Healthcare specialist MIP Holdings is developing a R10 million IT system that forms the backbone of GPNet, the managed care company co-owned by more than 2 500 general practitioners.
The core system went live in January and the capitation system went live in April. July will see the implementation of a database of patient medical information that GPs will be able to access via the Internet.
The system is delivering significant benefits to GPNet members, who represent some 60% of SA`s GPs. While GPs receive only 10% of SA`s medical aid spend, they are responsible for 70% of all decisions regarding health expenditure.
"It can be expected that the system will help GPNet make a considerable impact on SA`s healthcare spend in the future," says Richard Firth, chairman of MIP Holdings.
"The system is a triumph of co-operative knowledge sharing in response to the new economy," says Firth. "MIP and GPNet co-operated closely to pool knowledge resources, insight and vision regarding the future of healthcare in order to create a managed care system to help GPNet`s members transform their practices into profitable, yet affordable healthcare service providers."
"The system is enabling us to change the way healthcare services are delivered in SA," says Dr Hennie Duvenhage, CEO of GPNet.
"Delivering affordable health services in SA is key to the development process of the country. GPNet benefits medical schemes and ultimately patients by leveraging the GPs` controlling position in medical scheme cost flows and remunerating doctors for best practice," he says. "The system enables this. By analysing data supplied through the managed care system of our members, the quality of service of our practitioners is enhanced.
"We will be the first organisation to deliver a managed capitation model to the South African market. Capitation is widely considered to be the most viable answer to the problem of delivering healthcare to the broader South African market."
Capitation is the concept whereby the medical funder pays a doctor a set fee per month per patient, and requires the doctor to manage the patient proactively by regular preventative consultations in order to effect early diagnosis of life-threatening disorders, thereby pre-empting the high treatment costs that usually follow late diagnosis.
Another key feature of the system is the scientific formula that enables GPNet to analyse and control members` drug prescription patterns. "The system enables doctors to prescribe the most cost-effective drug to achieve the best outcome for patients," says Duvenhage. "Through this system, whatever you script to the patient is 20% cheaper and results in a better outcome for the patient."
The system analyses more than a million doctors` scripts at a retail value of more than R200 million a month. This represents 50% of the monthly medical aid funder drug spend. "Yet this considerable monthly scripting bill is still 20% cheaper than the national average due to GPNet`s managed care procedures that ensure costs are kept down to benefit patients and medical aids," says Duvenhage. "We save patients R40 million a month through controlling script patterns," he says.
GPNet has also developed a comprehensive database of general practice and patient information from its members countrywide, which is used to assist in monitoring various aspects of member GPs` practices. For example, it enables GPNet to assess whether or not a doctor over-prescribes. Over-prescribing doctors are advised as to how to prescribe more effectively to control costs.
"Our whole system is based on checks and balances with professional affairs overseen by an independent body, the Board of Health Executives, that has established clinical guidelines and therapeutic algorithms as well as a mechanism for peer review, accreditation, grievance and disciplinary procedures," says Duvenhage.
"Through the information collated on the system databases, GPNet can offer quality healthcare at an affordable price to patients, medical scheme administrators, managed healthcare companies, employer bodies and government," he says.
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