In a health system under pressure, value-based care (VBC) is increasingly under focus as a more sustainable approach to delivering quality care. But what does VBC mean for doctors in private practice? We asked Nomfundo Khabela, Strategic Relationships Executive at Healthbridge, to unpack how this model works, why it matters now more than ever, & what Healthbridge is doing to make the transition from fee-for-service to outcome-driven care not only possible, but practical.

Let’s start with the basics. What is value-based care &why is it such an important shift for South African healthcare?

At its core, value-based care is about putting patients back at the centre of healthcare. For more than 300 years, we’ve operated in a fee-for-service model where doctors are paid for the number of services they deliver, such as consultations, procedures, tests, but not necessarily for the outcome of those services. So if a patient goes back to their doctor three times for the same issue, the system pays three times, regardless of whether the problem was solved.

Value-based care flips that around. It asks: What outcome did the care produce? Did the patient get better? Did we prevent a hospital visit? Did we slow the progression of a chronic illness? It’s a shift from volume to value, & it’s a necessary move if we want to improve access & outcomes while managing healthcare costs.

Why is the shift to VBC happening now?

There are a few reasons. Insurers are seeing their membership base shrinking & ageing, which makes the traditional risk-pooling model less sustainable. At the same time, the cost of healthcare is going up, but outcomes haven’t kept pace. Patients are paying more & asking, “What am I getting for this?”

Globally, we’re seeing healthcare systems move to value-based models because they offer a more sustainable way forward. In South Africa, the momentum is growing, especially with NHI on the horizon.

How does VBC tie into the bigger picture of universal healthcare & NHI?

Ensuring access to healthcare is a fundamental right for every South African. But access alone isn’t enough. It has to be quality, coordinated care, & it has to be sustainable. The NHI aims to provide universal access, & value-based care is a model that helps make that vision a reality. It aligns incentives, strengthens primary care, & ultimately makes the system more patient-centred & cost-effective.

What is Healthbridge’s position on value-based care?

We’re absolutely supportive & believe it’s not just timely, but necessary. It’s the right direction for our healthcare system, & we see Healthbridge as having a key role to play in enabling the transition. We design digital tools that make the shift easier for doctors. We aim to simplify the process, reduce admin, & help doctors deliver better care without being overwhelmed.

What are some of the practical ways that Healthbridge is helping practices make that shift to care by multidisciplinary teams?

We’re building tools that help doctors implement value-based care without adding more complexity. That includes features like care coordination engines that prompt patients to book follow-ups or complete tests. We’re also developing risk stratification tools that help identify high-risk patients quickly, using predictive analytics.

At the same time, we support doctors with smart summaries before each consult, prescribing tools that flag scheme-compliant medicines, & even AI that listens & transcribes consults into structured notes. It’s all about giving back time & headspace.

From what you’ve described, it’s safe to say that technology is central to making VBC work?

Absolutely. You can’t scale VBC without good digital infrastructure. But it’s not just about having tech, it’s about using it well. Many practices still use paper, & that’s holding them back from a service & a business point of view. Digital tools &information are part of our everyday lives & for good reason. We’ve already established its effectiveness. In healthcare, electronic medical records or EMRs need to be intuitive & genuinely helpful. That’s what we’re building with Healthbridge Nova because, as a society, we are well beyond the point of technology for the sake of technology. It’s no longer novel, it’s necessity.

What about the day-to-day impact on doctors? Some might speculate that VBC is more work for already stretched GPs?

That’s the fear, but it’s not the reality. Value-based care isn’t about doctors doing more; it’s about doing things differently. The idea that everything has to sit with the doctor is outdated. For example, wellness care, things like postnatal check-ins or chronic screening, can be led by nurses or other members of a clinical team. That allows the doctor to focus on acute care, where their expertise is most needed.

The challenge is that current tariffs don’t reward these high-value, preventive activities. So we need payment models that make space for team-based care, & systems that support it.

What have we learned from early pilot projects of VBC in South Africa?

The GEMS programme led by Dr Brian Ruff is probably the most successful to date, with thousands of doctors onboard & strong results in reducing hospitalisation. It’s proof that VBC can work here. But to really scale, we need more collaboration between providers & funders. Right now, there’s still a trust gap, & that’s something we have to bridge by working together to design care models & payment reforms that reflect the reality of practice.

What is that “trust gap” &how do we close it?

Providers feel they aren’t being reimbursed for the full scope of care they deliver, like following up with a patient after hours, coordinating with specialists, or managing chronic conditions. Funders, on the other hand, want to reduce costs & see measurable outcomes.

To close the gap, we need both sides to sit down & map out what it actually takes to deliver good care. That includes everything from staffing & admin time to clinical coordination. Once there’s shared understanding, we can design tariffs that make value-based care financially viable for doctors & cost-effective for funders.

How are outcomes actually measured in a VBC model?

Currently, the metrics that are being measured are things like hospital admission rates & bed days, but we’re working to expand that. We want to capture patient-reported outcomes too, using tools like WhatsApp to reach patients where they are, because what matters to patients should also be part of how we define success.

And financially, how does VBC compare to fee-for-service for private practitioners?

Done right, value-based care is more sustainable. Once we start reimbursing doctors for high-value activities, like patient education, prevention, & coordination, the financial picture changes. There’s also a long-term upside: fewer unpaid follow-ups, fewer admin headaches, & stronger patient loyalty. So yes, there’s definitely a financial benefit, but it starts with payment reform.

What’s the risk of doing nothing for practices that don’t digitise their practices & workflows?

They risk becoming irrelevant. Patients expect seamless, digital experiences. Funders will want data to prove value. If your systems can’t deliver that, you’ll struggle to compete. Going digital & embracing value-based care isn’t just good for patients, it’s essential for the survival of private practice.

As South Africa moves towards broader healthcare reform, the shift to value-based care is inevitable. But with the right technology & support, private practices can thrive in this new model, delivering better outcomes for patients & building more resilient businesses in the process. At Healthbridge, we’re here to help doctors navigate this change with practical tools, expert support, & a clear path forward.