. Supplementing our current datasets with claims data will allow for further enrichment of a patient’s profile, thereby facilitating better risk stratification and predictive models.

 

C    → Care Co-ordination: We will co-ordinate the check-in and check-out of patients between different HCPs, including clinics for biometric screenings, doctors for follow up consultations and script renewal or with or without adjusted treatment plans when uncontrolled, and virtual nurses to coach and guide patients through their journey. Our primary focus in terms of care co-ordination is that patients complete their due healthcare events while preventing avoidable and/or unnecessary utilization of healthcare services.

D   → Disease Management: The virtual nurses will engage with the patients telephonically and digitally to discuss relevant key messages and patient enquiries. Frequency of interactions will be based on the patient’s risk profile and take place as per the communication protocol assigned. Major issues to be addressed include disease education, lifestyle change and psychosocial stress. Using the theories of spaced repetition and cognitive behavioural therapy, we aim to promote real-life behavioural change.

The ABCD model has the patient firmly at its centre. We understand that it is the patient who lives with the condition and, therefore, requires support and assistance. It is also essential that the patient gains an understanding of their disease(s) and the impact that inadequate management can have on their lives and wellbeing. By managing a patient holistically, there can be greater reduction in risk of health-related complications.

BENEFITS FOR THE ROLE PLAYERS

TO CONTACT OUR TEAM FOR MORE INFORMATION

PLEASE CALL OR EMAIL US:

Tel: 012 844 9000

Email: info@healthwindow.co.za

41 De Havilland Crescent 

The Woods 

Persequor Technopark

Pretoria, 0200

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