EVA: Enabling Access to Quality Healthcare via Comprehensive, Gender-Equal, Health Insurance

One of the biggest development challenges in ASEAN, South Asian, MENA and Sub-Saharan African emerging markets such as Pakistan, Nigeria, Indonesia Philippines and Mexico, nations of 115+ million[1], is that there are fragile populations who lack social safety nets, who are financially excluded, have little to no savings and have minimal access to affordable, quality healthcare. The World Bank estimates that there are 600+ million workers globally who are linked formally or informally to corporate supply & value chains who fall into one or more of these categories (e.g. smallholder suppliers, seasonal farmers, distributor sales force, SME retailers, micro-retailers, factory workers, etc.)

In both developing countries and developed countries (eg. US), catastrophic health expenditures (e.g. heart attacks, strokes, trauma, maternal hemorrhage, etc) trigger major financial shocks for the uninsured (or under-insured) leading to generational indebtedness. Populations at heightened risk for this include migrant workers, refugees, internally displaced people and ethnic minorities. These fragile populations embody the ‘missing middle’ - neither are they eligible for national health insurance or government social security programs (usually because of their (il)legal status) nor are they able to afford quality, private sector healthcare.   

Without health insurance, these value chain workers are forced to liquidate their assets, falling further into debt traps, at the mercy of predatory loan sharks who exploit their financial exclusion from mainstream banking. 

Specifically focusing on the US, there are over 2 million elderly Brown people (mostly South Asians) who are dependent on family members to coordinate their care. This places a tremendous physical, psychological and socioeconomic burden on the Senior's family as the family member (predominantly the daughter) is forced to relinquish their full-time employment and exit the workforce or work part-time.  

EVA (Empathy, Voice, Agency) is the emerging world’s first digital “Kaiser-Permanente for the uninsured” and is powered by Naya Jeevan (‘new life’) a hybrid fintech/insurtech venture. EVA was launched in 2019 and is already scaling in South Asia (starting in Pakistan), providing over 150,000 lives with affordable access to high-quality healthcare.

EVA finances high-quality private sector healthcare for previously uninsured workers, including their families - spouses, children and elderly parents. EVA provides them access to a digitally-integrated ecosystem of innovative, healthcare providers (an Integrated Delivery Network (IDN) of over 1000 clinics, hospitals, pharmacies and labs).

EVA enables the delivery of these large-scale, digital healthcare & well-being programs for underserved workers linked to corporate and industrial value chains. These tech-enabled programs are financed by large, multinational corporations (MNCs such as Unilever, Mondelez, Friesland Campina, etc.) and structured as market-based incentive, performance, loyalty or workforce retention programs. As an illustrative example, one MNC has increased its 3rd party salesforce retention by over 40%, generating a 150% financial Return on Investment (ROI) over the past 5 years.

In the US, EVA focuses on Brown people of colour (South Asians). Its focus on the South Asian diaspora in the US (~11 million lives including 2 million elderly) leverages EVA's unique access to Healthcare Providers (HCPs) of South Asian origin (HCPs including doctors, therapists, nutritionists, pharmacists and community health workers). 

The initial focus for EVA in the US is the care coordination of underserved Seniors of South Asian origin (i.e. Brown people). The service would include: (i) escorting patients to hospitals or clinics for outpatient/chronic disease management,(ii) communicating directly with Primary Care Physicians (PCP) and/or specialists on behalf of Seniors, (iii) translating diagnostic and therapeutic advice received from HCPs into local language spoken by the beneficiary (Hindi/Urdu) in real-time, (iii) reinforcing adherence to therapy (performed by pharmacists) and  (iv) coordinating medical care (e.g. digitally integrating services received at hospitals, Skilled Nursing Facilities, Rehab Centers, home-based healthcare, etc)

EVA benefits low-income, underserved workers linked informally or formally to corporate and industrial value chains (e.g. smallholder suppliers, seasonal farmers, distributor sales force, SME retailers, micro-retailers and factory workers linked to the supply chains and value chains of MNCs such as Unilever, Mondelez, Friesland Campina, Tommy Hilfiger, Levis, etc.). The health insurance program also benefits the families of these workers (spouses, children and elderly parents). Household incomes for the target population range between $3/day and $10/day.

