Picture: iStock
Picture: iStock

Healthcare start-up firm Alignd is taking aim at medical schemes’ limited provisions for palliative care for cancer patients, and is offering the industry a new managed care model it says will save money and give patients a greater say in their end of life care.

Palliative care has traditionally been viewed as care that is provided in the final weeks of a person’s life, but it can in fact be provided far earlier during the course of a terminal illness. It aims to provide holistic care to patients that considers physical, emotional and spiritual needs, and can be provided at home or in a facility.

However, the Medical Schemes Act’s prescribed minimum benefits (PMBs) create a perverse incentive for end of life care to be provided in a costly hospital setting, as schemes are only obliged to provide 14 days of palliative care for terminal illness, said Alignd co-founder Linda Holding.

PMBs are the minimum basket of care that all schemes must provide to their members, regardless of the benefit option they belong to.

“Most patients want to die at home, but most unfortunately die in hospital,” she said. International research showed between 65% and 70% of patients expressed a wish to die at home: in SA, between 65% and 75% of patients using private healthcare died in intensive care or high care units, said Holding.

About 8% of medical scheme expenditure is directed to the last year of life, equivalent to an estimated R11.6bn in 2017, said Holding.

Alignd co-founder Shivani Ranchod, who is also CEO of health consultancy Percept, said Alignd had applied to be registered as a managed care organisation with the Council for Medical Schemes, and was in talks with medical scheme administrators and several self-administered schemes.

Alignd’s model centres on a concept called “value-based care”, which links doctors’ remuneration to the quality of care they provide to their patients, rather than simply paying them a fixed fee for each service they provide. It also encourages palliative care outside a costly hospital setting.