Protecting Households, Promoting Health

Evidence from India points out that 70% of all out of pocket expenses on health is on medicines and outpatient care, playing a major role in 7000 people slipping every hour into poverty. However, most of the health insurance including those funded publicly, is focused on hospitalisation. Further the asymmetry of information that exists in accessing health care in cities adversely affects the poor, as they end up, paying more. 

A health insurance where people participate in the design and decision making , a health insurance design where the focus is wellness and keeping people healthy, and one that reduces information and access barriers to health-care, can bring out a wider adoption of health insurance specially for those who are under-served and need them the most.

A community-designed model of health insurance covering primary health-care and access needs could make the under-served meaningfully protected against health risks.

7000 people slip in poverty in India by the hour because of out-of-pocket expenses on health, of which 70% is on medicines and out-patient care.

With public spending on health-care just above 1% of the GDP, millions of households either borrow at very high interest rates, mortgage their belongings to fund their health expenses or forgo treatment all together. 

Absence of timely primary health-care access including affordable medicines, information asymmetry about health-care options contribute majorly to the financial distress that families face. Existing health protection solutions are top down in design and do not empower households to keep themselves healthy and focus mostly on post risk management. Women Children and the elderly are the most vulnerable amongst the affected ones.

Uplift Mutual has designed one of the only women-led, health-focused tech-leveraged health protection  programme in India aimed at protecting households against both catastrophic and long term health risks by offering primary health care solutions.

By offering cashless primary-health services like outpatient care, screenings, 24X7 access to doctor , network of care-providers, medicines with discount along with a hospitalisation cover , through a women managed claims design, we build trust , education required to sustain such health-protection models.

Our current focus is on the 70% of India's 1.4 bn population living in urban slums and settlements, micro entrepreneurs, daily wage workers, house maids, sanitation workers, gig economy workers ,Medium and small enterprises employees, unorganized sector workers to farmers across rural and tribal settlements .

With about 6-10 $ a day family income, health is not their priority till they have a financially destabilizing health event or are diagnosed with lifestyle diseases that need long-term medicines and diagnosis for which they have to either give up on their hard earned savings, cut basic expenses or borrow at very high rate of interest.

We work with these households through cooperatives, trade-unions ,Micro-finance institutions, employers, farmer producer companies and offer membership with voting rights and representation in the protection programme.

We first understand the health care access needs and behaviour of the given segment and sit with the community leaders to validate the actuarially designed product and service features.

While this is a onetime process it ensures that the product meets their health protection needs and works to fulfil them. The product covers both daily health needs including access to medicines as well as that of hospitalisation risks.

We work with households and communities to design and deliver mutual health protection that covers 70-80% of their health care and access needs including hospitalisation risks and medicines with discount.

Our target households do not know or do not trust available health protection. We break down health insurance components into easily understandable concepts and work with women to redesign the same using established principles of solidarity and risk pooling. This way we make member households party to the design and decision making.

At Uplift we onboard such families through member organizations who are solidarity based or provide livelihood support to these families. Upon enrolling as a member, the families for the first time get cashless access and opportunity to manage their health via the nearby outpatient care facility , the 24X7 medical helpline, the savings on medicines and diagnostics, the targeted health screenings and follow ups and the health coaching.

Uplift solves the major issue of information asymmetry by building a network of multi care preferred health-care providers and providing health care intelligence to its members on appropriate care and cost and facilitating the same. We work with a variety of health care providers primary, secondary and tertiary and create a process where our members feel welcome and safe.

The 24X7 medical helpline is one of the most important services as we have been able to guide members to quality health care in emergencies at the best rate available. This information is generally not available to member households and provides them the information to make an informed decision.

In case of hospitalisations, the members file claims that are first medically validated and then come to member claim committee meetings for decision making. This is the most empowering part where the members decide how they spend the money they have together, to help one of them. Where decision making is not required the claims get settled within 8-48 hrs. This has brought not just a sense of ownership in members but also helped take decisions that are fair and sound for the claimant and the mutual-aid fund respectively.

Uplift follows a radical transparency model where the risk pool and service details are available to every member via a mobile app available in local language and serves both as an access and service point. The app also allows for getting real time feedback from members and for voting on governance purposes.

We are redesigning health protection solution to protect 7000 people from slipping into poverty every hour. We are working with under-served families and communities to cover wellness than just hospitalisation. We are building inclusive solutions that allow people irrespective of their age to join this health protection. We are reducing out of pocket expenses on primary health care and medicines and making it easy for low income families to access the often opaque system of health care provision. We are doing so by delivering them through technology by automating processes one by one and in a staged manner so that they can be scaled across geographies while maintaining the trust and radical transparency that a community-model brings. 

