As far back as 2013, The Minister of Health, Dr Aaron Motsoaledi, warned that a survey by the Human Research Council (HSRC) and The Medical Research Council highlighted that chronic lifestyle diseases in South Africa is an emerging epidemic.
The concern is global. The International Diabetes Foundation predicts that by the year 2040, over 642 million people worldwide will be diagnosed with the disease. Gerhard van Emmenis, Acting Principal Officer of Bonitas Medical Fund, explains why a proactive and holistic approach to diabetes management is essential.
Chronic disease fiscal fallout
Chronic conditions are the leading causes of death and disability globally, putting an enormous and increasing burden on most healthcare systems. Prevention and early intervention are a big step towards the ultimate aim of making populations healthier through better lifestyles and increased compliance with their suggested care regimens.
Over the past few years, the Council for Medical Schemes cited an increased prevalence of chronic conditions, and diabetes in particular, as one of the key contributors to a rising disease burden and escalating healthcare costs. As a means to offset this growing disease burden and proactively empower patients with diabetes to take control of their health, Bonitas Medical Fund in partnership with Medscheme, has developed an integrated, holistic programme that is based on the specific needs of Bonitas members with diabetes.
Diabetic co-morbidities – a higher risk
Individuals with diabetes often have other chronic conditions (co-morbidities) as well - such as high blood pressure, high cholesterol, heart disease and depression. "Over 80% of our 46,000 diabetic members have associated chronic conditions," confirms Van Emmenis.
This fact greatly increases the risk of diabetics developing complications such as nerve damage, eye problems, kidney damage as well as problems in pregnancy. To manage diabetes effectively, all the other conditions and complications must be managed as well. A key feature of the diabetes programme that Bonitas has developed is that it manages each individual’s unique mix of disease and lifestyle factors rather than a standard approach to managing a specific disease.
Diabetes can be managed successfully with a healthy lifestyle and often the addition of medicine. "To ensure continuity and coordination of care, we generally recommend that members with diabetes consult with a dedicated doctor that is skilled on all elements of diabetes care," Van Emmenis explains. "We conduct GP upskilling sessions, whereby we equip doctors with the latest medical developments and best clinical protocols so that they are able to treat complications and refer patients for secondary care appropriately." By connecting doctors and patients electronically, via an electronic medical record, communication is improved and doctors are kept informed of all health related events and medical scheme benefits linked to their individual patients. At the same time the patient is empowered as they also have access to information and can actively participate in their care. To supplement this, members all have access to a health coach who helps them navigate the healthcare system.
Complications of diabetes must be prevented by ensuring access to proper treatment. When complications present they must be detected and treated early to prevent long-term illness. "Our integrated approach includes diabetes education, monitoring adherence to treatment (both medicine and other care), screening for complications and access to healthcare professionals who can assist with dietary advice and exercise. Doctors are able to support this tailoring a specific, individualised care plan for each of their patients. This ensures that all chronic conditions are adequately catered for as well."
Medication – door to door
Globally, there is a move to leveraging off the successes of HIV/AIDS programmes and applying these to other chronic (non-communicable) diseases. "One of our keys successes has been the use of a dedicated courier pharmacy, Pharmacy Direct, in achieving reduced viral load in patients with HIV/AIDS, as delivering antiretroviral therapy by courier has significantly improved adherence to treatment. We aim to replicate this for diabetes patients by offering courier delivery of diabetes medication and medical supplies such as needles and testing strips,” he says. “In addition, because Pharmacy Direct is a designated service provider, we are able to ensure that members are not faced with additional co-payments, don’t have to leave work to fetch medication and get maximum value for money. Members have enjoyed the benefits of this courier pharmacy service for many years." Research has demonstrated the benefits and impact of using courier pharmacies in achieving good outcomes and this strategy is being applied in large national health programmes as well.
Containing the risk
"We believe the way forward is an increased focus on prevention, lifestyle changes, coordination of care by doctors and the utilisation of evidence-based disease management interventions," says Van Emmenis. Consequently, Bonitas uses an innovative Emerging Risk predictive model and screening algorithms to identify pre-diabetics and those Scheme members likely to develop complications and other serious conditions. "We want to work with healthcare professionals to create an environment that supports them to optimise clinical outcomes. Together we can help these members at high risk so that they can proactively improve their health and reduce the chances of developing complications and additional conditions," concludes Van Emmenis.
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