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KIDNEY AWARENESS WEEK. HOW EFFECTIVE NETWORK MANAGEMENT IS SAVING LIVES

05 September 2024

Amee Adonis Advanced Specialist:  Health Facility Strategy Unit from Medscheme, an AfroCentric Group company writes about the power of healthcare network management in improving healthcare renal care outcomes for patients

As Kidney Awareness Week unfolds, it's time to shine a light on a critical yet often overlooked aspect of healthcare—network management. This might not be the first thing that comes to mind when thinking about kidney health, but it's a game-changer for patients relying on chronic dialysis. Understanding how healthcare networks operate can reveal the enormous impact they have on patient outcomes, healthcare costs, and the overall quality of care.

When your medical scheme encourages you to use its network providers, it’s not just about cutting costs. It’s about tapping into a system designed to deliver the best possible care. Behind the scenes, there’s a sophisticated web of data, collaboration, and strategy at work—all aimed at one thing: improving your health.

In the private healthcare sector, network management is the lifeblood of patient access and quality care. At AfroCentric, through our managed healthcare subsidiary, Medscheme, we oversee the care of over 4 million members. Our renal dialysis network is a prime example of how strategic network management can lead to life-changing results for patients with chronic kidney failure.

Renal failure, also known as kidney failure, occurs when the kidneys lose their ability to filter waste and excess fluids from the blood effectively. This leads to the accumulation of harmful toxins in the body, which can be life-threatening if not treated. The International Society of Nephrology (ISN) Global Health Atlas survey for Africa estimates that the prevalence of chronic kidney disease (CKD) in South Africa to be 10.7%, with a significant portion of these leading to end-stage renal disease (ESRD), an advanced stage of CKD that necessitates dialysis or transplant. Unfortunately, access to these treatments is often limited. The high cost of care, coupled with limited healthcare resources, means that many South Africans with renal failure do not receive the treatment they need, highlighting the importance of effective healthcare management and support systems.

For those unfamiliar, dialysis is a life-sustaining treatment for patients whose kidneys can no longer filter waste and excess fluids from their blood. Without it, survival would be impossible. However, the cost is steep—on average, a single patient requires around R350,000 per year for treatment. This is where effective network management comes in, not just to manage these costs, but to ensure every patient receives the best possible care. Of the 4 million Medscheme universe members, 6000 receive dialysis.
We’ve harnessed the power of data to track health outcomes at every step of a patient’s journey. This isn’t just about numbers on a spreadsheet; it’s about real lives. We measure everything from treatment compliance and mortality rates to the efficacy of dialysis and overall healthcare costs. The result is a detailed report that tells us—and our healthcare providers—how well we’re doing and where we need to improve.

But we don’t stop at collecting data. When our reports show that patients aren’t doing as well as they could be, we take action. We partner with healthcare providers to co-create strategies that improve patient outcomes. This is a collaborative effort, and it’s making a real difference in people’s lives.

Looking forward, we’re pushing the boundaries even further by moving toward value-based reimbursement. This means providers will be rewarded not for the volume of services they deliver but for the quality of outcomes they achieve. In other words, the better they care for their patients, the more they’ll be compensated. It’s a bold step, but one that we believe will revolutionize how healthcare is delivered.

And while our current focus is on dialysis, this approach has the potential to transform care for other high-cost, high-impact medical conditions as well. The key is collaboration. We believe that healthcare providers—from GPs to specialists to wellness teams—must work together as a cohesive unit. It’s this collective effort that will ultimately improve patient outcomes, reduce unnecessary hospital visits, and help patients live longer, healthier lives.
This approach isn’t without its challenges. Traditional healthcare contracts focused primarily on access and price. But we’re flipping the script, shifting the focus to quality of care. This requires a new conversation around how diseases are managed and how patient care is coordinated across different streams of healthcare.

Beyond the data and the reports, there’s another layer of quality control—facility site visits. We don’t just take a provider’s word that they’re meeting our standards; we go and see for ourselves. These visits ensure that dialysis facilities meet stringent requirements, from staffing levels to emergency equipment. If a facility falls short, they either step up their game, or they’re out of our network. Our patients deserve nothing less.

As members of a medical scheme, it’s important to remember that the funds we contribute are pooled together to support everyone’s healthcare. Effective network management ensures that these funds are used wisely, adding value to every treatment and every rand spent.
The future of healthcare networks is clear: better data, better care, better outcomes. By focusing on what really matters—patient health—we’re shaping a system where everyone wins. This isn’t just about saving money; it’s about improving lives.

So, as we mark Kidney Awareness Week, let’s take a moment to appreciate the intricate work that goes into managing healthcare networks. Like the kidneys filtering waste from the body, effective network management sifts through mountains of data to improve patient care. It’s a vital process, one that ensures we continue to provide the highest quality care while driving efficiencies and reducing costs.

Looking ahead, Medscheme is committed to leveraging the latest technologies and data management practices to keep pushing the boundaries of what’s possible in healthcare. Because when we talk about improving healthcare, we’re not just talking about numbers—we’re talking about real people, real lives, and a healthier future.