By understanding and focusing on what people need in terms of health care , we have covered out patient care, health screenings, wellness sessions, access to quality medicines at appropriate costs that allow a large number of our members to not only navigate the complex medical system but also have options of accessing preventive care near to them. This has led to lower hospitalisations over a period and high client value and satisfaction for the member families. 

We maybe one of the few in the health micro insurance space in India that work with under-served communities directly as members and use technology and data to make decisions in making the scheme technically viable.

Our solution is empowering women at the base-of-pyramid to take decisions around their health and take preventive and promotive measures.

We have re-imagined health insurance , community driven health insurance to be delivered to the last mile using technology so that we could be both efficient and effective. Consequently, we have developed a micro insurance solution architected  to handle health, agriculture, cattle, property and life risks. Developed as one production version and instance it has been developed as software as a service model and is hosted on AWS. It’s a web-based application with a mobile app portfolio. It has role-based authentication, is modular, is event driven and a transactional business model.

The solution allows for settling of claims in a matter of 8-48 hrs and stores all data and transactions related to on-boarding and health services accessed. This was earlier a community intensive process and would take 30-45 days as the claims committee would meet once a month. It has reduced operations cost by 30%.

The mobile app follows a radical transparency design in showing real time data of the number of members in the programme, number of people availing  different services, number of claims filed, and financial aid disbursed. Members can access their policy data.

The app also allows members to file a claim, register for a health service, order medicines and find information on network of hospitals. 

Developed as a CSR support, we have several iterations planned in stages to make the application mirror the operations  including online on-boarding, payments gateway, integrating health records and crunching data to predict the kind of preventive services required for the members.

With 70% of total out-of-pocket-expenses on health being on medicines and out- patient care, under-served families in India really need health insurance/protection  to work for them. They need quality primary preventive care, they need access to medicines and they need to access care that is appropriate in both quality and cost. Otherwise all financial progress made by these low-income households could be lost to one catastrophic health event or long-term care that requires medicines and diagnostics. Hospitalisation-only based solutions fall short of what people need and people need health.

Many argue that insurance penetration is low in India because the vast majority are uneducated, unaware, true to some extent- our on-field experience says existing solutions do not solve the real needs of these households and have been found wanting when people who had them, really needed it. Our solution builds trust , it provides value for money, it hand-holds these households into changing their health- seeking behaviour by offering primary-care as part of the protection. It empowers women to take charge of their health. The technology part allows us to offer the solution irrespective of geography-the model is working in urban, and tribal dwellings across three states in India and we are working to integrate primary health services on to the tech platform so as to offer them seamlessly.

An ILO study found us to be one of the highest client-value offering programmes while our own data shows that our hospitalisation incidence is lower thanks to our health services. 

Started in 2017 , we are currently reaching out to 35000 lives across three geographies in India. 

Based on our capacity to raise further funds, we plan to reach about 50,000 people next year and about half a million lives by 2025. 

In our mutual risk pool we have currently women and their households as members from the housemaids association, women from the credit cooperatives, women who are micro-entrepreneurs, construction workers, restaurant employees, school teachers, farmers producer company, self-help group federations, employees of small and medium enterprises, people from all ages are included in the programme without any price differentiation. 

These households have never had access to any health protection programme and have often relied at private health care in the absence of public health care services paying at times more than the affluent for the same type of care. 

We have old couples as members who would otherwise not get access to any programme due to their age.

We have very recently started to introduce this programme in Govt sponsored and aided schools as children coming to study in these schools will never get access to such programmes and will learn very late in life if they ever will about health protection.

Our overall goal is to reach millions of families with a high impact and viable health protection model that prioritises wellness and allows families to enjoy their economic growth without having to worry about adverse impact of out of pocket expenses on health whether catastrophic or long term.

Our next year goal is to expand and grow our distribution channel so as to reach out to the number of people we have planned for. Our goal next year is to also bring high quality and low cost diagnostics into the offering and understand how to price it within the design. We currently offer discounts from third parties. Our goal is to integrate online payments and on-boarding capacity as well as health records on to the app.

In the next five years we should have all the processes digitized with only physical health services delivery and member outreach remaining. We should have developed technical capacity to work in partnership with fintech's working to bring financial solutions to the masses and use them as our distribution channel.

We have  three main barriers for achieving our goals 

We are currently a B2B2C company working mostly with distribution channels that are mostly micro finance institutions. While many of them have found the product to be needed by their target clientele, they have regulatory apprehensions in working with us at scale since its a community driven design.  

