Patient Driven Care

A HELPING HAND FOR HIGH RISK MEMBERS

Like you, Resolution Health is dedicated to assisting its members in their efforts to stay as healthy as possible, for as long as possible. Testament to this commitment is our industry first Patient Driven Care™ (PDC™) programme, which is Resolution Health’s unique way of offering additional support to those members who sometimes need a helping hand when it comes to taking care of their health.

A next generation managed care model, PDC™ manages the entire risk profile of patients, from primary to tertiary clinical intervention. While this is in stark contrast to the traditional disease-specific approach, PDC™ consistently delivers superior managed care results. 

Take the recent Health Quality Measurement (HQA) statistics that represent 77% of total industry beneficiaries as example:

 
 

 

PDC™: A dynamic approach to chronic disease management

We work in close partnership with you to track your patients’ journey to wellness through risk profiling. By monitoring your patients’ adherence to medication and treatment, we ensure the optimum management of their condition. Our unique risk rating technology uses evidence-based disease algorithms and protocols to accurately risk rate members.

Follow-up calls and individualised patient care paths allow our Personal Health Coordinators to intervene when a member’s risk rating changes. They will then refer the member to their doctor for timely follow-up care, enabling us to proactively prevent any unforeseen relapses, complications and unwanted hospitalisation.


Initial member visit for diagnosis

As a service to you, the initial member’s visit for diagnosis will be paid from risk and not from normal day-to-day benefits. To facilitate the management of their disease condition, PDC™ members need to request an authorisation number upfront before any doctor’s visits (PMB conditions), additional tests or services are undertaken. Additional services will be funded in justifiable circumstances on receipt of a motivation letter from yourself. Extended chronic medication automatically pays from the allocated benefit and is option specific. Once depleted, members need an authorisation from the pharmacy for additional medication. 


Our dedicated Personal Health Coordinators

Our Personal Health Coordinators are on hand to help members maintain a healthy lifestyle and adhere to their treatment plan. They track every PDC™ member’s progress in terms of their medication, doctor’s consults, rehabilitation goals and health services. They also provide education and advice to members by advising them on appropriate diet, exercise and lifestyle choices in consultation with their treating doctor. This is a decision support programme and assists members to timeously visit their clinicians. Clinicians may request data on, for example compliance, to better assist patients with treatment choices and education.


Screening / preventative benefit

Members on our Supreme, Millennium, Millennium Select, Progressive Flex and Progressive Flex Plus options have access to a Preventative Care benefit which covers basic biometric tests such as blood pressure, blood sugar, cholesterol and Body Mass Index (BMI) which can be done at any GP or Pharmacy (Medi-Rite, Clicks and Dischem). Our Foundation members can receive this benefit via their extensive Designated Service Provider (DSP) network. 

Please encourage your patient to submit their results to their Personal Health Coordinator to help them accurately monitor their condition and assist with their treatment plan. 

If you have any unanswered questions, please get in touch with us on 0861 111 778 or pdc@resomed.co.za.

To join a reliable health scheme that has your best health interests at heart, be sure to take a look at Resolution Health’s options here