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June 2007
MEET THE PROfESSOR
EXPERTS PRaNEET Valodia
Qualsa has a reputation for PRofilE
incredible depth of expertise
QualificaTioNS: BPharm, MPharm, PhD
when it comes to its highly
qualified staff. The two Qualsa ExPERiEncE: Prof Valodia joined
Executives we meet in this Qualsa in July 2002, bringing with
edition of Our Q are certainly him wide-ranging knowledge and
experience in medicine, pharmacy
strong evidence of this. We talk
and pharmacology. Prior to leaving
to Professor Praneet Valodia, academia, he was appointed as
Research and Development an extraordinary professor for his
Executive at Qualsa, and Dylan unique contribution to research in
Moodley, Executive for Qualsa pharmacy and pharmacology. Over
the past 23 years, he has worked
Electronic Benefit Management as a lecturer and researcher in
(QeBM) and Networks. pharmaco-economics, pathology,
pharmacology, health systems
Should you have any questions research, mathematical modelling
of data for medicines (the focus
for them, or wish to discuss
of his PhD), disease management,
their focus areas further, patient education, health-related
you are welcome to contact quality of life assessments, the
them directly or e-mail impact of professional fees on the
talk2me@qualsa.co.za with pricing of medicines, development
of lung perfusion systems and the
your questions and comments.
pathogenesis of lung diseases.
Praneet served as managed
healthcare consultant to a leading
medical scheme for 5 years before
joining Qualsa in 2002. His research
has been published in various
accredited journals and he has
presented his research findings at
32 scientific conferences nationally
and internationally. In 2004 he was
invited to join the honorary editorial
board of the journal ‘Therapeutics
and Clinical Risk Management’.
He also serves on the pricing
committee of the Department of
Health.
lEadiNg THE Way iN HEalTH ouTcoMES
MEaSuREMENT
What is the value that managed healthcare to produce health outcomes information
or health risk management delivers, and which determines the value of the
how do we accurately measure that value? intervention.
How does one reflect the value of wellness?
These are questions often asked by medical Quite often, the challenge starts with
scheme and company management teams. the baseline data, particularly when one
Health Outcomes Measurement is the area considers that the use of ICD10 coding in
where the answers are to be found. billing only became compulsory in 2005.
According to Praneet, health outcomes Praneet and his team have designed and
measurement is far more than simply tested methods that will provide Qualsa
reporting on health data. The two visuals with the ability to report on health
below provide an overview of the process. outcomes. He is also contemplating unique
Described in very basic terms, the process models that will enable the prediction of
starts with measuring reliable baseline data. health outcomes. These models will be
PRaNEET Valodia A specific intervention in turn leads to unique in the local (and even international)
post-intervention data. This data is analysed healthcare industry.
Praneet heads the Research
and Development Department
at Qualsa. He is also PRE- aNd PoST-iNTERVENTioN
chairperson of the Qualsa
drugs and Therapeutics last intervention
committee. What does all this date
mean and how does it translate Date of 1st
into value for Qualsa’s clients? intervention
5 MoNTHS 5 MoNTHS 3 MoNTHS
Baseline Intervention period Post-intervention
1 Jul 05 1 dEc 05 30 aPR 06 30 aug 06
Health outcomes Project overview
i N T E RV E N T i o N
a N a ly S i S
PoST-
BaSEliNE
iNTERVENTioN ouTcoMES
daTa
SERVicE daTa
PROViDER
Probability model
RETRoSPEcTiVE daTa
assumption
EcOnOMic
ModEl
dRugS aNd dylaN MoodlEy
THERaPEuTicS
coMMiTTEE Dylan has developed Qualsa’s
strategic business unit
A key part of Qualsa’s Medicine Risk responsible for real-time data
Management programme is to practise
sound, evidence-based medicine and
exchange. How does it translate
to apply the most up-to-date clinical into value for Qualsa’s clients?
knowledge.
