20233101 dubai health insurance
Dr Mohamed Farghaly, Consultant, Dubai Health Insurance Corporation, Dubai Health Authority, at Arab Health at Dubai World Trade Centre on Monday. Image Credit: Ahmed Ramzan/Gulf News

Dubai: Patients with as many as 30 predominant diseases will receive quality-based care and insurance approvals that will cut costs of their treatment in Dubai with the Dubai Health Authority including these diseases under its value-based healthcare model called ‘Ejadah’.

On the first day of Arab Health 2023 on Monday, DHA announced that it will introduce the model across 30 disease areas for the emirate by 2025.

Ejadah, which means proficiency in Arabic, is a value-based healthcare model, rather than a volume-based model, that was launched in June 2022.

DHA’s Dubai Health Insurance Corporation, which regulates the health insurance sector in Dubai, is overseeing the implementation of Ejadah.

Saleh Al Hashimi, CEO of Dubai Health Insurance Corporation, said: “The model will create a transformational shift in the health sector as providers and payers move towards a value-based care model instead of the current volume-based care model.”

The value-based healthcare model will pay for performance and outcomes that matter to patients. It will provide healthcare service providers with evidence-based guidelines, which will be a framework for all physicians to follow with regard to treatment protocols for all ailments.

Minimising expenditure

Al Hashimi said that payers and providers have been undergoing training to understand the framework and KPIs (Key Performance Indicators) which will lead to minimal waste of healthcare expenditure and enhanced focus on preventive care.

Under this model, insurance providers will have a strong foundation to refer to evidence-based data and all stakeholders will work together to enhance healthcare and reduce unnecessary medical expenditure. Accordingly, only procedures and tests done as per the value-based framework guidelines and KPIS will be approved by insurance companies, thereby minimising unwanted requests for tests and procedures and medical expenditure.

“The model is driven by quality outcomes and at its core lies the health of patients, it will help shift the focus on preventive care, which will benefit patients and lead to reduced healthcare expenditure thus leading to healthcare sustainability,” said Al Hashimi.

He added that the model will also “help improve government oversight of the health sector by overseeing clinical outcomes, economic and human-centric outcomes. The implementation of this model will lead to a transformation in the health sector wherein the focus lies entirely on performance and clinical outcomes.”

“The value-based model will benefit patients, it will lead to transformation towards preventive and outcome-based care, at the same time, it will benefit providers and payers as it will optimise healthcare expenditure and lead to better population health,” said Al Hashimi.

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Using AI for predictive analysis

The model uses Artificial Intelligence (AI) technology for predictive healthcare analysis for early intervention, disease prevention and to prevent complications caused by the disease. The AI technology will be initially used for two diseases: diabetes and asthma.

The model will also include patient-reported outcome measures (PROMs) to assess the outcome of care from the patient’s perspective.

Which disease will be covered?

Since the launch of the model last year, DHA has identified and prioritised 30 key diseases until 2025 where this model will be applied, said Al Hashimi.

In 2022, Dubai’s healthcare sector received training to use this model across diseases such as asthma, diabetes, Gastroesophageal reflux disease (GERD), lower back pain and respiratory infections. The sector was also provided in-depth training on maternity care guidelines in line with international best practices.

In 2023, the focus will be on: Chronic obstructive pulmonary disease (COPD), Inflammatory bowel disease (IBD), Osteoporosis, Hyper/Hypothyroidism, Atopic dermatitis, Urinary Tract Infections, Migraine and Myocardial Infarction(MI).

In 2024, the focus will be on: Peptic Ulcer Disease, Rheumatoid Arthritis, Obesity and Metabolic Syndrome, Polycystic Ovarian Syndrome, Acne, Benign Prostatic Hyperplasia and Arrhythmia.

In 2025, the areas of focus will include: Gallstones, Osteoporosis, Thyroid disease, Dermatitis, Psoriasis, CHD/Stroke, DVT and renal failure.

Sustainable healthcare system

Dr Mohamed Farghaly, Family Medicine Consultant, Diabetologist and Professor of Medicine at Dubai Medical Collage and Consultant at the Dubai Health Insurance Corporation, highlighted that the model will lead to a sustainable healthcare system.

Dr Farghaly, who is also the lead of the Ejadah project at the DHA, explained how a significant percent of the cost of managing non-communicable diseases such as diabetes actually goes towards managing the complications of the disease rather than the disease itself.

He said that by implementing an ecosystem that focuses on preventive care and patient-centered care, this cost can be significantly reduced.

The model will empower patients and lead to a sustainable health system. Dr Farghaly added: “It will increase efficiency, efficacy, and safety whilst utilising best-practices and methodologies.”

What will change under Ejadah

In volume-based care, healthcare providers are reimbursed for the number of interventions performed. In value-based care under Ejadah, providers are reimbursed on health outcomes.

In volume-based care, healthcare providers could order or perform as many interventions as possible to maximise reimbursement. Under Ejadah, providers have to reduce unnecessary interventions and should keep patients healthy post treatment.

While the focus earlier was on individual patient episode/visit and complex all-purpose treatments, the focus under Ejadah will be on outcomes across continuum of care and treatment based on medical necessity (lower cost, focused care, delivery sites).

This will see the role of providers changing from the siloed approach based on speciality-driven interactions to team-based care continuum.