South Africa case study policy brief

Overview

The PPO Serve value-based care (VBC) pilot of its Value Care Team (VCT) model began in September 2019 and currently covers 5620 patients in Pretoria North, Gauteng province, South Africa. It is funded by the Government Employees Medical Scheme (GEMS), a closed, private voluntary insurance scheme for civil servants. The model aims to overcome the limitations of fee-for-service (FFS) payments, including supplier-induced demand, unnecessary admissions, and poor coordination and measurement of outcomes. It also aims to shift care to the primary setting to reduce hospital admissions and length of stay.