Personal Health Pathways is a programme that guides the member along a comprehensive series of personalised health and exercise actions. These actions are designed to help members better understand and improve their long-term health, while rewarding them for doing so.

A pathway consists of a detailed set of health and exercise actions tailored to each individual, recommended for completion over time to better understand and improve their health.

A next best action (NBA) is one of the defined actions, established through review of the member's existing health status. Completed actions will contribute to maintaining or improving the member's health. When an NBA is prioritised, it is displayed to the member in the Discovery Health app or WhatsApp. The categories of NBAs are: clinical, exercise, lifestyle and screening.

Research shows that healthy behaviours lead to better care outcomes. Discovery Health's Personal Healthcare Pathways gives members suggestions and rewards for taking positive actions that improve or maintain their health.

Members of Discovery Health Medical Scheme (with or without Vitality) are eligible if:

• It is clinically appropriate
• They are 18 years or older.

Access to Personal Health Pathways is available to:

• Main members
• Spouses
• Adult dependants
• Child dependants 18 years or older

Note: Other medical schemes administered by Discovery Health are currently excluded. If these schemes want to extend Personal Health Pathways (PHP) to their membership base in the future, the eligibility criteria will be determined separately for each scheme. Similarly, we may extend Personal Health Pathways to Vitality Health members through Discovery Life/Group Risk (without a qualifying Health policy) at a later phase.

Doctors are provided digital tools to prescribe a Personal Health Pathway (PHP) through HealthID. Subject to member consent, a doctor can view a patient's dashboard in their health record and be alerted of the following:

• This member is eligible for Personal Health Pathways (PHP), but has not yet activated it. You can prescribe PHP through HealthID.
• This member is not eligible for Personal Health Pathways (PHP). This means the member has opted out of PHP or the member is in an ineligible cohort.

Doctors will be able to encourage participation and completion of next best actions (NBAs) for members who have activated Personal Health Pathways but have never engaged with it.

Once a doctor has recommended Personal Health Pathways (PHP) for a patient through HealthID, a communication is generated to the member (via WhatsApp, Discovery Health app notification or email), encouraging the member to participate in Personal Health Pathways at an overall level. The member will also be able to view the details on the Health App.

As a member's nominated primary care provider, you can dismiss an action through HealthID. You can also add a note to alert other medical professionals of the reason for the dismissal.

A doctor will be able to view a member's current progress in completing their next best actions (NBAs) and Personal Health Pathway on the PHP dashboard in HealthID.

The normal consent rules for HealthID apply, and the member would have had to give the doctor consent to view and engage with their data on HealthID.

The doctor's role will be to encourage the completion of next best actions (NBAs), track each patient's progress and provide encouragement through endorsement of tailored NBAs.

In keeping with Discovery's shared-value principles, practices are rewarded for supporting patients in activating and completing next best actions (NBAs). Discovery Health's Personal Health Pathways (PHP) is a value-add initiative available at no additional cost to our members or your practice. This means that a member's Discovery Health Medical Scheme contribution and/or Vitality premium will not be increased to cover the cost of PHP.

It is important to note, however, that this does not include data usage fees and activation fees for certain benefits (for example, HealthyWeight). These additional costs will be covered by the applicable plan benefits, where available, or must be paid by the member.

Yes, the reimbursement model will be communicated soon.

General practitioners (GPs) and specialists who are treating members that are eligible for Personal Health Pathways (PHP) can access it on HealthID.

You can visit the Personal Health Pathways content hub:

https://www.discovery.co.za/portal/medical-aid/personal-health-pathways.

Exercise next best actions (NBAs) change as the member engages in physical activity over time. Therefore, the steps or goals recommended will increase or decrease based on engagement. Therefore, a full pathway cannot be shown in advance.

Health actions

Not all completed actions are rewardable in Personal Health Pathways (PHP). However, completing actions contribute to closing a member's health ring. A completed ring earns an instant reward.

Exercise actions

For completing weekly physical activity actions or goals and closing the exercise ring, members will earn a reward. Members have an option of redeeming an instant reward or waiting for a gameboard play to earn Discovery Miles.

A pathway will always include three prioritised actions. Two of the prioritised actions will always be health actions, which include a clinical, lifestyle and supplementary next best actions (NBAs).

Members have personalised actions allocated to them. An engaged member can exhaust all their health actions. Members will always have exercise actions available and can continue to engage in Personal Health Pathways (PHP) through these actions. Health actions will be displayed as they become available for the member again. This is communicated to the member in the Discovery Health app.

Yes, it should be.

Yes, only a primary care provider (PCP) can prescribe Personal Health Pathways (PHP) to a member.

This feature may be available in future phases.

Currently, the primary care provider (PCP) is only able to reprioritise the existing next best actions (NBAs).