Unlocking the value of data through innovative care models In our increasingly digital and connected world, we see an opportunity not just to make step-by-step improvements in healthcare, but to completely rethink how we deliver and finance care. This opportunity is even more significant in sub-Saharan Africa, where mobile technology is transforming the region’s economy and empowering individuals.
PharmAccess’ goal is to optimize healthcare outcomes for patients in African communities, delivered through the most efficient digitally enabled solutions that respond to their needs. There is a global movement towards healthcare models based on value and outcome, rather than services delivered. This value-based healthcare approach is making an impact, and we are proud to champion this movement in sub-Saharan Africa.
Positioning empowered patients at the center of their care journeys
We can transform the system with innovative models that increase efficiency – ways of providing healthcare that achieve more with the available funds. Traditionally, the care process starts with the doctor. But with mobile technology making it possible to reach individuals at marginal cost, we can transform the care journey, so it starts with the patient. This allows for transparent and accountable processes throughout the care system, and for new ways of financing care based on the successful outcome of the journey.
Many of our models incorporate value-based care principles, which PharmAccess has been working with since 2018, though not all of them have the required components yet. The private sector has been adopting the concept of value-based care, but the biggest hurdle is redirecting public and bilateral donor funding to payments that are linked to outcomes. In 2022, we built on our results so far, focusing on scalable solutions (lower cost) and advocating for adoption by private scaling partners.
Our results with tens of thousands of patients demonstrate that following value-based principles is a better way to organize long-term care, for example for pregnancy and non-communicable diseases (NCDs). It creates trust between patients and providers, but more importantly, it provides the opportunity to truly target the needs of patients by paying for health outcomes rather than services delivered.
The care bundle approach: innovating with MomCare
With MomCare – a care bundle for expectant mothers that covers antenatal care, delivery, and postnatal care – we have helped make pregnancy and birth safer for over 50,000 patients in sub-Saharan Africa. With only limited additional cost, MomCare leads to significantly better value and increased utilization of care.
When a woman starts their pregnancy journey, they receive a digital health wallet with the maternity services they can access. The patient can access and follow directions from their healthcare provider on their cell phone, and the healthcare provider can track their progress with data and technology. This helps patients stay committed to their healthcare journey and the healthcare facility, reducing the risk of pregnancy complications. Importantly, mobile technology allows for tracking and paying for the services throughout the referral system and rewarding timely referrals, which are critical for better health outcomes. This way, payers can contract multiple facilities in a hub-and-spoke approach.
Providers can also unlock this data for better care: insights from more than 50,000 patients and 69 healthcare providers supported so far can help shape more effective and efficient maternal care in the future. For example, we can show that the approach creates better journeys, reduces risks, and can be scaled. Data transparency also means providers can better determine the costs of safe deliveries and other types of care.
Building on the success of MomCare
In 2022, we focused on improving and strengthening our MomCare model even further, optimizing the way we link payments to health outcomes through the use of data, and advocating and supporting others to design and implement similar models. In general, healthcare providers receive payment for services as well as outcomes, encouraging them to improve quality and efficiency. In Kisumu, Kenya, we started working with facilities that have embraced the MomCare approach, based on fees that are topped up by bonus payments. These bonus payments are linked to the number of antenatal visits and ultrasounds carried out at the right time in the pregnancy journey; timing of these healthcare services is crucial for safe delivery. We work with CarePay for fast and reliable bonus payments – reliable payments build the confidence of healthcare providers, allowing them to look to the future with trust and optimism. We aim to show the impact we make more widely and encourage governments to adopt a value-based approach to healthcare. This is already in motion in the Hanang district of Tanzania, where clinics were given the tools to collect necessary data and empowered to work with operational and patient-level insights through dashboards. While the clinics are getting used to this digital way of working, we are closely collaborating with the government to adopt the MomCare principles at the county level. Through our long-term collaboration with clinics across the sub-Saharan region, we were able to test additional innovations in clinic settings. In Kisumu, Kenya for example, we successfully trialed group-based mental health engagement during the pregnancy journey. We learned that the need for maternal mental health intervention is high: approximately one-third of the women participating in MomCare there screened positive for mental health problems, with underlying causes including poverty, lack of social support, no reproductive autonomy, intimate partner violence and sexual abuse. Despite some initial hesitation, participation in the mental health sessions was high (over 70%), and two-thirds of participants showed mental health improvements.
The Global Coalition for Value in Healthcare at the World Economic Forum recognized PharmAccess’ maternal health model MomCare as a Global Innovation Hub. The platform highlights organizations showing best practices, qualifying as ‘mature early adopters’ of value-based care models. Read more here
Addressing the biggest disease burden: NCD care bundles
Noncommunicable disease (NCD) is a major concern in sub-Saharan Africa, as chronic patients account for the highest disease and cost burden in the unstable healthcare systems. According to research, by 2030 NCDs are expected to overtake combined communicable, maternal, neonatal, and nutritional (CMNN) diseases as the leading cause of mortality in the region.
Chronic care is expensive because people need treatment for the rest of their lives; the currently fragmented healthcare funding does not cover patients throughout their journeys, so many are going untreated and dying.
We believe bundle care packages are a viable solution for more effective and affordable NCD care. In Ghana and Kenya, we are working on innovative care models for hypertension and diabetes, showing how they can increase efficiency, improve quality and expand care for the same cost to the providers.
Chronic care is about more than medication – it’s about behavior change. Our NCD care models put the patient in control of their own healthcare journey, empowering them to manage their own progress.
The digital approach can also lower the threshold for seeking care, while improving efficiency. In Ghana, we have been partnering with the Dutch healthcare platform Luscii to test a remote patient management model: PharmAccess and Luscii aim to scale this through a sustainable business model.
With the remote model, patients can send details like blood pressure and glucose levels via the app. This is less costly and it’s easier, so patients are more likely to do it, improving their health outcomes. We have had positive feedback, and the uptake was good in 2022: almost 70% of patients show good adherence by entering measurements and using the platform.
We have also focused on increasing efficiency and unlocking buying power through group treatment in Kenya. By forming patient support groups that hold monthly clinic meetings, providers can give patients access to education on their condition, measurement devices and checkups at a lower cost. By purchasing medication in bulk, they can also pass cost savings onto patients.
The way forward: data as a public good
In 2023, we continue to innovate and create even stronger business models that show the power of patient-centered healthcare journeys. Our goal is to demonstrate that by optimizing innovative care models, clinics can empower patients to self-manage and take charge of their health, and that value-based financing models optimize efficient spending. We also aim to build the capacity of clinics and policy makers to use important data insights to improve healthcare journeys and outcomes. To maximize the potential of these innovative care models, we must also continue to champion and highlight the importance of complete, reliable, and interoperable data for improving efficiency and quality of care. This is an international conversation: who owns and controls healthcare data? Our models put the patient in control, raising questions around privacy and access. And to ensure systems are interoperable and form a solid foundation as the conversation continues, we work with the African Virus Outbreak Data Network (VODAN) to promote standardization through the use of FAIR data principles.