Read the Conversation

EF: If 2020 was the year of diagnostics, 2021 the year of vaccines, what will 2022 be the year of?

Dr. HH:  2022 will be the year of recovery and a year of restoring levels to those of pre-COVID years. We are currently seeing many non-communicable diseases that were not focused on during the COVID-19 years, for various reasons, specifically in younger children that weren’t exposed to schools and other social activities. During this period, they were not exposed to several infectious diseases, and their immune systems must now adjust. We are an integrated healthcare organisation and the biggest part of our business is out-patient focused, but we do have in-patients in our sub-acute rehabilitation centres and day hospitals. We have seen a major recovery and have passed pre-COVID numbers, which we are grateful for.

HH: I agree that 2022 will be the year of recovery, I also think it will be the year of reflecting on the learnings, technologies, and changes that happened over the last two years. The focus is now to capture those learnings in the business models of tomorrow. The other message is that one shouldn’t wait for dramatic events to change. There are a lot of talking points in South Africa and several areas require action, such as infrastructure, this was known before the pandemic, yet suddenly since the events surrounding COVID-19, everyone is willing to change. Consequently, the key message is to be receptive to ideas of continuous change and not wait for large-scale, drastic events.

EF: What message would you give to DAVOS in a healthcare context?

Dr. HH: Never underestimate a pandemic. If I look back over the past 20 years, since we started Intercare, we would never have thought that a virus could have such a big impact on the healthcare system. Do not sail too close to the wind, always leave a margin for error or for unforeseen events to happen. That is the message.

EF: How can the industry continue the momentum on the advantageous adaptations?

Dr. HH: Looking forward, there are great opportunities for forming partnerships and developing integrated models. Together with Discovery and Mediclinic, we have just launched a very innovative product, readily available on the Discovery medical scheme, aimed toward the employed but uninsured market, and it comes at a very competitive price. The whole principle is digital-first, patients will have access to Intercare digital clinic through the Discovery website or app. The journey begins with a chat, then a video consultation, and then a physical consultation with Intercare GPs. They can also get access to specialists and hospitalization, so it’s a closed network, based on a regional plan which is the first of its kind in South Africa. This is where we believe the future is going to be.

HH: At Intercare, we realized that the need for healthcare in South Africa is prevalent. It can only be achieved in cooperation with one another. It’s about putting differences aside, combining skills and capabilities, and expanding access to healthcare to all the people in South Africa. Another partnership that I think is innovative is between Intercare and Unjani, a non-profit nurse-based network of clinics, where Intercare is busy adding virtual capabilities to this network. This allows patients that have previously not had any access to healthcare, or had access but needed to go to the public sector or pay privately, to access another tier of service before going to another level of care.

Dr. HH: One thing that we have realized is that you don’t have to own everything to provide a comprehensive range of services. You can extend your clinical reach through partnerships. Referring to the partnership with Unjani clinics, these are also located in the peri-urban and rural parts of South Africa, where we currently don’t have a presence. To install a comprehensive Intercare medical and dental centre in a place with a lower volume of patients is not always viable, but we can now extend our clinical reach through partnerships to provide quality healthcare to people who up to now, didn’t have access to it.  

EF: Intercare has recently taken part in education initiatives. Could you elaborate on the overall importance of education in healthcare?

Dr. HH: Education is fundamental to anything in life, not just to healthcare. Education is crucial to any country and any society, and of course to healthcare. There are some great institutions in South Africa, an example of this is the Foundation for Professional Development, a subsidiary of the South Africa Medical Association, where they upskill all healthcare providers across the spectrum to provide better healthcare, if we can do more of this it would be wonderful. As an organization, we have a great learning platform where we provide training to all our staff, not just healthcare professionals, to upskill them so that in addition to providing better care, they can also provide better service, whether they provide clinical care or administration.

HH: Consumer education is also a big focus.  Consumers are currently forcing a lot of change in healthcare because consumers are increasingly aware of their healthcare requirements, yet there is still a long way to go in educating consumers about the need for healthcare, both in general and in specific areas. As a population, we must take preventative steps to become healthier.  

