Centres of Excellence
to provide members with

quality healthcare and
enhanced cover

One of Discovery Health Medical Scheme’s key strategic priorities is to drive value-based healthcare, a delivery model placing members at the centre of care. In such a model, providers are reimbursed based on health outcomes rather than inputs. This ensures that health results are prioritised over the volume of services delivered, giving members access to facilities, programmes and providers that are committed to continuous improvement in quality healthcare. This approach also encourages healthcare providers to collaborate in providing holistic, high-quality patient care to members.

In 2017 DHMS introduced two Centres of Excellence, the Major Joints Network and the Specialised In-Hospital Psychiatry Network. The widespread adoption of the Major Joints Network by both healthcare professionals and members is evidence of its success with over 95 participating Centres of Excellence, 340 surgeons, full coverage for over 90% of Scheme members and improvements in clinical outcomes. 

In a similar way, the national coverage afforded by the In-Hospital Psychiatry Network ensures that members admitted for mental health reasons receive treatment in facilities with access to specialist psychiatrists and psychiatric facilities, with full coverage.

Building on this success, for 2021 Discovery Health Medical Scheme is introducing two new initiatives to improve outcomes for colorectal cancer surgery and spinal care.

Improved clinical outcomes for colorectal surgery

Colorectal cancer is the third most prevalent cancer and every year affects over 3 200 members on Discovery Health Medical Scheme.

The treatment regime for colorectal cancer may often include surgical intervention, the success of which has a significant impact on the survival rate of colorectal cancer patients.

Discovery Health Medical Scheme funds more than 900 colorectal cancer surgeries each year. There are a number of hospitals where surgeons routinely perform colorectal surgery, with statistical evidence of lower mortality rates and improved survival rates in these high-volume hospitals.

Introducing Centres of Excellence for colorectal cancer surgery

Discovery Health Medical Scheme is introducing a network of Centres of Excellence for colorectal cancer surgery in 2021.

The network provides members with a number of benefits:

  • The network includes hospitals where surgeons routinely perform colorectal surgery with improved clinical outcomes.
  • Participating hospitals, surgeons, aneasthetists and physicians have been contracted to the network based on the  clinical outcomes, to ensure quality of care for members.
  • Members enjoy full cover for surgery in the network, which applies to all DHMS plans.
  • Doctors benefit from bidirectional information sharing through a Colorectal Cancer Record, which will create the first Colorectal Cancer Registry for South Africa.
TECHNICAL DETAILS
  • Colorectal Cancer Surgery Network will be applicable to all DHMS plans.
  • A clinical exceptions process will apply to approved and clinical appropriate surgeries to be performed outside of the network.
  • This network will not apply to emergency and trauma-related surgeries.
  • The Colorectal Cancer Surgery Network list will be available in January 2021.

Introducing the spinal care programme and spinal surgery network

Back pain is one of the most common reasons why people miss work, visit the doctor, or stop exercising. Locally and internationally, evidence points to early conservative treatment as the most effective for back pain, and reduces the need for invasive treatments such as injections or surgery. Where surgery forms part of an effective regime of conservative treatment, outcomes are significantly better when compared to spinal surgery that does not form part of a broader treatment plan.

In 2021, Discovery Health Medical Scheme will introduce a Spinal Care Programme and Spinal Surgery Network which aims to improve the outcomes of back treatment for members of the Scheme.

 Spinal Care Programme

The Spinal Care Programme is a coordinated out-of-hospital conservative treatment programme for back pain. Access to the benefit requires referral from a spinal surgeon and includes access to:

  • A network of physiotherapists that have been trained in the management of back pain supported by a panel of specialist surgeons.
  • Up to 6 face-to-face consultations with an appropriately registered allied healthcare professional, of which two may be virtual consultations, where appropriate.
 Spinal Surgery Network

The Spinal Surgery Network provides members with full cover for approved spinal surgery admissions. The network consists of hospitals, surgeons, anaesthetists and allied healthcare professionals that are contracted to the network on clinical outcomes.

TECHNICAL DETAILS
  • The Spinal Care Porgramme is only available to members on Executive, Comprehensive, Priority, Saver, Classic Smart and Core Plans. Conservative back and neck treatment and surgery is an exclusion on Essential Smart and KeyCare plans except for PMBs.
  • Members using the Spinal Surgery Network will enjoy guaranteed full cover, with planned admissions outside the network attracting a 20% co-payment on the cost of the hospital account (except the Essential Smart and KeyCare Plans where back and neck surgery, except for PMBs, are excluded).
  • The Spinal Surgery Network list will be available in January 2021.
  • This network will not apply to emergency and trauma-related surgeries.