The Disruptive Solution to Transform Health Systems
Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.
Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.
Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?
Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?
Founding Story
Organization for Research and Community Development
Chun
Wong
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Most countries are burdened by an increasing healthcare cost, unequal distribution of quality and quantity of care, and unsustainable model of care regardless of their delivery system. A major reason is the ineffective management of chronic diseases, their growing prevalence, and progression to acute episodes and long-term burden.
• Consumers recognize the limited success of self-care for their chronic conditions.
• Providers frustrated with low reimbursement of managing chronic diseases and their co-morbidities.
• Employers and/or government see the high economic cost of healthcare decreasing their resources and abilities to compete globally.
• Policymakers realize the disconnection between incentives, management of chronic diseases and overall effectiveness of health system.
The disruptive factor that we proposed is the initial free BPHP. This package helps address the challenges of chronic care. BPHP is segmented to different population groups. It consists of conventional diagnostic and therapeutic services with emphasis on patient advocacy targeting obesity, cardiovascular health and diabetes. Researchers at MIT’s Poverty Action Lab have proven that when the benefits are not instantly visible but have potential to extend beyond initial users onto a larger social circle then the ‘product’ is a good candidate for free distribution. Even if the ‘free product’ is not utilized completely, the ROI of preventive behavior is huge. Last, a free package can circumvent the ‘thinking factors’ of inconveniences and finance, and encourages increase usage.
Already there are others such as the Clinicas del Azucar who has created an integrated “one-stop-shop” medical care but yet there are more of those in our system who are just traditional healthcare facilities that are incentivized by volume. It is true that some are innovated to provide low cost services that are fully sustainable. However, our approach differs amongst them because BPHP is evidence-based practice and ‘free’. We based our approach on findings by MIT that even small fees can cause big reduction in uptake of services and not promote usage. This attempt diluted balance access and sustainability as small fees raise little revenue, and restricted distribution. Moreover, an initial free offering is more likely to stimulate further consumption within and among even at a cost.
Our ‘idea’ works best in a mature primary care environment whereby the System has already a platform of delivering services and products. This matured system has a network of consumers, providers and insurance companies. It is even more urgent if the System has experienced a ‘wicked’ state of much needed health reform, and the population has adopted a national culture of consumerism. For example, a traditional facility can be easily converted into a clinic with wellness coaches, and taking advantages of electronic medical record, community facilities, websites and social media capabilities, and focused health educational materials for targeted group. Insurance and companies even State are more likely to fund this initiative as the short and long term effect is cost-saving.
We realized that all plans are not without constant challenges especially along the growth path. Therefore, ORCD as its primary mission is constantly performing feasibility and impact evaluation of similar or new model in other markets especially those supported by governments and donors. As a NGO we have the capacity to do randomized studies about the different attributes of BPHP to better the program and hence, adapting it to constant climate changes of market. Also, as an ‘idea’ BPHP should be tested in smaller and stable markets such as within companies and employers or even a community center. It is more effective if collaboration can be formed between governmental agencies for promotion and insurance companies.
, KAB, Kabul
Realign the incentives in the public healthcare system in mature markets, or
Primary healthcare services
Prevention, Detection, Intervention, Follow-up, Social integration.
Idea (poised to launch)
Approaches to behavioral change at the individual level, Patient-centered design, New/redefined roles for healthcare service provision, New approaches to distribution of health products and services, Unconventional partnerships (between traditional healthcare players and players outside healthcare), New financing strategies for health.
Technology, Education/training.
Our value proposition is three-fold. We are targeting high risk groups that are on an increasing rise. For an individual primary care physician; our idea would saw increase revenue, and an ease of patient management because of high enthusiasm and compliance. Patients are easily enrolled as they are captive audiences in companies and institutions. For the hospitals; BPHP could be used to leverage their long-term competitive position in the community as health care dollars become scarce and consumers value individualism and indulgence. This idea is particularly attractive to their stakeholders because of a population-based care management. For the health insurance companies; it is a value-added service for their plan to provide BPHP and can increase enrollment from healthy population.
Our BPHP works best in situations with groups and communities such as villages, companies, institutions and even conglomeration of families. Therefore, our ‘customers’ are them and the local health clinics. The local clinics are easily integrated into the lives of the community because they have already earned their trust as a source of credible information and experts in health care. Moreover, most clinics are basic in operation and need high revenues to be sustainable. BPHP is easy to incorporate into them because all we need is a doctor, a health coach which could be them or a volunteer, an efficient web presence with superior social media capacity, customized and printed materials, and partnering with unconventional healthcare actors.