A significant portion of the target population is internally displaced people (IDPs) who work as seasonal farmers in agri-value chains (e.g. cotton pickers, dairy or livestock farmers, etc.) or as factory workers in the garment/textile industry which is prevalent across East Africa, the ASEAN region and South Asia.

In the US, EVA focuses on Brown people of colour (South Asians). Its focus on the South Asian diaspora in the US (~11 million lives including 2 million elderly) leverages its unique access to HealthCare Providers of South Asian origin (HCPs including doctors, therapists, nutritionists, pharmacists and community health workers). 

By financing catastrophic health expenditures, EVA enhances the resilience of fragile populations, providing them with a durable safety net (or trampoline/springboard – choose your metaphor).  The most valuable, income-generating assets are human assets – these assets are protected via tech-enabled, comprehensive health insurance provided by EVA.

The EVA team is a multidisciplinary group of entrepreneurs, doctors, nurses, MBAs, design thinkers and UX experts. One Co-Founder is a former VP of Sales at Thomson-Reuters (USA) with expertise in women’s entrepreneurship – she has also accelerated over 200 women-led businesses as part of a World Bank Women X accelerator. The other Co-Founder is a US-trained medical doctor-cum-MBA (in finance) with over 25 years of healthcare experience in global health systems.

The EVA team is fluent in Hindi/Urdu (spoken in India and Pakistan) and Mandarin (spoken in China and Taiwan) and represents the communities it works in. The team has spent over 10 years on-ground in Asia and is sensitized to the local cultures and social norms.   

The EVA program was co-created with the direct input of the target population using human-centred design thinking. Members of the EVA team embedded themselves within target communities and diverse work environments (factories, fields and farms) and silently observed the lived experience and unmet health needs of value chain workers and their families (especially women, children and the elderly). 

Direct customer feedback and immersive, experiential and iterative learning guided the EVA team during the program design, prototype and pilot phases. 

During the rapid prototype phase, several revisions were made to the digitally integrated health (finance + service delivery) model (e.g. any insurance reimbursements were made via digital bank accounts. These accounts were automatically opened for beneficiaries (especially women) to help promote their financial inclusion.

Since 2019, EVA has impacted over 300,000 workers linked to corporate value chains. With over 75,000 supply chain workers actively enrolled in its annual subscription plan, EVA generates more than $2 million in Annual Recurring Revenue (ARR). NAYA JEEVAN is the social enterprise that operates the EVA program and has raised over $3 million in equity and R&D grants.

EVA has scaled to service workers across all 6 provinces and 92 districts of Pakistan (out of 144). It is well-positioned for replication in other South Asian countries (India & Bangladesh) between 2025 and 2027.

EVA is especially primed for replication in the US with a special focus on Brown people of colour (South Asians). Its focus on the South Asian diaspora in the US (~11 million lives) leverages its unique access to HealthCare Providers of South Asian origin (HCPs including doctors, therapists, nutritionists, pharmacists and community health workers). 

The initial focus for EVA in the US would be care coordination of underserved Seniors of South Asian origin (i.e. Brown people). This service would include: (i) Hindi/Urdu translation services (ii) reinforcement of adherence to therapy by pharmacists and (iii) medical care coordination (e.g. integrating services received at hospitals, Skilled Nursing Facilities, Rehab Centers, home-based healthcare, etc)

Thousands of qualified, Brown (South Asian) healthcare providers (HCPs) are not participating in the US workforce and can be reintegrated for non-diagnostic care coordination. Many of these providers are women who are Foreign Medical Graduates (FMGs) - they are completing their US medical licensing exams (USMLEs) for full-time reintegration into the US workforce. Such well-trained resources are ideal for delivering high-quality services such as Medical Care Coordination (MCC) that reinforce the diagnosis and treatment plan recommended by the patient's Primary Care Physician (PCP). In other words, these FMGs would serve as a vital health support system for elderly Brown people in the US.  

