Driving Value-Based Care
Meet the Disease and Medicine Management Strategic Team (DMMST), who are at the core of Medscheme’s mission to provide access to affordable, sustainable, and high-quality healthcare.
This dynamic team is committed to shaping the future of healthcare by driving innovation and enhancing efficiencies in areas such as disease management, chronic medicine management, and Ambulatory Prescribed Minimum Benefit (APMB) services. Their focus on strategic planning, product design, and collaborative partnerships ensures that Medscheme remains at the forefront of healthcare transformation.
A dynamic and multidisciplinary team
Beyond their clinical backgrounds, the team also brings a wealth of experience in operational management, data analysis, project management, clinical risk management, health content writing, and stakeholder engagement.
This multidisciplinary approach allows the DMMST to comprehensively review product designs from end to end, identifying gaps, opportunities, strengths, and challenges. Through collaboration and strategic stakeholder engagement, the team ensures that every solution is aligned with Medscheme’s mission of improving healthcare outcomes.
The DMMST is composed of a group of clinical professionals with extensive experience across various fields within the healthcare ecosystem. The team includes pharmacists with deep expertise in medicine and pharmacy management, a nurse with a holistic understanding of patient care, and a dietician who emphasizes the critical role of nutrition in disease management.
Key Initiatives and Achievements
- Out-of-Hospital Medicine Management Report: The DMMST has achieved a significant milestone by driving the publication of the Out-of-Hospital Medicine Management Report. This comprehensive report offers valuable statistical insights into medicine utilisation and associated costs, serving as an essential tool for Medscheme and its schemes. The report helps evaluate members’ medicine co-payment experiences and identify gaps in medicine access.
- Increasing access to medicine: The team has been instrumental in implementing Therapeutic Medicine Reference Pricing, which benchmarks the cost of medicines within each therapeutic class. This initiative enables Medscheme to provide members with access to medicines that were previously not funded. The first phase of the project has been successfully rolled out, and efforts are underway to extend this model to more medicine groups.
- Enhancing operational efficiencies with automation and digitalisation: In pursuit of greater operational efficiency, the DMMST has embraced automation and digitalisation. Leveraging technology, the team streamlines operations, reduces administrative burdens, and enhances the patient experience. One such innovation is the Acute-to-Chronic project, which automatically registers members claiming chronic medicine from acute medicine benefits onto the Chronic Medicine Programme. This initiative eliminates manual registration, providing members with quicker, more sustainable access to benefits. Another example is spearheading the use of AI in the organisation by engaging with a new digital partner to achieve scale in the operational areas.
- Pharmacy strategy: The team has developed a comprehensive pharmacy strategy designed to improve patient outcomes and access to healthcare. This strategy includes the creation of a Pharmacy Performance-Based Reimbursement model, which encourages better outcomes, and Pharmacy Clinic Service agreements, which expands member access to primary healthcare.
Transforming healthcare delivery with Value-Based Care
A key area of focus for the DMMST is the adoption of Value-Based Care (VBC), which shifts the focus from volume-based healthcare to one that prioritises quality and patient outcomes. By harnessing their expertise in chronic disease management and preventative care, the team aims to improve clinical outcomes while reducing unnecessary costs.
The DMMST is actively working on implementing a VBC Diabetes Programme through active collaboration with other internal stakeholders, such as the provider team, reporting team, hospital event management team and many more to ensure that we align the interests of both healthcare providers and patients. This programme focuses on ensuring that outcomes are meaningful, measurable, and aligned with patients’ needs.
Join us on our Mission
The DMMST is not just a team – it’s a driving force behind the transformation of healthcare delivery. Our passion for improving healthcare outcomes is matched by our collaborative approach to innovation and care. By using data-driven insights, we continuously evaluate and refine our Disease and Medicine Management products and services to ensure that they meet the needs of our members.
If you are interested in learning more about the DMMST and our products, click here.
To get involved in our exciting projects, feel free to reach out to us at dmmstrategic@medscheme.co.za
