Why is managed care necessary?
Managed healthcare is often seen in a poor light by healthcare professionals. Most often, managed care is associated with limited therapeutic choices and reduced access to care, in the drive to cut costs.
The CDE care programmes are different. The CDE programmes are fully comprehensive, best-practice baskets of care that provide healthcare professionals with more clinical autonomy, and greater access to appropriate therapeutic options for patients.
The principle of the CDE programmes of care is to manage diabetes as best as possible, from a clinical point of view, and thereafter reap the financial benefits of reduced emergency diabetes hospitalisations, and reduced diabetes complications. We focus on managing the clinical risk, patient by patient.
Diabetes is usually managed sub-optimally
Typically, diabetes care outside of the CDE managed care environment is sub-optimal. Recent reports by the non-profit organisation Health Quality Assessment (HQA) demonstrate levels of servicing that are well below expected, and hoped-for, standards of care.
For example: diabetes guidelines recommend that all patients with diabetes should have an HBA1c test performed at least twice per annum. The results shown here by the HQA report indicate that more than 50% of people with diabetes do not have an HBA1c test performed at all.
The unfortunate reality is that the sub-optimal treatment of diabetes creates a false impression of the true costs of diabetes. Some medical aid funders cannot see past the fact that on a day to day basis, diabetes may be cheap to fund – if services are not provided, funding is not needed! They ignore the fact that poorly controlled diabetes leads to expensive hospitalisations and costly down-stream complications!
Importantly, many medical aid funders DO recognise the importance of best-practice care. These medical aids have partnered with the CDE to ensure best possible health outcomes for their beneficiaries with diabetes.
Delivery of Care
The CDE contracts with medical aid schemes, to provide diabetes care. Members of these schemes have the opportunity to join the CDE programmes at no cost, and when services are provided, there are no co-payments that are applied.
Care is delivered via the CDE Diabetes Excellence Network – an up-skilled and accredited network of healthcare professionals providing co-ordinated care to patients. The CDE programmes of care ensure that patients receive best possible care, based on recognised diabetes guidelines. Importantly, for patients on the CDE programmes of care, healthcare professionals are not confronted by the same restrictions on therapeutic options. Best clinical practice is applied at all times.