Feeding the Loop: From Insurance to Health Systems

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Feeding the Loop: From Insurance to Health Systems

Karachi, PakistanKarachi, Pakistan
Year Founded:
2009
Organization type: 
hybrid
Project Stage:
Growth
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Naya Jeevan is Pakistan's first 'health plan for the marginalized'. Over the past 4 years, in response to continuous customer engagement and feedback, the health plan has evolved from a hospitalization-only insurance plan to an integrated health plan offering a variety of primary care services.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if marginalised communities had 24/7 access to medical doctors via an affordable, cashless, integrated, quality health system
About Project

Problem: What problem is this project trying to address?

7 million of Pakistan's poorest citizens are pushed into poverty every year, unable to pay their healthcare bills. Public health infrastructure is broken, private care too expensive, and both private providers/NGOs struggle for viability because they either provide only hospitalisation insurance, or only primary care services. No integrated, affordable, quality health system exists in Pakistan for low-income people.

Solution: What is the proposed solution? Please be specific!

Social sector programs must adopt the best business principles of the private sector, integrating customer feedback in order to optimize their service delivery and consume satisfaction. Over the past 4 years, Naya Jeevan has sustained a direct, frequent dialogue with its members through quarterly events including health benefits orientation, health screenings, interactive health education workshops & a 24/7 telehealth line. In 2012, responding to continuous customer demand, it opened its first primary care clinic and is expanding its primary care network. Naya Jeevan now aims to be the first integrated health system in Pakistan, providing its members with comprehensive health insurance, primary care services and pharmacy benefits.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Our clinic is transforming the lives of our insured members, providing primary care services that are not normally covered under health insurance in Pakistan. As a result, low-income beneficiaries do not need to change their healthcare provider/doctor at times of need. One of our valued members is Waqas, a 10 year old son of a Janitor. He was diagnosed with both pancreatic cancer & asthma, and has undergone multiple surgeries for his cancer. While his hospitalization expenses were covered under the Naya Jeevan Health Plan, Waqas previously had to travel quite far for his asthma nebulizations. Now, however, our Clinic provides urgent nebulization services and Waqas' family do not have to spend precious time and resources on commuting.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

The Naya Jeevan community health center has seen over 8000 patients since its opening, with almost 30% of that traffic coming from insured Naya Jeevan members, reflecting the considerable unmet demand for primary healthcare. Aside from basic primary healthcare, it also provides emergency nebulization for asthmatic patients as well as vaccinations for Polio & other infectious diseases, in collaboration with UNICEF. 500 pregnant women have been examined in Ante/Post Natal care visits, and clinic-facilitated OB/GYN consultations have led to 70+ safe hospital deliveries. The clinic has also served as a check on unnecessary hospitalizations, by ensuring health conditions do not deteriorate. Future strategies include the integraton of remote-video consultations from highly qualified doctors, the provision of mobile banking services and the expansion of diagnostic services on site.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

The clinic will use its insurance membership base to achieve self-sufficiency. Naya Jeevan will charge $0.6/month from each of the 5000 insured members in the area, & build it into the cost of the in-patient/outpatient integrated $ 30/year health plan. This will easily cover the monthly operating costs of the clinic ($ 3000/month). As Naya Jeevan's grows its membership base, the $0.6/month charge will decrease, enhancing affordability.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Health programs in Pakistan approach the problem of poor healthcare for low-income people through a uni-dimensional approach. Marie Stopes (Primary Care) Jubilee Insurance (Insurance only, through village associations) SINA Clinics (Low-Cost Primary Care) NRSP (Health Insurance bundled into microfinance loans) Programs where health insurance is bundled with another product have low tangibility, few benefits & are unresponsive to customer feedback. By venturing into primary care, Naya Jeevan is the ONLY insurance provider offering an integrated health system for low-income people.
Team

Founding Story

Shakila Bibi, a stitcher at a local garments factory in Karachi, became a member of Naya Jeevan's insurance plan in 2012. When her daughter fell sick with flu, Shakila took her to the hospital, thinking her insurance card would cover it. The hospital turned her away though, as the insurance was only in-patient hospitalisation, without any outpatient benefits. Her daughter could not be covered unless her condition worsened and led to hospitalisation. Caught between a rock and a hard place, Shakila approached Naya Jeevan, asking for assistance. While she was eventually accommodated, the need for a long-term solution was felt. Shakila became the catalyst for what our beneficiaries had long been demanding: outpatient primary care.
About You
Organization:
Naya Jeevan
About You
First Name

Owais

Last Name

Rasool

LinkedIn URL
About Your Organization
Organization Name

Naya Jeevan

Organization Country

, Karachi

Country where this project is creating social impact

, Karachi

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Impact
Full Impact Potential: What are the main spread strategies moving forward? (Please consider geographic spread, policy reform, and independent replication/adoption of the idea or other mechanisms.)

Geographic Spread: The clinic currently provides services not just to the already insured Naya Jeevan beneficiaries, but also the surrounding community of 250,000 low-income urban dwellers; Naya Jeevan will use community mobilisers to market its health insurance and expand its insurance coverage in this community which can then be replicated.

Replication: Franchise a network of similar clinics that are operating in low-income areas.

Policy Reform: Lobby Pakistani government to subsidise the health insurance premiums of the 60 million ultra-poor in Pakistan along with primary care.

Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?

Security: As the clinic is located in a slum, security challenges could arise due to lawlessness in the area. We have involved community elders to protect the clinic.

Political; No microinsurance program in Pakistan currently operates their own, self-managed OPD clinics & regulators could turn that into law. However, we maintain constant contact with regulators to ensure our beneficiaries' concerns get top priority.

