In a platform-driven digital world, this facilitation wholly relies on how well we know our customers –the core of data's strength.
Data lies at the centre of how any business wins in a digital world, but in healthcare, the wellbeing of human lives are on the line. We must recognise the interconnected nature of devices, networks and platforms. In healthcare, we are committed to harnessing this power to create a platform-driven environment that collects data and drives innovation in healthcare. The more volumes of data you process, the more you can personalise the journey.
Medical scheme administrators need to use data daily to identify trends in healthcare utilisation, costs, and outcomes. By analysing this data, they can identify areas where costs can be reduced, such as those related to unnecessary procedures or over-prescription of medications. By analysing patient data, they can identify patients at risk for chronic conditions and provide preventative care to reduce the likelihood of them developing chronic conditions.
Take, for example, Medscheme. They manage 13 medical schemes, serving over 3.8 million beneficiaries and process more than 12.5 million claim lines every month. To harness this wealth of data, it must use modern and robust data tools, including artificial intelligence and machine-learning algorithms.
Data-driven healthcare is a game-changer, and it is changing the way healthcare is delivered, and is systematically making healthcare more efficient and cost-effective.
Our value-based care model illustrates a design that aims to achieve balanced outcomes on five pillars- access to care, cost of care, health quality outcomes, patient experience, and provider experience. The data of care is the intelligence driving these efficiencies, and it is transforming the healthcare industry around the world, especially in South Africa. But innovation doesn't come without its challenges.
Safeguarding data accuracy and security is a top priority, as is ensuring that data-driven solutions are accessible and understandable to all stakeholders. To overcome these challenges, it's essential to implement strict data governance policies and invest heavily in training of staff in data management and analytics.
Good data practices can significantly impact the healthcare journey for consumers. For example, by using data analytics to identify patterns and trends in patient behaviour, it's possible to proactively identify and manage chronic conditions before they become more serious. By doing this, patient outcomes and efficiencies are improved and the cost of care reduced.
It also enables the identification of patients at risk for certain conditions, sharing patient data among healthcare providers, and using patient outcomes to identify areas for improvement. In addition, it provides patients with personalised health information and reminders, monitors healthcare provider performance and takes proactive steps to prevent or manage conditions before they become more serious.
Let's not forget data systems' critical role in rooting out fraud and corruption. By collecting and analysing data from millions of claims, it's possible to identify patterns and anomalies that may indicate fraudulent activity. For example, that data systems can look for claims submitted at an unusually high rate or services billed at a much higher rate than the industry standard.
By detecting and preventing fraudulent activity, administrators can ensure that medical schemes use funds for their intended purpose: to provide quality healthcare to those who need it.
Simply put, comprehensive data practices are essential to promote transparency, accountability, and trust in the South African healthcare system – private or public.