EF: How did digitalization evolve during the pandemic and how is digitalization advancing in healthcare?

Dr. HH: We knew the issue of digitalization and digital healthcare was coming, but Covid-19 kickstarted that, it gave us extra momentum and overnight we transformed our organization to provide care virtually.

HH: Intercare has always been innovative, we continuously consider our competitors’ new developments, as well as worldwide trends and developments. Many years ago, although it was new to South Africa, we implemented electronic medical records. The change management process surrounding this was huge for doctors, but we knew it was imminent and we understood its importance for digitalization. We also implemented online bookings for patients before any other provider, and today, online bookings equate to around 60% of our total appointments.  

There has been a lot of digitalization within the business, but not necessarily in delivering clinical services. We knew this was an issue and we had a vast strategy in place to address this, we agreed that we had to approach this with drive and determination, the same way we drove electronic medical records, but the adoption was slower. Within the first month of the pandemic (and the subsequent lockdown regulations), we realised that people had to be given access to healthcare and the only way we could do that was by delivering digital services to patients wherever they were. Consequently, we implemented video consultations, just like many other healthcare organizations. We were one of the first providers of digital healthcare services in South Africa, and it is evident from research and feedback, that our adoption rate was very good. It is one thing to launch a service, but it’s also crucial for it to be received and adopted well. We kept our patient and provider journeys as close to the norm as possible. From an administrative perspective, it was very much the same, except we had to implement technologies that had the capability to provide virtual consultations.  

Dr. HH: We implemented an integrated solution, where virtual consultations were not developed in isolation from physical consultations. Whether the doctor provided a physical consultation or a virtual one, it was documented in the same electronic medical record, which was critical for continuity of care.

HH: We also had to evolve and be agile to find solutions, we believe we did this over the last two years, we changed and with that, the consumer and the provider changed. We applied our learnings in facilitating normal interactions with providers. All our patients and providers must be given the choice between physical and virtual; this must be available across the spectrum of physical needs. The question was, how could we extend our clinical reach? We reached the conclusion that partnerships had to be formed and that we had to provide our partners with virtual services. Nurses with patients needed to connect to a doctor, we facilitated this. We have implemented an on-demand, digital health service where any patient can enter our clinic, even through different entry points. You can imagine walking into a physical practice where there is a choice of service and a queue to stand in, with certain providers at the back, this is exactly what we have created, an on-demand service for consumers, this is the product of our partnership with Discovery. The next question is, how do we make sure that this is a seamless healthcare experience, but also delivers quality outcomes. It is one thing to say that we can deliver healthcare, another is doing it to add or improve quality and not to the detriment of the patient, making sure that we monitor and improve on this service.

Dr. HH: We aim to create an integrated, hybrid organization where patients and doctors move seamlessly between the virtual and physical worlds for appropriate care. We must all be on one platform so both doctor and patient don’t have to use different systems to receive care.

EF: The use of Artificial intelligence is increasing in the health sector, is Intercare adapting to its usage?

HH: For us, there is a lot that could be done with data, not necessarily commercializing, but delivering more personalized care. Whether that is done by AI algorithms or data mining is up to the clever people, but data plays a key part. You can’t use AI if your underlying data is not accurate, industries that want to utilize this technology must have their fundamentals in place. Intercare has partnered with a company that provides mental health services through AI, supported by a psychology network. There are several elements to this, one is a chatbot powered by AI for mental wellness and mental health, it’s an internationally accredited chatbot that is localized using the data. It allows us to triage and assist patients, specifically in the mental health space, where issues such as stigma, limited access, and scarce resources are prevalent.

AI is about issuing the appropriate level of care and assisting patients, if you look at symptom checkers, they are very well known, I wouldn’t say it's about diagnosing, I’d say it’s about really making sure the patient ends up at the appropriate level at the appropriate time. The chatbot provides care for those who either couldn’t get it or maybe weren’t aware they needed it. Once a patient has to consult a psychologist, a provider network must be made available, only AI and technology is not sufficient. That’s why we believe in a hybrid practice, where virtual and physical care is combined.