The approaches we used depend on the community and its targeted groups. If it is a developed area then we would use low cost advances in the beginning such as networking and alliances with key stakeholders of organizations such as Diabetes Association, corporate companies, etc., and when we are profitable then we could use social medias to target forum and online groups faster. If it is a developing area we could form alliances with for-profit organizations such as Coca Cola, Telecom, etc. because of their massive delivery system, and we could also organized volunteers as an NGO to enter into villages and the community to reach our customers. Our experiences have shown us that religious centers are a cheap and easy communication route because of a dedicated and captive audience.
Our primary activities are providing preventive care for high risk population having chronic diseases such as diabetes, obesity, cardiovascular conditions, and even possibly stress-related emotional conditions. We would be operating in a clinical setting at a community level engaging local actors in workshops, schools, churches and companies. Our founder has recognized the immense value of women contributions and the potential efforts of the children for the next generation wellbeing. Therefore, we would focus our activities on them as stewards of our initiatives.
Like most NGOs our immediate challenge is the financial capacity to carry out the plan. In addition, as a young organization our next obstacle is the recognition of our great idea and proposal, and credibility to uphold the initiative. Our resources might be limited but we have perfected a system of mobilizing pro bono and per diem professional talents from among our sister NGOs, and using local volunteers we are able to penetrate the market. Our techniques are unusual in that we based our approaches on research and decentralization to reach targeted or segmented group in a sustainable style. This is also our trademark approach of peripheral empowerment.
The easier growth strategy for us is to capitalize on our existing health projects, and in countries that have major gaps in health care. As a NGO based in Afghanistan and many more of us in developing countries, we are most welcome by local agencies and actors. We have already formed many private and public partnerships especially with the health communities. We are ready for growth.
New regions(s), New market(s)/country(ies).
It has been almost two years that our organization has grown into different countries with different climate of system. These local contacts and know-how have given us an advantage for growth and expansion. Our relationships with different local organizations have strengthened our capacity to easily implement any changes in a positive way. Our core expertise is the health system.
Before we attempt large scale growth or duplication, we would like to fulfill our initial criteria of doing a feasibility and impact study on BPHP in developed and developing countries. The results are important for us to understand the socioeconomic effects before any large scale growth. We think this is the best usage of resources before expansion.
The impact of our approach is quantified using the quality-adjusted life year (QALY) and the social return on investment (SROI).
QALY and its cost ratio are a measurement of the effectiveness and cost-effectiveness of the intervention respectively. QALY is expressed with value of negative (worst health) to 1 (best). It measures the quality and quantity of health with and without intervention. The ratio or cost-effectiveness is expressed as dollars per QALY, and this number is compared with different interventions.
SROI is a process to monetize value of social impact. It is calculated by dividing the dollar value gained of the intervention (output) by the initial investment (input) to give you an indication of the value of social impact for every dollar invested.
It is highly possible that our solution can work in other geographical areas of both developed and developing countries. Our solution is to provide a preventive care package for chronic disease population, and this issue is prevalent worldwide. In theory, BPHP can works anywhere but customized to local culture. However, we cannot confirm the effects of socioeconomic and health impact without doing an evaluation which we recommended and normally does before any scaling-up. Based on our previous projects and partnerships in developing regions, we are able to ascertain the positive feedbacks about any health initiatives.
Our projected impact using diabetes example over the next 3 years in USA alone (not counting our sister NGOs) includes:
• Improved health outcomes and life expectancy by up to 10 years
• Saving of $245 billion for treatments
• Decrease % GDP of health from 16 to 1 annually
• Potential saving of about $2.85 trillion in total health expenditures
• Expansion to 20 clinics and 40,000 patients served annually
• Decrease in hospital admission by 10%, ER 20% and save patient $2000 annually
• Creation of 20 health coach jobs to contribute to local economy
• Hundreds of volunteers learn to be effective health stewards of community
• New rising generations groomed from school and community workshops to practice preventive care and healthy living ensuring sustainability of health system
Operating 1-5 years
ORCD has been recognized and honored with numerous provincial and international awards since its inception in 2011.
International:
• Aga Khan Development Network for sustainable management
• GIZ-DETA on behalf of Germany Federal Ministry for Economic Cooperation and Development in agriculture
• International WorkLife Balance Award for contributing to welfare of women in society
Provincial:
• Department of Women Affairs (women empowerment) in Daikundi
• Women literacy training in Baghlan
• Baseline Nutrition Survey using SMART methodology in Kandahar
• Provincial Coordination and Management Committee for agricultural projects in Baghlan