Value-based care in Africa: a myth or model for the developed world?

Profit-based healthcare systems have thus far been unable to find a sustainable model for global healthcare equality. This has become more apparent as international entities struggle to achieve universal healthcare coverage (UHC)under the UN’s 2030 sustainable development goals (SDGs).

In established healthcare systems, the transition has been slow. There has been resistance among some healthcare providers to move away from service-based profit models, especially in the pharmaceutical industry. Additionally, such a transition is complicated by the numerous small steps that are required to redevelop various parts of complex supply chains.

KimboCare’s founders believe the answer lies in emerging economies. In such countries, healthcare systems are still developing and thus ripe for new healthcare technologies. Their blockchain platform is just one example of how an end-to-end data solution is addressing the need for digital infrastructure while also creating a value-based care model in their pilot African countries. You can read more about their project here.

Their project and many others highlight how innovative technology already exists for implementing value-based healthcare. Below we discuss the need for value-based care and present examples of successful campaigns being implemented in African countries.

Fee-for-service (FFS) versus value-based care (VBC)

Traditionally, the argument has been that profit enables providers to give better quality healthcare and employ more medical services. However, this perpetuates the concept that people must continuously use medical services and that costs must gradually increase to maintain profit growth. However, history has shown this model to compound the issue of affordability and accessibility.

The WHO reported that households spending more than 10% of their budget on out-of-pocket healthcare costs increased from 9% to 13% from 2000 to 2015. In sub-Saharan Africa, out-of-pocket payments account for more than 30% of costs.

This is compounded by the pharmaceutical focus on profitability as well. Harvard Business Review, reported price rises of 2,800–5,000% in certain medicines and called for generic medicine to be the more important goal.

Such expensive services have become inaccessible for many people. Healthcare is becoming a luxury for the rich few. Today, these healthcare inequalities exist in both developed and undeveloped countries alike. In Africa, costs stop as many as 38% of the population from seeking healthcare.

Discovery, which launched a shared-value insurance model in South Africa, wrote that “fee-for-service is contributing to the rising costs of healthcare which everybody agrees is currently unsustainable.”

They reported that a system that emphasizes volume over value presents several issues:

- It encourages profit rather than optimal health

- There is little incentive to reduce costs or even measure cost as a goal for improving

- It rewards bad and duplicate services rather than healthcare that is efficient, quick, and high quality.

In contrast, Deloitte reports that value-based systems can improve future financial security and reduce costs. Value-based systems boost revenue by improving quality, utilization, and costs for society as a whole.

The need for value-based care is now

Innovators and analysts agree that the transition to value-based care (VBC) is key to achieving healthcare equality. This means systems need to transition from profit and volume-based metrics to patient-focused outcomes. We get a small glimpse into the success of such campaigns in efforts to eradicate diseases, such as polio.

More recently, Covid-19 highlighted additional weaknesses of current fee-for-service (FFS) healthcare models. Delayed care and fluctuating requirements almost collapsed healthcare systems around the world. 

VBC can achieve the opposite effect. As Harvard Business scholar Michael Porter says: “In healthcare, the days of business as usual are over.”

Michael Porter describes a six-point plan for transitioning to VBC:

- Standardize units of measurement

- Costs and outcomes must be measured for each patient

- Switch to bundled payments

- Optimize care delivery across stakeholders

- Scale across populations

- Build facilitating technology platforms

In African countries, many of these elements are easier to implement because of the absence of developed healthcare systems. As such, African healthcare systems are especially ready for new technologies.

Can Africa be ahead of the VBC game?

Financing and healthcare quality are huge barriers to improving healthcare access in sub-Sahara Africa. Although the region makes up almost 20% of the world’s population and accounts for a quarter of global diseases, it receives less than 1% of global health expenditure. This makes the region ripe for data collection and healthcare investment.

As data increasingly becomes a hot commodity, several companies are working towards monetizing healthcare data through patient-centric initiatives. Blockchain technology has been pivotal in creating platforms that can collect a patient’s data from various healthcare providers, then giving patients control over who can access their data. Some blockchains programs include incentives and tokenized reward systems to boost patient engagement and healthcare outcomes.

Longenesis has been a leader in monetizing healthcare in African regions. Their platform combines AI and blockchain technology to allow the storage and exchange of data between patients and enterprises. Africans can choose to monetize their own data, which in turn attracts more healthcare investment into their region. This can also greatly boost important medical research initiatives and trials.

For example, Ribbon’s Public Health Incentives platform aims to improve both public and clinician behavior by incorporating a review and reward system. It pools donor money into a cryptocurrency system, which is distributed to patients and healthcare providers for accomplishing set activities, such as HIV testing or adhering to quality standards.

Similarly with CareAi, blockchain is used to store and distribute data from machines that anonymously diagnose users for diseases that have social stigma, such as malaria and typhoid fever. By using smart contracts, patients can opt to share this anonymous data, which is bought by government agencies and enterprises using tokens. These tokens are reinvested back into the machines and healthcare NGOs, benefiting the population.

Aggregated data is the underlying key to building a value-based care model. KimboCare’s platform combines data from all stakeholders, including patient reviews, to make healthcare providers accountable. This aggregated data also highlights where healthcare quality can be improved. Their use of “health tokens” additionally incentivizes providers to focus on the quality of care rather than repeat services. Today, they have more than 20 medical providers dedicated to this VBC model.

