Alignd is the brainchild of 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. Its main intention is to provide alternative, more patient-centred and value-led healthcare models.

Metastaticised cancer in South Africa 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 R11.6bn in 2017 alone. The current focus of end-of-life care for these 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,” says Ranchod.

“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,” she says.

Collaboration encouraged

“Atul Gawande’s 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,” she says.

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 will be less costly to medical schemes.