While the fee for service model is used extensively by practitioners in South Africa, this traditional remuneration model needs updating as medical aids are faced with ageing risk pools, higher incidences of cancer, stagnant member bases, anti-selection and tough market conditions.

Patient-centric oncological care could increase revenue and lower costs by 27% in future.

For almost a decade the ICON Group, which recently restructured its business units under the ICON brand, has advocated for the VBC model in local oncology. As the leading oncology provider network in South Africa, representing more than 80% of oncologists, the ICON Group places the patient firmly at the centre of their treatment by aiming for the best clinical outcomes and patient experience (quality) at lower costs to both the patient and schemes. This without having a negative impact on the financial remuneration of their network oncologists.

Internationally, where VBC is becoming an established model, the argument is accepted as a viable alternative to traditional billing models. ICON has found, in preliminary studies, that this approach reduces treatment costs by as much as 27%, improves outcomes for patients – including reducing hospitalisation time, and drives financial sustainability in the medical industry.

Not in conflict with profitability

Value-based care is not in conflict with provider remuneration. In fact, adopting the model can future proof your practice financially. Being proactive and participating in the roll-out of VBC will give practitioners a competitive and economic edge,” says Marais.

These groups that provide VBC see patient outcomes improve along with an increase in patient numbers and this in turn improves revenue generated. This is done by utilising consensus-based protocols and generic-rich formularies.

“Doctors who practice VBC internationally are remunerated better for driving improved outcomes for their patients. This model rewards good patient care as opposed to the fee-for-service model which neither measures quality nor efficacy of patient care, nor rewards cost-consciousness,” says Marais.

By using the VBC model, it is possible to drive efficiencies in terms of costs and efficacy, both in the treatment and the outcomes for patients. This translates in downstream cost efficiencies for medical schemes without compromising on quality of patient care.

Recent research[1] published by ICON shows that patients treated using evidence-based protocols resulted in cost efficiencies while showing no evidence of inferior care with improved surrogate endpoints for outcomes.

The ICON solution which supports protocols and integrates evidence-based medicine, shows a significant reduction in costs (27%) compared to scenarios when no protocols are applied.  This means patients received quality, appropriate care at a significantly reduced cost.

Real-time authorisation

Among the biggest game-changers is the development by ICON of its proprietary eAuth® software platform. This allows immediate in-protocol treatment authorisation and reduces billing inefficiencies – a benefit both to oncologists and patients.

“Real-time authorisation is without doubt an industry disruptor. It significantly reduces both the administrative burden and costs in practices. Importantly, it reduces the conflict between practitioners and medical aids. It also has a tangible impact for patients who prior to this intervention had to wait for weeks before a treatment could start,” says Marais.

Peer managed quality

ICON treatment protocols are provider driven. The network oncologists actively participate in the development of evidence-based protocols. “In this way ICON becomes a continuous learning platform with best practice shared amongst peers, specialist disease focus groups and an expert panel of oncologists who consult on behalf of their peers to medical schemes,” explains Marais.

Data driven network

ICON has the richest oncology database (currently 92 550 cases) in the country, adding approximately 20 000 new patient cases per year. ICON uses this patient data to build efficiencies into the business process. Importantly from a clinical point of view it helps in the ongoing development of the treatment protocols based on measured performance and efficacy data.

“The future of modern medicine will be driven by new generation models such as VBC. At the heart of the ICON Group we advocate for patients to gain access to the right care, at the right time and at the right price. Putting the patient at the centre of their care reduces wastage and costs while improving efficiency and efficacy for all, as well as rewards oncologists for their behaviour,” concludes Marais.