Month: July 2017

18 Jul 2017

Getting a medical scheme perspective: A look at our recent workshop, The Funder Mindset

The question is often raised, as to why medical schemes do not pay for certain benefits. Members pay their contributions, but where does this go? What is risk pooling or cross subsidisation?

TCD Outcomes Research (OR) realised that indeed there is a gap in understanding this concept and so an idea was born – to identify and link the truths between administrator, funder and the paying member.

Last Thursday (July 13th) saw the hosting of the first of several workshops aimed at creating awareness, identifying challenges and ultimately working together to find solutions that are patient centric.

Gaining insight from the Medical Scheme Perspective is not an easy task. Our speakers, Milton Streak, Johan Van Zyl and Tienie Stander assisted in providing an objective view of the different industry role players.

Johan discussed the role of the administrator. Oftentimes there lacks an understanding as to the role that the administrator plays. Having years of experience in the field of health management, managed healthcare, health analytics as well as clinical and procedural coding, Johan was able to provide information regarding awareness, challenges faced, as well as potential solutions.

Milton spoke of governance of medical schemes, business trends in health care and amongst others enablers for improving health care. Milton has over 20 years experience serving in senior leadership positions at leading South African Medical Scheme Administrators/Managed Care Organisations and Medical Schemes and is currently an independent Healthcare Strategy Adviser.

Linking both Milton and Johan’s discussions, Tienie provided valuable insight as to how to bridge this gap. It starts with a partnership and joint discussions. The solution is the SA Constitution (S27). “Everyone has the right to have access to social security, even if they are unable to support themselves and their dependents, including appropriate social assistance. The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.”

We at TCD OR hope that by hosting such workshops we open dialogue that is so urgently required. A dialogue that challenges our approach, and perhaps serves as a catalyst to what ultimately requires a partnership of all stakeholders within the industry.

The Funder Mindset: Insight into the Funder’s World was the first of a series of workshops that will be held over the next few months. Follow us on Linkedin or Facebook to stay informed about our future workshops.


Johann Van Zyl
Johann is a medical practitioner and founder and Managing Director of Clinical Governance Services (Pty) Ltd (CGS).

Relevant Experience/Specialisation:
Johann has 12 years’ experience as a general practitioner coupled with some 19 years’ experience in health management, managed healthcare, health analytics and clinical and procedure coding. He specialises in clinical and procedure coding and the clinical analysis of health claims data.

Johann’s current responsibilities include:
Advising medical schemes on benefit design and related clinical matters
Advising medical schemes on clinical risk management strategies
Healthcare account auditing
Measuring financial and clinical healthcare outcomes
Monitoring outcomes and compliance reporting for contracted health care provider networks
Development of provider profiling models across various disciplines
Development, maintenance and costing of procedural coding structures
Development and maintenance of clinical coding grouping methodologies
Development of predictive models that are applied to analyse past claims experience and forecast scenarios
Advising corporate clients on health and wellness strategies

Education and Credentials
Bachelor of Medicine and Bachelor of Surgery (Studies in Medicine – University of Stellenbosch)
Master’s in Business Administration (University of Stellenbosch)
Registered with the Health Professions Council of South Africa

Milton Streak
Milton Streak was born on 31 July 1966 in the Northern Cape Province of South Africa. He matriculated from Potchefstroom Gymnasium in 1984 and obtained a B.Pharm Degree from the Northwest University, Potchefstroom in 1989. His post graduate studies included a Master of Management Degree (with distinction) from the University of the Witwatersrand, specialising in Entrepreneurship and New Venture Creation. Following completion of his Master’s studies, he was awarded the Wits Business School’s MANEX Award in 2012. Further post graduate studies included four Executive Management Programs at Harvard Business School from 2008 to 2016, focused on healthcare innovation and delivery as well as competitive dynamics. He also obtained a post graduate Certificate in Corporate Governance (Cum Laude) at the University of Johannesburg in 2011. He is a member of the Institute of Directors Southern Africa and has completed the IOD’s Directors Program.

Milton’s healthcare career includes both international and South African health insurance and healthcare management experience. His career spans over 27 years, with 21 years’ experience in corporate South Africa, serving in senior leadership positions at leading South African Medical Scheme Administrators/Managed Care Organisations and Medical Schemes, including the largest medical Scheme in South Africa, Discovery Health Medical Scheme, as Principal Officer/CEO from 2009 to 31 December 2016.

He is currently an independent Healthcare Strategy Adviser and has spent the last three months in India working with India’s 3rd largest stand-alone private health insurer on strategic projects.

Tienie Stander
Tienie graduated from the University of Stellenbosch and obtained an M.B., Ch.B. in 1981.  He practised as a MD until 1997 after which he managed a hospital. He was appointed as Principal Officer of a medical scheme in 1998. In 2000 he obtained an MBA at the North West University, South Africa.

He is the founder heXor (Pty) Ltd, now rebranded as TCD Outcomes Research where he acts as managing director.

Tienie was an extraordinary professor at North West University, school of pharmacy and is an external moderator of the School of Pharmacy of North West University.  He was a founding member and the first President of ISPOR South Africa and is a member of ISPOR International, International Aids Society and Health Financial Management Association.

