South Africa’s first funded digital therapeutic for mental health, offering internet-based Cognitive Behavioural Therapy (iCBT) to support the treatment of depression, is officially online.
Soft-launched to Discovery Health Medical Scheme (DHMS) members at the end of September, the medical scheme introduced its new health app to the media yesterday, highlighting three “hero” features: “Speak to a Doctor Now”, “Virtual Physical Therapy”, and “Digital Therapeutics for Mental Health”.
Sharing some alarming mental health statistics at yesterday’s media briefing, Dr Ron Whelan, the deputy chief executive of Discovery Health, said Discovery is not only seeing a rising prevalence across the medical base but also in life insurance.
“There is a 13% increase in Discovery Life insurance claims for suicide in 2022. The frightening thing is that when you break that statistic down, you notice that the higher rates of suicide in life insurance claims are in the younger population below the age of 30 (+149%) and people between the ages of 31 and 40 (+50%). We felt quite a strong sense of obligation to do something about this, and it is really one of the major premises of the app,” Whelan said.
Quoting statistics from the World Health Organization, Dr Ryan Noach, the chief executive of Discovery Health, said that globally, one in eight people were living with a mental disorder pre-Covid-19, and many data sources show that these rates have increased significantly, by up to 25% since the pandemic.
“South African trends align to these global mental health trends, with the prevalence of mental illness in DHMS members having increased by almost 20% relative to the pre-pandemic period. Mental illness now affects more than 13% of all scheme members – effectively one in six members is living with mental illness and registered for treatment.”
Noach said the most diagnosed mental illness is depression, representing 60% of all cases, with depression also growing in prevalence faster than any other mental health condition.
“Sadly though, the majority of people around the world do not prioritise their mental healthcare. One in three people in South Africa experiences a mental health issue, yet unfortunately only 1 in 10 of these accesses any form of treatment.”
Digital therapeutic – or DTx – is available to members aged 18 years or older who live with a diagnosis or symptoms of depression. The service is provided in partnership with SilverCloud by Amwel, a globally leading and clinically validated digital behavioural health and well-being platform. iCBT must be prescribed by a health professional (GP, psychologist, or psychiatrist) and is funded from the scheme’s risk pool, on the Mental Health Care Programme.
Described as a subset of digital health, DTx entails evidence-based therapeutic interventions driven by high-quality software programs to prevent, manage, or treat a medical disorder or disease. This new class of therapy registered with the South African Health Products Regulatory Authority.
Whelan said DTx was not just an app but a clinically validated therapeutic product.
“The assessment includes a mental well-being assessment with questions that allow you to diagnose and monitor mental health issues over time.
“What we’ve also done is we have built a risk evaluation algorithm that takes a range of datasets from a members’ healthcare behaviours. The predictive model helps to determine the level of risk, all the way from low risk to severe risk. And we’ve designed a comprehensive set of mental health benefits, mental health programmes, to help members in those categories as cohorts to manage their condition better,” Whelan said.
Speak to a Doctor Now
Another market-first digital healthcare innovation is the “Speak to a Doctor Now” feature.
Dr Sivuyile Madikana, executive assistant to the deputy chief executive of Discovery Health and product owner of “Speak to A Doctor Now”, said that according to the scheme’s data, members were going to emergency rooms for low acuity cases or minor ailments between 4pm and 7pm.
“Now we see the spike across emergency departments across the country. And this coincides with the time that GP rooms are closed, so members don’t have immediate access to their healthcare needs. The ‘Speak to a Doctor Now’ feature really answers this question around almost immediate access to speaking to a doctor. With the experience that we’ve had in the last month, we found that within 90 seconds calls are answered by the doctors,” Madikana said.
To man these digital doctors’ rooms around the clock, the scheme partnered with a group of emergency room doctors from ER Consulting Inc (ERC). Through the ERC emergency support call centre, these doctors can facilitate an immediate consultation, a treatment plan and, where necessary, scripted medicine.
Whelan said the online doctor panel is staffed to enable instantaneous access to care.
“We flex the capacity of a panel up and down, depending on the demand that’s required to make sure that we’re meeting our customer commitment of near-instantaneous access to doctors … and it is entirely scalable, so we’re able to add doctors in an unlimited way depending on how demand manifests. The system is also designed to cope with high volume loads, and we pressure-tested the system in high demand volumes so that user experience remains consistent. The system stays stable.”
For urgent care, the feature is funded through a dedicated new risk benefit. Non-urgent care is funded from members’ day-to-day plan benefits. The health provider decides which is which during the consultation.
Whelan said the scheme does not have a specific urgent-care or non-urgent care list, but it is left to the discretion of the treating provider.
“Loosely speaking, anything that can wait until the next day would be non-urgent care. Anything that needs immediate treatment, whether that be any form of pain, or any form of your controlling infection, could be classified as urgent care. Typically, our emergency room providers know the difference between urgent-care and non-urgent care, and certainly will be able to guide members in that direction.”
Whelan said there were preferential rates across this channel given the efficiencies DHMS was able to derive. He added they were trying to keep the platform’s market rates consistent with that of the face-to-face market.
“We certainly don’t want to disintermediate our general practitioner colleagues and friends through this process. The system is really designed for service when your GP is not available, or your doctor is not available, but it does come at a slightly preferential rate to what you would be paying in a general consult,” Whelan said.
Virtual Physical Therapy
Provided in partnership with Genie Health, the “Virtual Physical Therapy” feature gives members access to in-app support for their prescribed physical and rehabilitation programme, making it the first monitored virtual Musculo-skeletal platform in the country.
While doing the rehab exercises, the patient’s movement is tracked using computer vision through their device camera. An artificial intelligence engine is applied which ensures that the form is correct, to ensure maximum benefit from the home exercise programme.
Patients also have access to remote monitoring and coaching for better recovery outcomes through virtual consultations or through the available in-app-chat functionality.
“Evidence shows that only 50% of patients adhere fully to their home recovery exercise programmes,” Noach said. “Available evidence demonstrates that ongoing daily support to comply with a rehabilitation programme and prescribed exercises significantly improves recovery.”
The new health app is currently only accessible for medical scheme members., Discovery says it will be made available to their additional financial services customers “in due course”.
THIS IS AN EXCELLENT INITIATIVE, BUT I WOULD ALSO RECCOMMEND THAT MEN ESPECIALLY DIAGNOSED WITH DPERESSION SHOULD CONSULT AN ENDOCHRONOLOGIST TO HAVE THEIR TESTOSTERONE LEVELS CHECKED, AS LOW LEVELS OF IT CAN BE CAUSED BY CHRONIC STRESS WHICH CAN BE REMEDIED USING HOMEOPATHIC MEDICATION, RATHER THAN SO-CALLED ANTI-DEPRESSANTS.