Lessons learned will guide our healthcare future.

As a medical aid scheme, the biggest challenge during the Covid-19 pandemic and subsequent lockdown, was how to continue to honour our mandate to act in the best interests of our members and deliver quality healthcare while keeping the Fund financially stable. This required flexibility, adaptability and, above all else, innovation, as we took a more assertive stance. 

Leadership and courage of conviction was paramount. This included making short-term decisions with the long-term view and sustainability in mind. Our business has had to contend with an ageing membership profile, the increased prevalence of lifestyle diseases, economic turbulence, a defined number of healthcare practitioners and facilities juxtaposed by an increased demand for healthcare services – all impacted by the unpredictability of the extent and impact of Covid-19.

Comorbidity complications

When the pandemic hit, connecting with members and collaboration with suppliers became a priority. The first step was to identify our high risk members in order to put interventions in place to provide support. Our actuarial team estimated these members were around 30% or 215 851 of the Bonitas population. Of these, 30% are based in Gauteng, 19% in KZN and 15% in the Western Cape. 

One of the biggest lessons learned was the impact lifestyle diseases and comorbidities have had on those who contracted Covid-19. South Africans suffering from high blood pressure, diabetes and obesity were and remain, at higher risk. And, if there are one or more diseases simultaneously, the risk of getting seriously ill with Covid-19 increases.

Given the current trends around lifestyle risk factors, we now know we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions from diabetes to heart disease, mental illness and even cancer. Obesity is a second order risk factor that is common to those with chronic diseases. This is why our Managed Care is key. It’s about encouraging and empowering members to take charge of their health and to support them on their path to wellness

Key trends that emerged from a medical schemes perspective were:

• Changes to benefit structures and PMBs due to Covid-19;
• Lower than anticipated investment income as markets slumped;
• Changes in claiming patterns in terms of seasonality and volume, due to the lockdown measures that came into effect; and
• A Consumer Price Index that was lower than previous years. 

Proactive outbound communication became a crucial component of making sure members understood the importance of sticking to the protocols, maintaining their medication regime and eliminating risk as much risk as possible to stay healthy.

We constantly updated the number of detected cases, identified members with comorbidities, broke down positive cases according to age groups, reconciled recoveries as well as outlined costs from pathology through to hospitalisations. 

There was a high level of uncertainty around the level of care that would be required by our members, our projections were:

• 20% requiring hospitalisation (anything from six days in a general ward, eight days in high care and up to 15 days in ICU);
• 5% requiring treatment in ICU;
• 60% requiring treatment at home; and
• 20% being asymptomatic and not requiring treatment. 

Our projected overall Covid-19 costs are estimated at around R340m. 

Interventions put in place

We set up a Covid-19 hub on the Bonitas website where members could access the most updated, relevant, reliable information and statistics. This included a specific call centre with registered nurses ready to respond to any questions or concerns related to the pandemic, provide support and access to updated clinical information from credible resources.  

A WhatsApp self-help platform was launched with a specific Covid-19 option that provides information on everything from symptoms through to treatment, recovery, transmission, costs covered by your medical aid, frequently asked questions, updated statistics on active cases, recoveries and death and a self-screening test.

We also monitored the medicine supply chain and implemented measures between pharmaceutical and courier companies to ensure chronic medication scripts’ validity was increased, according to the revised Government guidelines and delivered to members’ homes. 

Virtual care

Over and above this, during lockdown, South Africans were advised to stay home. We knew that many wouldn’t be able to work, salaries were being slashed, others lost their jobs and everyone was financially stretched. However, staying healthy – especially during a pandemic – was critical. So we took GPs into their homes at no cost, with the introduction of virtual medical consultations, with GPs and other physicians. Then, we joined forces with ER24 to extend this service to be available 24/7 and made it free to all South Africans. 

Access is simple: Download the Bonitas Virtual Care App from the Google Play Store or iStore, register, and book an online consultation with a doctor from the extensive network. 

Workplace support

To support our corporate clients opening up their workplaces, we put structures in place which included offering onsite Covid-19 screening, providing masks and sanitisers, access to nurses to consult and guide high risk individuals or answer health related questions, education through a poster campaign, the production of short informative videos in four different languages, online trauma counselling and referrals to mental health programmes.

The future

Despite the challenges, the Fund remains robust, stable and strong – especially from an investment perspective. 

The changes in healthcare, as a result of Covid-19, are likely to revolve around preventative care and sustaining well-being as opposed to responding to illness. Members need to be at the centre of all the activity, have access to credible information and empowered to make more informed decisions in the management of their treatment. The management of health is critical in containing lifestyle risks and keeping South Africans healthier. 

The future will see everyone involved in healthcare being more agile and adapting to the ever-changing needs of all role players: Providers, members, local government/the Department of Health, through to the procurement of equipment, medicine supply management, use of day hospitals as well as alternative reimbursement models. 

Technology will also play an ever increasing role as will virtual care and we also hope to see public/private partnerships going forward so that we ensure more equitable healthcare for all.  

Lee Callakoppen is the Principal Officer of Bonitas Medical Fund.