Another successful project was the implementation of the mobile healthcare platform M-TIBA in Kenya. This patient-centric platform connects patients directly with healthcare providers, while also facilitating mobile-to-mobile payments. It collects a huge amount of medical data in areas where such data typically doesn’t exist.

KimboCare: achieving health access equity through VBC

KimboCare realizes the importance of technology in achieving VBC goals. Their healthcare platform sets out to achieve the principles of VBC in several ways:

- An end-to-end digital solution avoids data siloes that typically prevent transparency and get in the way of achieving VBC.

- The interoperable platform facilitates integration with other existing systems.

- Standardized data and repeatable processes help drive scale and health impact.

- Metrics and KPIs are defined across the entire healthcare supply chain, from the delivery of care to patient outcomes. 

- Costs are trackedthrough “health credits,” which enable the traceability of purchased care bundles, services delivered, cost of care per patient, andpayments between relevant stakeholders.

- Patient reviews and engagement are used as metrics to ensure healthcare quality.

- Real-time data enables a quick reaction and reallocation of resources when needed.

Through several healthcare campaigns, KimboCare’s platform has proven how data and value-based models can improve healthcare access and quality, which we look at below.

Embedding VBC key principles with medical providers’ engagement

The key principles of VBC guide how KimboCare works with medical partners. The components of KimboCare’s medical care are measured by:

- the health and wellbeing of a patient rather than services rendered.

- patient engagement and feedback, which is an important component to make sure that value is delivered as promised to clients and patients. 

KimboCare’s medical partners are naturally incentivized by the fact that there is a limited source of health credits (as opposed to an insurance based fee-for-service claim system). Providers must deliver the best care possible with such a limited source of financing.

Besides benefitting patients, integrated digital systems are also key for medical providers to improve the delivery of care. Clinicians can better monitor their patient’s health, communicate and share progress with other stakeholders, and contact patients for both preventative check-ups and necessary treatments.

How blockchain can propel the effects of VBC in Africa

Blockchain is a cost-effective way to gather data and implement value-based solutions for millions of patients. This is because it has a high capacity for data collection, secure storage, aggregating data, and automating analyses to provide real-time insights.

More specifically, Blockchain technology has been pivotal in creating platforms that can collect a patient’s data from various healthcare providers, then giving patients control over who can access their data. Some blockchains programs include incentives and tokenized reward systems to boost patient engagement and healthcare outcomes.

KimboCare’s blockchain technology is an example of how to facilitate the deployment at scale of a VBC model by providing:

- an end-to-end digital platform

- end-to-end coordination of care across various stakeholders 

- patient participation in improving care management

- traceable delivery of care 

- interoperable and integrated system interfaces

- the same level of care with the same or less money

- payments to partner providers made on the basis of data-driven metrics (some related to population health)

This was highlighted in a recent healthcare campaign. KimboCare was able to help a corporate client achieve their aspirations to boost access to quality healthcare. The campaign offered free screening for hepatitis through associated medical providers in Douala, Cameroon, reaching hundreds of patients. More than 25% of patients were pregnant women, empowering them to lead healthier pregnancies and protect their unborn children.

The role of data in VBC and reducing wastage

Some 25% of healthcare spend in the US is unnecessary or wasteful, equaling almost a trillion dollars. Healthcare waste is up to 40% in some other countries. Monitoring data boosts profitability by finding ways to increase access and service utilization, while reducing waste and inefficiency. 

Another notable issue when it comes to Africa is the disparity of health workers and poor distribution of resources. The WHO estimates one doctor per some 3,600 people in Africa compared to one doctor per 230 people in Europe. 

Tracking financial and health data enables leaders to identify areas where economies of scale can be leveraged to reduce costs and increase resource utilization. This is especially important for boosting accountability, which is vital for organizations seeking to drive healthcare access at large through ESG investments, public money, donations, or grants.

However, a significant challenge behind reducing costs and allocating resourcesis the lack of aggregated data; only half of the world’s countries publish these metrics.

Many countries do not have the capacity for systematic monitoring of the quality of care. This creates blind spots for policy maker when deciding how and where to effectively allocate resources and reduce wastage and costs or for organizations when seeking to introduce new products to those markets.

This is why KimboCare believes that data is one of the first factors to address when creating value-based systems. “Without adequate data, it is harder for healthcare systems to better identify key areas for lowering costs and improving services. A robust and standardized IT structure will be key to achieving a full pivot of the system.”, comment the founders.

This was the inspiration behind KimboCare’s centralized data platform, which aggregates data from all healthcare stakeholders to measure quality and gaps in the delivery of care. Can such aggregation lead KimboCare to become tomorrow’s Amazon for Healthcare? Time will tell.

Conclusion

VBC models will be vital to achieve universal healthcare. Current pilot programs in Africa, such as KimboCare’s healthcare platform, are proving that technology will be key to achieve the transition. Data will especially be important to reduce costs while boosting healthcare quality and access. 

With the power of blockchain technology, KimboCare’s model illustrates how value-based incentives can bring Africa (and beyond) closer to achieving healthcare access for all.