Executive Head of Data Insights at the AfroCentric Group, Vukosi Sambo, writes about how data does more than just turn people into numbers… it saves lives.As the healthcare industry continues to evolve, the role of data to drive efficiencies and improve patient outcomes has become the core of our industry. To me, we aspire to be like the ridesharing app Uber, enabling access to the best doctors and treatments at the best prices, all while facilitating the optimal healthcare ‘route’ for our members based on their individual lives and economic circumstances.
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.
Data to identify trends in healthcare utilisation
As medical scheme administrators, we use data daily to identify trends in healthcare utilisation, costs, and outcomes. By analysing this data, we can identify areas where costs can be reduced, such as unnecessary procedures or over-prescription of medications. By analysing patient data, we can identify patients at risk for chronic conditions and provide preventative care to reduce the likelihood of developing chronic conditions.
Take, for example, Medscheme, AfroCentric’s biggest subsidiary and medical scheme administrator. They manage 13 medical schemes, serving over 3.8 million beneficiaries and processing over 12.5 million claim lines every month. To harness this incredible wealth of data, we must use the most modern and robust data tools available, including artificial intelligence and machine learning algorithms.
Data-driven healthcare is a game-changer, and it is changing the way healthcare is delivered. We are systematically making healthcare more efficient and cost-effective. Our value-based care model is designed 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.
Data accuracy and security is a top priority
Safeguarding data accuracy and security is a top priority, as is ensuring that our data-driven solutions are accessible and understandable to all stakeholders. To overcome these challenges, we must implement strict data governance policies and invest heavily in training our 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, we can proactively identify and manage chronic conditions before they become more serious. By doing this, we improve patient outcomes, reduce the cost of care, and improve efficiencies.
We can also identify patients at risk for certain conditions, share patient data among healthcare providers, and use patient outcomes to identify areas for improvement. We can also provide patients with personalised health information and reminders, monitor healthcare provider performance and take proactive steps to prevent or manage conditions before they become more serious.
Fraud and corruption
Let’s not forget our data systems’ critical role in rooting out fraud and corruption. By collecting and analysing data from millions of claims, we can identify patterns and anomalies that may indicate fraudulent activity. For example, they may 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.
Looking to the future, data will continue to play a critical role in AfroCentric and healthcare. We are committed to investing in the latest technologies and data management practices to ensure that we continue to provide the highest quality care to our patients while driving efficiencies and reducing costs. By leveraging the ever-evolving potential of data and insights, we believe we can truly revolutionise the healthcare industry and provide better care for all.