To ensure this, Qualsa established a PRofilE
Drugs and Therapeutics Committee in
2002, chaired by Praneet, and consisting
QualificaTioNS: BSc, BPharm,
of Qualsa’s own clinical staff as well
Masters in Business leadership
as independent external consultants
with expert knowledge of drugs and
ExPERiEncE: Dylan started his career
therapeutics.
in the pharmaceutical manufacturing
industry as a production pharmacist
The panel includes clinical
before moving into the retail
pharmacologists, physicians and
pharmaceutical sector. in 1994 he
professionals with experience in
joined Medscheme and contributed
pharmaco-economics.
to the establishment of Medpharm,
a medicine clearing service, for
Medscheme.
The purpose of the panel is
to review all new and existing
dylan joined Metropolitan Health
drugs for their clinical efficacy,
group (MHg) in 2001 as general
appropriateness and cost-
manager for the gauteng region,
effectiveness, which then forms
servicing the Transmed Medical fund.
the basis of the reimbursement
He has held various leadership positions
policies which Qualsa recommends
such as gM: group Marketing for MHg
to its clients.
and has developed Qualsa’s strategic
business unit responsible for real-time
data exchange.
Praneet is passionate about his current TakiNg ElEcTRoNic
areas of focus at Qualsa: “There has
been much talk about health outcomes BENEfiT MaNagEMENT
nationally and internationally, however, To gREaTER HEigHTS
our investigation indicates that very
little has been done in this area in the
managed healthcare environment. The Dylan was instrumental in the development
challenges are to develop methods for and roll-out of the Qualsa Pharmacy
automation of the health outcomes Benefit Management (QPBM) capability.
measurements using ‘real world data’ QPBM provides online, real-time approval
and to collect meaningful data. Health of pharmacy claims at the time that the
outcomes measurement is key in medicine is dispensed by the pharmacist.
determining the value of healthcare Focus is placed on cost-effectiveness,
interventions offered by a managed appropriateness and the quality of the
healthcare company. It also assists medicine dispensed. Qualsa has also
in improving efficiency by knowing established pharmacy networks to ensure
which intervention to focus on and that our medical scheme clients have access
who will derive benefit from such an to stable medicine prices.
intervention.”
Qualsa is the medicine clearing
service of choice of a number of
leading medical schemes, including
the Government Employees Medical
Scheme (GEMS).
Continued E
E TakiNg ElEcTRoNic BENEfiT ENSuRiNg QualiTy
MaNagEMENT To gREaTER
aNd accESS WiTHiN
HEigHTS coNTiNuEd
accEPTaBlE coST
Dylan is currently heading an
initiative to take the real-time PaRaMETERS THRougH
model and technology beyond NETWoRkS
medicine management by applying
it in areas such as hospital benefit The other key area that Dylan
management. To this end, a pilot oversees is network management,
is currently under way with Medi- which involves the creation,
clinic where the technology has management and monitoring of client-
been applied to create a business- specific networks of service providers.
to-business interface that allows for The advent of Prescribed Minimum HEalTHcaRE BENEfiTS iN BalaNcE
the automation of all Medi-clinic Benefits (PMB) has made effective
hospital authorisations. This will offer network management a key focus
all Qualsa clients a highly efficient area in medical schemes. Qualsa has
process and 24/7 access to hospital developed network capabilities across accESS
admission authorisation. all major disciplines (GPs, specialists,
hospitals, optometrists and dentists)
Says dylan: “This will be a first in with the objective of managing access,
the industry, and we are delighted to quality and cost.
be able to offer Qualsa clients the
opportunity to be at the forefront The premise of the Qualsa network
of experiencing the benefits of a model is the organisation of healthcare
fully automated, real-time hospital with a strong front-line primary care
authorisation system”. focus and a specialist referral network QualiTy coST
to assist with the containment of
downstream costs.
Dylan’s team is also focusing on
developing “Centres of Excellence”
– specialist networks that deliver the
highest quality outcomes on the most
cost-effective basis.
According to Dylan: “Patients should
be treated in facilities that specialise
in certain diseases or procedures, as
the clinical and financial outcomes are
generally better.”