EVA has already prototyped a B2C (Direct-to-Consumer) business model in the US using a monthly subscription plan of $99/member/month for unlimited access to women Foreign Medical Graduates (FMGs) Care Coordinators

We believe SOLVE can help us in the following ways:

Markets: SOLVE can introduce us to large corporate clients in the US with whom we can replicate our inclusive, digital health insurance model

AI Technology: We generate a lot of health insurance claims data. Access to AI expertise (predictive analytics) would enable our healthcare delivery system to shift from reactive healthcare (post-event) to proactive, personalized healthcare (pre-event). Early intervention based on predictive analytics would help improve health outcomes for our insured beneficiaries while also enabling EVA to price its health plans more accurately. In addition, providing our beneficiaries with real-time access to generative AI (via a mobile-app-enabled chatbot) would help improve our efficiency in responsiveness to customers (health seekers) and timely healthcare delivery.

Entrepreneurial Learning Journey: We would like to share key insights from our learning journey with other SOLVERs via opportunities for peer-group, knowledge exchange.

Visibility with Mission-Aligned Impact Investors: SOLVE provides impact ventures with a tremendous opportunity for potential investor-investee matching, especially via the Marquis event in NYC every September.

In the US, our Theory of Change is the following: we believe that foreign medical graduates (the ‘inputs) can help deliver high-quality coordination of healthcare (the ‘outputs’) that lead to better management of chronic diseases (e.g. intermediate-term outcomes such as successful management of type 2 diabetes and blood pressure) that culminate in a reduced incidence of catastrophic health events (i.e. long-term out-comes such as heart attacks and strokes).

In emerging markets our Theory of Change is the following: we believe that corporate financial resources, value chains and human talent (the ‘inputs) can lead to the enrolment of underserved value chain workers into inclusive, digital health insurance plans (the ‘outputs’). These outputs lead to improved, affordable access to quality healthcare and protection against financial shocks triggered by catastrophic health expenditures (the ‘intermediate-term outcomes’) that culminate in increased financial inclusion and improved health outcomes events (the ‘long-term outcomes’)

Impact goals for our US model include:

(i) Improvement in health outcomes for Brown people (especially the elderly)

(ii) Increase in income levels of Foreign Medical Graduates (FMGs) not participating in the US workforce

(iii) Inclusive employment of women FMGs in the emerging care coordination industry

These goals are measured quarterly and annually using the following Key Performance Indicators (KPIs):

(i)  %  relative change in Incidence of Non-Communicable Diseases (NCDs) in the target population

(ii)  % relative change in prevalence of mood disorders (anxiety, depression, PTSD) in the target population

(iii)  Change in individual monthly Income level of FMGs not participating in the US workforce

(iv) Number of inclusive jobs created for women care providers in the emerging care coordination industry

Impact goals for our emerging markets model include:

(i)  Improved health outcomes in value-chain workers and their families/dependents

(ii) Improved financial return on investment (ROI) for corporate financiers of health insurance plans benefiting value chain workers

These goals are measured quarterly and annually using the following Key Performance Indicators (KPIs):

(i)  % relative change in prevalence of mood disorders (anxiety, depression, PTSD) in the target population

(ii) % relative change in Incidence of Non-Communicable Diseases (NCDs) in the target population

(iii)  % change in financial Return on Investment by corporate-financier (MNC)

EVA is a fintech-cum-insurtech-cum-healthtech that uses a mobile-app enabled solution to provide its health insurance members with cashless (digital) access to a nationwide network of providers (clinics, hospitals, pharmacies, labs, etc.). Any co-payments are made digitally via automated deduction from a digital bank account that is linked to the digitally-enabled health insurance plan.

Health plan members are also able to chat, text, VM and schedule video-consultations with healthcare providers (HCPs) using EVA’s digital health platform.

As part of its next phase of evolution, EVA is integrating predictive analytics into its healthcare utilization forecasting models and generative AI (genAI) into its health plan service delivery model.