EF: How are physicians adapting to these technological changes and do they see these new features as a threat?

Dr. HH: Doctors will not be replaced by AI, but doctors who don’t use AI will be replaced by those who do. What we are doing in our organization is continuously sharing the future with our physicians. If people understand likely future trends, they can easily adapt. I have always said, don’t resist change, be a catalyst of change. If you resist change, it will overtake you. We spent a lot of time taking our doctors with us, we don’t have all the answers, but by empowering people with the knowledge there is such a great future. Doctors are smart people, if they understand that AI can assist them, they will not resist.  

HH: Healthcare is driven by the consumer, whether we like it or not. Healthcare professionals will say bring the right patient to me, bring me the patient that needs my help, it doesn’t matter how we get there. Technology can help with that. In terms of decision making, it depends on the trust and education of the technologies, we have seen some good examples of this, and others that need a bit more time.

EF: What is the role of health infrastructure in developing the economy?

Dr. HH: Infrastructure is critical in any society and for developing the economy. We must ask ourselves, what is the appropriate infrastructure that we need, do we have enough hospitals? We must not just develop infrastructure for the sake of infrastructure. Some years ago, we didn’t have enough hospitals, I’m not an expert on that because we don’t operate in the acute hospital space, but we must ask what is the appropriate infrastructure that is needed to grow the economy? Infrastructure will play a critical role going forward.

HH: What is important is that if people are sick, they can’t work, if they can’t work, the economy can’t grow. We saw evidence of this during COVID-19.

EF: Home-based healthcare was accelerated by the pandemic; can you elaborate on the direction of this trend heading into the future?

Dr. H: Worldwide, there is an outmigration from the acute hospital space. Even South Africa, up to now, was a very hospital-centric healthcare system, but it is changing, it’s moving into the home. South Africa will not be different from any place in the world, you will always need hospitals, but the role of hospitals will change. They will become specialized centres of excellence rather than general hospitals. There will be an overall movement toward bringing healthcare to the home, and technology will play a role in this process. The future is about a healthcare ecosystem where the patient or the consumer will access healthcare at the most appropriate place and time.

EF: You have been operating in South Africa for over 20 years, what are the main achievements you have celebrated over this time?  

Dr. HH: From humble beginnings 20 years ago, where we only served several patients with a handful of healthcare providers, to today, where we have 34 healthcare facilities in the country with a lot more access points, we provide care to more than a million patients a year. If I look at the business and at what we have achieved, we are a trusted brand that provides compassionate, quality care. For the past number of years now, one of the regional newspapers has given us the award for the best medical centres. Our patients and consumers vote with their feet, we have seen wonderful growth and we are humbled by this. As a company, we hope that our growth will continue and that we will be able to serve many more patients. The ultimate achievement is having a happy customer that is pleased with what you provide, that is our biggest accomplishment, that our patients are happy and that they come back. Also, more people are coming to get care, not only at Intercare facilities but in the future also with our partners.  

EF: What is the role of Intercare in advancing South Africa’s healthcare system? Will Intercare be a role player of note in South Africa’s future healthcare system?

HH: We believe in South Africa. We want to play our part in making it a great place to be and provide everyone with access to a key service that they require. We are positive about South Africa and about the opportunities that await, along with the challenges.  

Dr. HH: The true purpose of Intercare is to make people feel better. We can’t always make people healthier, but one thing we can do is make people feel better. Whether it’s a patient in our sub-acute rehabilitation hospital with a stroke, perhaps we can’t cure them, but we can make them feel better. If it is a patient with depression visiting our primary care centre we can make them feel better. Intercare is a value-driven organization, we aim to enhance access to affordable, quality, integrated care. We are deeply patriotic and believe in this country, that is why we are here and that is why we hope we can play an even bigger role in the future.

June 2022
South Africa