Technology connectivity; Slow/unreliable internet could prevent smooth, 24-7 videophone-assisted medical doctor consultation in the clinic. We will carefully vet our ISPs.

Sustainability
Partnerships: Tell us about your partnerships.

Corporations: Allianz-EFU is our primary insurance underwriter; Unilever is our primary corporate client

Healthcare Providers: Over 250 providers are part of our nationwide network

Funders: USAID has financed the startup costs of the outpatient clinic

Beneficiaries: Over 15,000 outpatient and inpatient beneficiaries are the real drivers behind this service evolution.

Closing the Loop
How does your project primarily ensure that feedback delivers results?

Demonstrate how closed feedback loops can make a difference in people’s lives.

Please elaborate on your answer to the above question.

Feedback is collected quarterly through in-person meetings with beneficiaries & community leaders, medical screenings & a telephone helpline. It is then relayed to the insurance team to assist in the assessment of services (of which the Clinic’s establishment was one outcome). Unlike most social sector programs, beneficiaries contribute a nominal fee for services, which is nonetheless critical to the operational model & ensures that feedback is taken seriously. If services do not evolve as per demands, sustainability would be undermined, and the model would fail, thereby closing the loop.

Languages: In what languages are you able to read and write fluently?

English.

2nd Round Questions
Thinking about your feedback loop; what information are you trying to get from whom, to whom, and to bring about what change?

Information is collected from the low-income beneficiaries/customers of our healthcare plan and primarily pertains to four criteria:

- comprehension of insurance plan benefits and services
- ease of accessing these healthcare services
- experience pertaining to utilization of services
- affordability & willingness-to-pay for the healthcare plan

The information is routed towards the in-house insurance/business development team to assess and make the appropriate adjustments in the health plan. Sometimes these adjustments can be basic, relating to benefits or coverage levels and can be easily implemented. At other times, they involve a holistic needs-assessment of our beneficiaries’ demands, and a strategic review of what services we can realistically offer - the establishment of our Clinic being one outcome of such a review.

What is the purpose of your feedback loop?

Improve quality of programs

If other, please specify
What mediums or mechanisms do you use to collect feedback? (check all that apply)

Paper, Phone or voice, Physical gathering.

If other, please specify
Could you briefly describe the way you collect the feedback?

The Member Services team is our critical link, not just in the administration of services, but also in the collection of feedback.

At the Clinic level, both the front desk officer and the Clinic Doctors receive patient feedback and transmit it bi-weekly to the Clinic Director through both verbal and written communication. Round-table meetings with community leaders also take place every month in which input relating to the operations of the Clinic is shared and suggestions for improvements noted.

In addition, the Insured beneficiaries undergo mandatory bi-annual medical screening, in which their feedback is collected in written form by the screening Doctors and Medical Assistants. A dedicated internal resource also engages in periodic random customer surveys by phone to assess beneficiary satisfaction. Finally, a 24-7 telephone hotline is available to receive calls from beneficiaries relating to administration of the health plan.

What mechanisms are in place to protect people from retribution?

Option to provide feedback anonymously

If other, please specify
What are the immediate benefits or incentives for people to provide feedback?

Confirmation of use of feedback

If other, please specify
How do you ensure new and marginalized voices are heard?

Specific targeted outreach efforts

If other, please specify
What are the incentives for the intended recipient to act on the feedback?

They understand that feedback is necessary

If other, please specify
How does the feedback mechanism close the loop with those who provided feedback in the first place?

Meetings discussing results with providers

If other, please specify
How is feedback published/transparent?

Written report

If other, please specify
Give two concrete examples of how feedback loops have brought a program or policy more in line with citizens’ desires.

1 - Establishment of Clinic - previously, Naya Jeevan's health plan operated as in-patient hospitalisation insurance only, much like other insurance programs in Pakistan. However, given the target market of low-income people and their families, beneficiaries constantly demanded out-patient primary care services as their utilisation of it was much more frequent than hospitalisation services. As they were all paying beneficiaries, and their contributions were essential to the success of the program, it soon became unrealistic to operate without starting in-house primary care services. Thus, a dedicated Clinic was established that now serves both insured beneficiaries and the wider community. Interestingly, provision of primary clinical services has also indirectly fed demand for insurance services amongst non-insured community residents, thereby closing the loop.

2 - Provision of Ultrasound Diagnostic Services - the cost of travel + antenatal checkup services at the tertiary hospital was $10 for female beneficiaries in the Health Plan. As this was much too expensive, both female patients and community elders demanded that ultrasound services be provided at the clinic itself as such services were not available in the community. An ultrasound machine & toolkit was soon procured, along with a dedicated consultant who now conducts approximately 40 such checkups every month at a much lower cost of $3 per screening.

If there was one thing you could change to increase the impact of your feedback loop, what would it be?

While our current feedback loops are quite robust, and have evinced visible changes in our health plan and service offerings over the years, more efforts are needed to engage those beneficiaries who may not be using our healthcare services as robustly during the year as other beneficiaries. Naya Jeevan has now dedicated an internal resource to conduct surveys of random beneficiaries by phone, to ensure that feedback generated in the loop is reflective of the wider demographics of our beneficiaries. Such surveys will also ensure that those who may not be utilising our health plan extensively are still aware of the services should they ever be in a position to utilise them.

What are your biggest challenges or barriers in “closing the feedback loop”?

Lack of incentives for people to provide feedback

If other, please specify
Are you aware of The Feedback Store?

What are the main uses you can envision for the Feedback Store?
What is the one thing you would most like to see changed to improve the competition process?
What are you doing to make sure that feedback providers know that they are empowered by the information they can give and that they know exactly what the information they are providing?