Vukosi Sambo

(South Africa) Digitalization creates large-scale and sweeping changes across economies, industries and business  operations and public policy. One sector that is being disrupted significantly is the healthcare  sector, with the healthcare system look very different in future than it is currently. Technology  developments offer a unique opportunity to transform this industry in a way that will create and  capture value and solve most of the structural challenges of the industry both globally and at a  country level. 

South African healthcare dynamics are largely characterized by low patient coverage, limited access,  skills shortage, unaffordability, and disempowered consumers. There are multiple reasons for this  state of the sector, most of which are macro-economic and social in nature, reflecting deep rooted  structural and historical challenges. 

With just over 8 million (under 14%) of the 59 million estimated population covered under medical  aids, much of the population remains without private health cover. This, combined with the 42%  high unemployment rate according to the expanded definition that includes discouraged job seekers  that has been worsened by Covid 19, clearly demonstrates the enormous burden exerted on the state  to provide quality healthcare cover to much of the population. While acknowledging the need to  address these structural factors, this article primarily focuses on the role and impact that digital  transformation in healthcare could mean for the South African healthcare system. 

The current healthcare dynamics manifest themselves in the form of high cost and low access  resulting from information asymmetry that exists between the consumer, funder, and health  provider. This results in a provider induced demand. Four main areas of impact from digital  transformation of the healthcare industry are briefly explored that springs some hope to the future  of our healthcare system. These are tech-empowered intelligent care, care anywhere, empowered  care and intelligent health enterprise. Implementation opportunities and challenges are summarized  based on funding, people, process, technology, and data related factors.

1. Intelligent Quality Care

Advances in the use of wearables, facial recognition, precision medicine, robotics and medical  printing will significantly accelerate the quality of care in a historically low diagnostic environment.  This will enable early intervention and better health outcomes. Use of wearables remains low at  7.2% penetration, equating to 4.3 million users. While this reflects a 22.9% increase year on year, the penetration remains relatively low and could derail the benefits of a consumer centric care that is driven by data opportunities that this carries. The independent Communication of South  Africa reports a 91.2% smartphone penetration. This provides the greatest opportunity for the role of  facial recognition in innovations such as emotion detection, exercise apps that could improve  lifestyle driven care. Use of robotics is likely to remain low given the expected low infrastructure  investment of a strained state fiscus. 

One promising discovery was the transplant surgery, successfully performed by Dr. Tshifularo and his  colleagues in South Africa, takes Hirsh’s work one step further. It is the world’s first middle ear  transplant using 3D-printed bones: It effectively replaced the hammer, anvil, and stirrup – the  ossicles that make up the middle ear. Using 3D printing technology, the medical team was able to  print these bones and reconstruct the ossicles in surgery.

2. Care Anywhere

Covid 19 has accelerated the adoption of virtual care. This brings care closer to home and works to  resolve access challenges for people that historically have not had access to a health provider within  reasonable radius. There exists limitations of technology infrastructure and data costs to this enabler  that may slow utilisation. Collaboration between telecommunication companies and health insurers  has seen some increased utilisation of virtual care to 100 000s in the wake of Covid 19. This is  indicative of good adoption and well-engineered process that is supported by world class  technology.  

3. Empowered Care 

Liberate data sources in compliance with data laws to clarify that patients are the ultimate owners of their clinical data and  facilitate the transfer of this data between providers, according to the patients' wishes. This will  drive a better electronic health records system and result in significant improvement in health  outcomes. This will need to be a policy driven intervention that requires careful considerations on  data standards and infrastructure. Central to improving efficiency to delivery of care is correcting the  information asymmetry that stems from disempowered patients. The main challenges will be the  time it may take to achieve the statutory changes. This shift is instrumental to achieving high levels  of trust with patients, the main ingredient of the sustainable adoption of data privacy practices and  laws. Key to the implementation is the creation of a central health identification system that is  integrated to insurers that currently house the disparate patients records and enables the patient to  transfer the data between various providers. 

4. Intelligent Health Enterprise 

The successful health enterprise of the future will be one that integrates all these solutions with a  quality provider network solution to provide a data-driven solution. This enterprise will succeed in  dismantling the non-macro and socio-economic challenges to create a health balance between the  

patient, the funder, and the health provider. The result of this will be better information symmetries  and will drive costs down, thus enabling greater access. This data driven patient centric solution will  also achieve a better understanding of what could be an optimised routing experience for patients that delivers better health outcomes in the most effective route and channel. 

While it is hard to accurately estimate how these factors will improve the low 8 million access, there  is a strong argument that this will achieve high affordability that will likely see better coverage for the  employed population. Much of the unemployed will continue to rely on state for care, but this may well enable the provision of care by state a greater reality than in the current climate. This at large  reflects the great opportunities and hope for the healthcare system for enterprises and policy  makers. 

 

Vukosi Sambo is an experienced executive with over 11 years’ experience in insurance, banking, FMCG and Market Research.  He is an expert specialist in data science, digital strategies, risk management and actuarial, business architecture, consumer research and insights, remuneration design, and operations management. He currently serves as the Head of Data Solutions at Medscheme, a leading South African health insurer with estimated over 3 million lives under administration.

Prior to Joining Medscheme, Vukosi served as Chief Data Officer at Kaelo, held senior roles in Discovery Bank, SAB, Nielsen and Discovery Health. He has won several awards including 2020 Global Top 100 Data Visionary. His background includes studies in Bachelor of Economic Science (Wits), Post Graduate Program in Artificial Intelligence from University of Texas (USA), Post Graduate studies in Risk Management (Unisa), Post Graduate Diploma in Business Administration (Unisa), Post Graduate Executive education in Digital Strategies for Business (Columbia Business School, USA), Certificate in Lean Six Sigma (BMGI University, USA) and Certificate in Advanced Forecasting for Data Analysts (Adcorp Analytics). He is currently studying towards MBA with Unisa SBL. He is a comrade marathon, two oceans marathon and Soweto marathon finisher.

 

Reference Material- CDO Magazine- Vukosi Sambo- Healthcare Digital Transformation

 

Medical Aid Membership- South Africa. Council for Medical Scheme Annual Report- Page 280 & 281

https://www.medicalschemes.co.za/publications/#2009-3506-wpfd-2019-20-annual-report

South African Population Statistics- Statistics SA

http://www.statssa.gov.za/?p=13453#:~:text=South%20Africa's%20mid%20year%20population,%25)%20living%20in%20this%20province.

Unemployment Rate- Expanded definition

https://tradingeconomics.com/south-africa/unemployment-rate

Digital Wearables Statistics- 2019 & 2020

https://www.statista.com/outlook/319/112/wearables/south-africa

Smartphone Penetration- South Africa- ICASA Annual 2020 Report (Page 33)

https://www.icasa.org.za/uploads/files/State-of-the-ICT-Sector-Report-March-2020.pdf

Virtual GP Consultations

https://businesstech.co.za/news/technology/386837/discovery-and-vodacom-are-now-offering-free-online-doctor-consultations-to-all-south-africans/

Professor (Dr.) Mashudu Tshifularo- World first Ear Transplant, University of Pretoria

https://www.up.ac.za/news/post_2750323-up-academic-pioneers-worlds-first-middle-ear-transplant-using-3d-printed-bones