Alignd, an all women-led fintech start-up, aims to bring alternative and affordable healthcare models to the South African market.
With an intention to provide alternative, more patient-centred and value-led healthcare models to the country’s medical schemes, Alignd is the brainchild of three South African women Dr Linda Holding, a palliative-trained doctor with 20 years of clinical risk management experience; Victoria Barr, a healthcare economist and Senior Director at FTI Consulting; and Shivani Ranchod, a healthcare actuary and academic.
Their starting point? One of the most emotionally- and financially-challenging areas of the healthcare system: palliative, end-of-life care for metastatic cancer patients
“Using a combination of innovation, data analytics and a desire to bring the patient’s life to the fore, we believe we have a model that benefits all stakeholders and incentivises them to collaborate for the greater comfort of the patient and their wellbeing,” Ranchod said.
Metastaticised cancer among South Africans absorbs a disproportionately high percentage of funding from medical aids. The most recent estimates indicate that 8% of scheme expenditure is in the last year of life – a staggering R11.6 billion in 2017 alone.
In 2012, cancer was South Africa’s fifth leading cause of death, causing 8.7% of all deaths, according to the South African Medical Research Council. (Ref: Africa Check: “Analysis: is cancer a white people’s disease in South Africa?” By Dr Patrick Ngassa Piotie. December 2017.)
The current focus of end-of-life care for metastatic cancer patients is on curative care and mostly in a hospital setting making it hugely expensive and geared to manage the patient’s medical costs in the final stages of their life.
“In current medical scheme approaches, healthcare costs in the last year of life are more than three times higher than in the second last year. This ramping up of cost represents the huge efforts to stave off death, efforts that are often invasive and non-beneficial,” said Alignd Director Shivani Ranchod.
By definition, palliative care is care given to improve the quality of life of patients with a serious or life-threatening disease such as cancer. It is an approach that addresses the person as a whole, not just their disease. The goal is to prevent or treat, as early as possible, the symptoms and side effects of the disease – and the treatment being given – in addition to related psychological, social, and spiritual problems. Patients can receive palliative care in a hospital, an outpatient clinic, a long-term care facility or at home.
As medical aid models for end-of-life care currently stand the patient’s medical scheme will pay for costly in-hospital care but won’t pay for home-based care.
Alignd has developed an opportunity for patients to have meaningful conversations about the end-of-life, to document their preferred place of care and death and to have access to palliative care delivered by a multi-disciplinary team.
“Atul Gawande’s in his book ‘Being Mortal’, talks about hospital-centric and aggressive treatment options at the end of life as a symptom of modern medical philosophy,” Ranchod says.
“There is little financial incentive or pressure for doctors to consider alternatives. A key moment in Gawande’s book is a discussion of a study where patients with complex and high-risk diagnoses had a consultation with a palliative specialist. The results were astounding – patients made dramatically different choices, costs came down and both the patient and their families reported higher levels of satisfaction.
“If the solution is as simple as a conversation, what are we waiting for?,” Ranchod concluded.
The Alignd model brings to the healthcare system a carefully-constructed set of basic operating principles: a multi-disciplinary team naturally means that collaboration between role players lies at the heart of the business. It is also one that Alignd believes will be less costly to medical schemes.
Being new means that innovation is key and Alignd conceptualises innovative solutions to deeply complex problems and delivers on those solutions. Finally, the solution offered explicitly addresses the need to build trust between funders of healthcare and those on the frontline delivering care.
Making palliative care more accessible isn’t easy. In developing their healthcare model Alignd has grappled with a complex system and answers a host of difficult questions: How do we build trust between funders of healthcare and those on the frontline delivering care? How do we enable co-ordinated care and teamwork in a fragmented system? How do we make sure that the nexus of the system is the patient?
Ranchod believes that Alignd’s revolutionary approach to end of life healthcare can be applied to patients and healthcare providers outside of South Africa as well.