The second is finding financial support to invest in health services, in software development, in research and development and sustaining the minimum level of operations till we reach a critical mass as without a strong distribution network, growth is slow and uneven.

Being a niche area of development we dont find suitable talent to manage the operations or the health services. If the first two barriers are adequately addressed support for skilling field and management staff would be critical.

From our past two year learning's, developing  distribution channels that are open to work with us is a capital intensive measure. We are looking for investors who can provide us with debt to invest in our distribution channels and are currently scouting for patient investors or philanthropic capital. 

Concurrently as we plan to scale we are working with our stakeholders and well-wishers and our advisory council to advocate with the Regulator to give us recognition as a successful community driven design.  

Meanwhile as we are very new to fund raising be it grants or investment, we are trying different routes to raise philanthropic resources and start becoming visible to organisations looking to invest or support in models like ours. We have a five year business plan with clear components that need grant funding and where investments could be taken up. We are currently working with an tech-accelerator to understand the environment and help us navigate the same.  Our founder is an ASHOKA INDIA fellow and is using the fellow network to identify potential support for the solution. 

We are also trying to find resources for HR development in the interim.

Full time staff-20

Part time- 2

We are a team of practitioners that have been working on developing health mutual micro insurance solutions since 2004 across 9 different urban rural and tribal geographies in India that together today cover  300000+ lives. 

In its second iteration we are developing a new model where different communities across different geographies are together in our effort to grow and scale.

We have a team of medical doctors that has been working on the primary health care design now for 10+ years. We have actuarial support  on our advisory committee. We have a tech person as part of tech CSR partnership under whose leadership our software has been developed and the app is under construction.

The founder is an ASHOKA fellow and is recognized for the work currently under progress. He has led the team in expanding footprints into rural and tribal areas as also designing the application for the members.

We are supported by the International Cooperative and Mutual Insurance Federation based out of Manchester and the Cooperators- a cooperative insurance company from Canada who have given us the first financial and technical support for starting this new iteration.

Current Partnerships

TIETO India: For coding and developing the management information system for the programme and the application for members

International Cooperative and Mutual Insurance Federation Foundation,UK and the Cooperators, Canada : Technical and financial support to initiate the new multi community multi geography version of community driven health protection. 

We reach out to under-served families through our partner organisations who are either solidarity based, have micro-finance operations are farmer cooperatives producer companies or medium and small enterprises.

We introduce the concept to the clients/ member families of these partner organisations and after a process of being vetted by the families introduce the product on an annual membership fees basis.

The product is available for individuals as well as families- The contribution received from members covers mostly the claims part of the product. The health services and other development cost part is subsidised by a donor till the point we reach a number where the subsidised contribution becomes the real cost per member family. 

The business model that we follow is that we reduce health risks over a period by investing in primary and preventive health care and families receive value for money for the contribution they make. Funding the health services keeps the contribution affordable to this target segment and it breaks even at a certain number. 

The contribution is for a year so every year the member families have to pay the contribution to receive the services.

Explaining and developing understanding of health insurance is a behaviour change process and very few programmes invest in detailed education of the participating families and is mostly limited to marketing. We bring investments in this along with the support for health services.

Our current model requires 3/4th funding while the other part is paid by the member household.

Being a not for profit so far we have raised grants and will need them till we reach our break even numbers. 

Alternatively we are also exploring to raise debt/venture debt, philanthropic/patient capital to finance our development of our distribution channels.

We feel that we need more minds who understand what we do and why we do it to support us to endeavour in order for us to be able to reach a substantial number of families so that we provide an alternative business model of insurance in developing markets.

We need exposure to investors philanthropic or otherwise to showcase what impact we can bring in making cities and its citizens healthier. 

We need help in refining our business model using technology as a differentiator in reducing costs and ability to grow across geographies. 

1. Organisations with large distribution networks servicing low income population (Micro-finance)
2. Fin-techs working with low income population
3. Cooperatives, 
4. Trade Unions or Associations
5. Investors participating in Social Impact Bonds
6. Philanthropic Foundations working on Health, Financial Inclusion

We will utilize the prize money to find and test low cost good quality diagnostics as part of the programme offering. Working in remote areas and even in slums we have found out that good quality diagnostics are difficult to come by. If we can provide for diagnostic care- we can also free a lot of time of the doctor in the out patient clinic who spends time diagnosing the patient.

We will also use it to integrate electronic health records onto the member app.This will allow us to create a history of the health services accessed by the member family, plan for preventive screenings and design programmes that help members stay healthy.