He collaborates extensively with international academic organisations such as Harvard Medical School and British Columbia University, as well as most South African universities.  International experience includes consulting work in the SADC, Mauritius, Ghana, Libya, Egypt, Sudan, India, Thailand, UAE, Oman and China related to policy, health systems and health economics and outcomes research.

12 Jul 2017

TCD attending the ISTH 2017 Congress in Berlin, Germany.


The Largest International Meeting of the Thrombosis and Hemostasis Community, the ISTH 2017 Congress, is currently taking place at the CityCube/Messe Berlin in Germany. It is the 26th Biennial Congress and will run until Thursday, the 13th of July. The ISTH 2017 Congress is the foremost global meeting in thrombosis, hemostasis and vascular biology. The event is organised by the International Society on Thrombosis and Haemostasis and theme of this year’s congress is Transcending Scientific Boundaries.1

Japie van Tonder, Director, Global Data Services at Triclinium Clinical Development (TCD), is presenting a poster at the congress: Comparison of the Injection Site Reactions Elicited by Two Subcutaneously Injected Heparins, Nadroparin Calcium and Enoxaparin Sodium [J.J. van Tonder, S. Mathijs, J.M. Dippenaar, O. Greeff (South Africa)].

The International Society on Thrombosis and Hemostasis (ISTH) is a global not-for-profit membership organisation advancing the understanding, prevention, diagnosis and treatment of thrombotic and bleeding disorders.1

The congress started on Saturday the 8th of July with the 63rd Annual ISTH SSC Meeting, followed by The ISTH Congress opening ceremony on Sunday evening. More than 8,000 scientists, clinicians and leading experts on thrombosis, hemostasis and vascular biology come together from around the world to present the most recent advances, exchange the latest science and discuss the newest clinical applications designed to improve patient care.2

The scientific part of the congress features 131 invited speakers, including eight plenary lectures by front-line scientists and 84 state-of-the-art lectures by leaders in their respective fields. The congress offers 39 abstract symposia with an introductory review lecture, followed by oral presentations of top-scoring abstracts.2

A late-breaking session was held on Tuesday highlighting important and timely results from clinical trials, with poster presentations taking place from Monday through to Wednesday. Overall, more than 3,000 abstracts will be presented as oral or poster presentations. The congress closes on Thursday at noon with a session on the highlights of ISTH 2017. 2

For more information on the congress visit: and to receive news and updates visit




05 Jul 2017

Personalised (precision) medicine: what is it, and how does it work?

John received chemotherapy for colon cancer. The chemotherapy drug that he used, however, was not effective for him. He also experienced severe nausea and diarrhoea when using this chemotherapy.

He speaks to another patient treated at the same hospital, who has the same type of colon cancer and who received the same chemotherapy. For this patient, the chemotherapy was very effective and the patient only experienced mild nausea. What causes these differences between patients and what approaches are needed to overcome them?

Patients have different responses to different treatments, as well as different adverse reactions[1]. These differences could be caused by genetic or other factors. The solution here lies in personalised, or precision, medicine.

What is personalised medicine?

Personalised medicine is the concept of adapting patient treatment (drug and dosage) to a specific patient, based on that patient’s specific characteristics, such as genomic information and environment[1].

The aim of personalised medicine is to provide a patient with the correct treatment regimen that will potentially result in better treatment of a disease, as all patients do not have the same characteristics and do not respond the same to the same treatment.

What is required for personalised medicine to work?

Personalised medicine typically consists of two parts: firstly, using diagnostic medical devices to identify specific characteristics of a patient. Diagnostic devices or tests could include, amongst others, genetic tests, or imaging equipment. Secondly, therapeutic products (drugs, devices or other treatments) are provided based on the results of the diagnostic test[1].

This implies that there could be a synergy or collaboration between device and pharmaceutical companies in providing personalised medicine to a patient.

For personalised medicine to be successful, data on past patients should be available. This can be in the form of patient registries or clinical trials. This data should include the various characteristics of the patients (for instance, biomarkers, genetic information, age, gender, family history, etc.) and disease (especially if the disease can present in different ways). This data should also provide information on the outcomes for patients using specific drugs.

Predictive and prescriptive modelling can be used to analyse this data and provide insights into the relationships between patient characteristics (biomarkers, genetic information, etc.) and the outcome (cure or survival using a specific drug). Predictive and prescriptive modelling can also be used to determine if patient characteristics have a significant impact on the outcome, whereas this can become a focus point or objective for further research. This is done to further improve knowledge and treatment habits for a given patient.

As mentioned in a previous blog post, “Predictive and prescriptive modelling in health care”, TCD Outcomes Research can assist you in your prescriptive and predictive modelling requirements. We can also assist in positioning your product, using this information, for the correct market segment. This will not only assist the pharmaceutical or medical device company, but also the patient, for whom funding for the correct treatment would more likely be available from the medical aid. A patient would also know that treatment with a specific drug is catered to their needs and that the patient receives the best treatment based on his/her medical records.



  1. S. Food and Drug Administration. Paving the Way for Personalized Medicine – FDA’s Role in a New Era of Medical Product Development. October 2013. Available from: Accessed on: 15 March 2017.