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Uplift Health Mutuals

Uplift Health Mutuals. Saurabh Sharma. Uplift Health Mutuals. Community based health fund (CBHIs, MHOs) Uplift Mutuals: Group of Social Sector Organisations Based in Maharashtra & Rajasthan . Uplift Health Mutuals: A Case Study. Purpose of Study

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Uplift Health Mutuals

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  1. Uplift Health Mutuals Saurabh Sharma

  2. Uplift Health Mutuals Community based health fund (CBHIs, MHOs) Uplift Mutuals: Group of Social Sector Organisations Based in Maharashtra & Rajasthan

  3. Uplift Health Mutuals: A Case Study Purpose of Study • Document the Uplift Model & Processes • Review Key Performance Indicators, Sustainability, and Client value Method of Study • Qualitative and Quantitative • Literature review • Interviews with process managers, clients and senior management • Secondary Data Analysis • Observation of key procedures

  4. Flow of Presentation • Community Based Health Insurance • Uplift: Timeline, Model & Product • Growth & Impact • KPIs • Client Value • Program Sustainability • Cost model • Program Costs • Way Forward

  5. Outreach of Community Based Insurance in India

  6. Challenges for community based risk solutionsSource: ILO, MIF Low community participation Lack of professional management Small size of risk pool Incomprehensive product Isolation from formal insurance mechnisms

  7. Uplift: Timeline, Model & Product

  8. A Decade for Uplift

  9. Partner Members

  10. Arogyanidhi: the product

  11. Value Added Services: Reducing Health Risk

  12. Health Education: Reducing Risk Awareness Material Awareness Sessions

  13. How it Works Uplift as TPA Negotiated Rates Monitoring HCPs Networked Health Care Providers Claim Processing Health seeking Guided by Arogyasakhis Final Claim Settlement & Disbursement at community level

  14. Growth & impcat

  15. Reviewing Growth: Number of Ongoing Members

  16. Uplift: Efficiency & Client Value • 24% Reduction in Out of Pocket expenditure • Remarkable impact • Service Ratio at 56% • Proportion of clients using IP/OP insurance Services • Claim rejection Ratio at 2% • Initial high rate at 10.5% • Key for Community Based Models • Voluntary enrolment at 8-10%

  17. Client Value: PACE Analysis Source: ILO, MIF

  18. Reducing Out Of Pocket Expenditure

  19. Improving Client Value • Challenges in improving client value • Reimbursement based product • High OP Care expenses leading to high OOP • Challenges in providing Cash less system • Increase in negotiated prices • Role of community diminished • Increased chances of Fraud

  20. Program sustainability

  21. Costing Model • 100% Gross Premium Collected • 60%: Claim Fund • Claims Disbursed • Solidarity Fund • 20%: Uplift • TPA Services • Value Added Services • Opex • 20%: Partner Organization • Value Added Services • Opex • Subsidy Provided by Inter Aide • Opex • Value added services

  22. Total Program Costs Total Program Costs on Per Member basis for Partner Organizations Source: 2009

  23. Dependency on Claim Funds Claim Ratios for Partner Organizations

  24. Operating Expenses Operating Expenses on Per Member basis for Partner Organizations

  25. Dependency on Subsidy

  26. Way Forward • High Operating expenses for partner organizations • Tripling the current outreach • Automation of routine functions • Enhancing Client Value • Instant Cash Loan Product (Health Expenses) • Reinsurance facility to increase cover • Structural challenges • Attrition of Service executives • Adverse Selection • Fund management at branch level

  27. QUESTIONS?

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