In the media

Extra support for advanced cancer patients through medical scheme innovation

13 October 2022

AfroCentric Group subsidiary Medscheme's partnership with value-based care provider, Alignd, is transforming advanced cancer care delivery and enhancing patients' experience.

JOHANNESBURG – As countries expand health benefits for cancer care, there's a risk that people suffering from terminal cancer will spend their last days in hospitals away from their loved ones, often in pain and struggling with debilitating side effects of medicines.

Most people prefer to spend their last days in the comfort of their own home, surrounded by their loved ones. However, families are often ill-equipped to manage this time at home.

Medscheme, as part of its innovative and progressive managed care strategy has partnered with Alignd to give members of Medscheme clients, like Fedhealth, access to the Alignd Palliative Care Programme on diagnosis of advanced cancer and at no extra cost to members.

Medscheme is a subsidiary of AfroCentric Group, South Africa's largest JSE-listed and black-owned healthcare group. Alignd is a value-based managed care organisation that provides specialised care for anyone with advanced cancer, focusing on providing relief from symptoms, pain and stress.

"Medscheme's partnership with Alignd is a recognition of the growing importance of early referral to palliative care for patients suffering from advanced cancer," says Dr Mike Marshall, Research and Product Development Executive Manager at Medscheme.

The Alignd palliative care team, which includes doctors, nurses and social workers provides medical expertise, pain management, and care and support for patients and their families at their homes. This extra layer of care can be accessed while having disease-directed treatments.

"In recognition of World Hospice and Palliative Care Day last week, we're showing our support for the power of palliative care by building stronger health systems and designing a value-based palliative care programme to be covered by medical schemes," says Alignd CEO Dr Lungi Nyathi.

"Almost 80% of patients that have accessed the Alignd Palliative Care Programme had their healthcare wishes respected by planning early with their palliative care provider teams and families. Enabling the coordination of care and the effective working of teams has been life-changing for patients and their family members. The reduction in unnecessary procedures, tests and hospitalisations has impacted positively on the quality of life for Alignd patients," Nyathi said.

"A Fedhealth patient's family member told us: 'Everyone in the palliative care team helped us to understand Mrs M's health issues. Her care was exceptional and we are very grateful for all she did, as well as Dr J, who was most helpful in addressing emotional and social issues. The home visits team was very supportive and Mrs M's pain was managed well'."

According to Nyathi, up until now, if medical scheme patients wanted to access palliative care from early on in their cancer journey, the cover for these costs would be limited and would typically be paid from their day-to-day benefits, if available. Too often, patients are offered palliative care only in the final weeks or days of life rather than at the start of their metastatic cancer journey. As a result, they and their families miss an opportunity to benefit from assistance with psychosocial, spiritual and emotional support, essential planning with their team of providers and help with navigating the healthcare system.

Added Marshall: "Through Alignd, nearly 2,000 families have experienced the much-needed provision of coordinated, value-based palliative care services to date. In 2023, we hope that close to three million people will have access to the Alignd Palliative Care Programme through their medical scheme. Great successes have been reported in the first two years of the programme, with exponential growth in the number of patients accessing palliative care and an increase in the number of palliative care providers able to be remunerated for the care they provide."

Fedhealth has offered the Alignd Palliative Care Programme enabled by Medscheme for the last two years.

"Our partnership with Alignd allows us to offer this ongoing specialised care and support to our members and their families on diagnosis of a serious cancer. And if their cancer progresses, allows them to be cared for at home if they choose, and avoid costly and often unnecessary treatments and hospitalisations near the end of life," says Jeremy Yatt, Principal Officer of Fedhealth Medical Scheme.

Yatt says: "Our members feel taken care of, as one told us: 'As a huge part of serious illness care is admin and bills and phone calls and approvals, we felt lucky that my mom's medical scheme, Fedhealth, has partnered with Alignd – all this valuable extra care comes with no bills – it's part of her cover'."

The end result is a win-win: for patients, who feel more empowered and better supported without enormous out-of-pocket expenses and for medical schemes like Fedhealth, who have been able to give their members additional cover when they need it most, while reducing spend on non-beneficial care.

And there's a third win. For palliative care providers. In a struggling healthcare sector, where palliative care doctors, nurses, social workers and hospices have relied on donor funding and cross subsidies to function, Alignd's solutions enables them to expand their services and work meaningfully within their scope to include private sector patients, especially in more remote areas where fewer specialists are, while diversifying their revenue base.

This value-based programme has been painstakingly but expertly and deliberately designed to integrate all the role players and deliver care differently and smarter. The partnership between Alignd, palliative care providers and schemes in this way is the way of the future for compassionate and sustainable healthcare.