The Disruptive Solution to Transform Health Systems

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The Disruptive Solution to Transform Health Systems

Kabul, AfghanistanKabul, Afghanistan
Year Founded:
2011
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Idea
Budget: 
$100,000 - $250,000
Website:
http://www.orcd.org.af
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Project Summary
Elevator Pitch

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

Our methodologies are based on sourcing international talents, conducting impact and feasibility evaluations, and empowerment of peripheral local actors. Using these experiences, we have come up with an idea to disrupt conventional healthcare model by providing an initial free Basic Preventative Health Package (BPHP) that has positive effects beyond the immediate users and is very cost-effective.

About Project

Problem: What problem is this project trying to address?

The problems of a health system are many and we are not trying to solve all of them. BPHP is an idea to reach out to as many people with minimum costs and maximum results. We realized the burgeoning cost of healthcare and lack of funds prevent accessibility, and an increasing demand for specialty care due to chronic conditions further exacerbates it. Preventive medicine has the potential capability to equalize these ‘pressures’, and by being accountable and having measurable performance we can deliver an effective care. BPHP is poised to adopt globalization by its advocacy nature and giving people a better choice. It not only provides complete coverage without burdening the nation’s spending but also keeps us healthy if possible or does it better and at a minimum cost.

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

For an illustrative example, we would use the employer as the major contributor of health coverage. During the free year all employees are mandated to attend preventative care under the guidance of a designated primary care physician. In this period, all employers would be evaluated and measured for anthropometric statistic and if they are identified with chronic diseases then they are coach by a wellness educator appointed by the company or community. The wellness coach can be a volunteer position, and is identified and trained by us. At the end of the period, employees are re-evaluated and data are presented to them and the insurance company to lower the premium. The expenses of the medical services can be negotiated to be paid by the company at a set fee or by the insurance plan.
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 vision is to revolutionize healthcare by bringing it back to the people. We envision the time when a primary care physician is also your health coach. He or she forms unconventional partnerships with ‘community healers’ as some culture commonly utilizes them and defines the responsibilities of a community. Every community should have health facility called ‘medical home’ for people to get integrated service and preventative care. This vision would save life and money. However, to achieve these we have set an overall objective. Our idea targets the high risk population containing chronic diseases because they are the main burden of health dollars spend. We aim to decrease one emergency room visit per year per person or save an equivalent of USD $1800 in matured market.

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

Our ‘idea’ at the current state is at its infancy, and hence, there is no solid data aside from research and successes seen in our private local clinics. These successful events later prompted our “Aha” moments and conceptualized our ‘idea’. Although we do not have any completed field data, studies have shown significant improvements in cost-saving and quality of life. BPHP is a simple solution that is incorporated into existing primary care with minimal efforts to improve the wellbeing of our fellow humans. Its nature is attractive as already consumers are gravitating towards healthy lifestyle but do not have the clinical knowledge. The impact of this solution is compelling at any levels. Let me illustrated with a story about solving the crisis of obesity in USA. BPHP has a proven success track of improving the BMIs of individuals over a year period. This is equivalent to solving obesity and its co-morbidities like diabetes 2 and hypertension altogether. These chronic diseases cost about $20,000 annually to treat per person, and our cost of management is $500 per person. To illustrate further, our clinic has the capacity to treat 2000 individuals at a total cost of $1M per year. Therefore, for a US population of 300 millions we would need 150,000 operating clinics for a total annual cost of $150 billion versus the current spending of $3 trillion. BPHP has demonstrated a social impact by saving 95% of our healthcare dollars annually and including the improvements in quality of life.
Sustainability

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

In the first 2 years (short term), we would like to build a solid base of evidence from field collection in two different settings: matured (USA) and immature (Afghanistan) markets using randomized studies. This is so that we could perfect our approach and gain valuable lessons about its socioeconomic impact. The following next five years (long term) would see us employing 500 BPHP facilities in all peripheral markets (Nicaragua, Zimbabwe, Afghanistan, Pakistan, Liberia, USA) as these are easily accepted and in needs the most. In this period, we continue to collect field data, refine our approach and engaging governmental collaboration. The long term sustainability would need to see the involvement of policymakers and support of large corporations.

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

As proponent of preventive care it is easy to identify our peers from the public health sector, CAM practitioners, allied and para-professionals, and including the community ‘healers’. In fact, in developing countries they are better received and regarded highly than the conventional doctor and hospitals. We have seen that some cultures patronize them more often than the doctor. Our competitors are hospitals and specialty group practice. They see us as hindrances to patient management or decrease revenues. However, we do not see them like this as every health system has a place for us. Our combined efforts in an integrated model can result in best practice, curb malpractice cost, and diversify from the shrinking health dollar.
Team

Founding Story

We have two “Aha” moments at the University of Liverpool and MIT. The first is that preventative medicine has huge payoff long term. The second is that the correct pricing of health products can improve access and cost. Based on these enlightenments, we created a model of ‘free’ preventative health care that would benefit beyond the immediate users, and is very cost-effective and efficient.
Organization Name

Organization for Research and Community Development

About You
About You
First Name

Chun

Last Name

Wong

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Innovation
Explain what the "innovation" is about, e.g., is it the idea and/or the model you use to accomplish the idea, or your understanding of the target population, etc.?

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.

Describe how your innovation model is distinct from any other organization in your field?

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.

What type of operating environment and internal organizational factors make your innovation successful?

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.

How do you make sure you constantly innovate in light of (potential) external challenges, or your growth plan?

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.

Organization Country

, KAB, Kabul

Business Model
The systemic challenge you are trying to overcome (select one)

Realign the incentives in the public healthcare system in mature markets, or

Health area (target market) where the need is [select only one]

Primary healthcare services

Categories along the health continuum you are covering [select all that apply]

Prevention, Detection, Intervention, Follow-up, Social integration.

Stage that best applies to your solution [select only one]

Idea (poised to launch)

Core strategies of your business model [select all that apply]

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.

If other, specify here:
Most relevant tools you are using to implement the strategies outlined above [select only two]

Technology, Education/training.

If other, specify here:
What is your value proposition?

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.

Who is your customer(s)?

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.

What approaches to you use to reach your customers?

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.

What are your primary activities?

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.

What other challenges - individual, organizational, or environmental – are you currently facing or might hinder future success of your business, and how do you plan to overcome those?

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.

Briefly describe your growth strategy going forward

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.

What dimensions for growth are you currently targeting for your innovation [select all that apply]

New regions(s), New market(s)/country(ies).

What makes your business "ready" for growth?

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.

What are your key growth objectives?

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.

Organization's Country of Operation
Social Impact
What methods for quantification of social impact are you applying (if at all)?

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.

Could your solution work in other geographies or regions? If so, where?

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.

What is your projected impact over the next 1-3 years?

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

Sustainability
Elaborate on your current financing strategy
Share of revenue generation in total income of organization (in percent)
Direct sales to patients or other beneficiaries (in percent)
Of the possible sources of these sales listed below, check all that apply to your current strategy

Licensing fees, e.g., for technology/franchise model (in percent)
Of the possible sources of these licensing opportunities listed below, check all that apply to your current strategy

Service contract with organizations, e.g., government, NGOs (in percent)
Of the possible sources of the service contracts listed below, check all that apply to your current strategy

Explain your revenue generation strategy in more detail
Share of philanthropy in total income of organization (in percent)
Philanthrophy strategies you are using

Explain your philanthropic approach in more detail
Expand on your selections; explain how you will sustain funding over the next 1-3 years.
Years in Operation

Operating 1-5 years

Has the organization received awards or honors? Please tell us about them

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