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Hygeia Community Health Information System -- HCHP

About the Project

 
Project Name: Hygeia Community Health Information System -- HCHP
Type of Facility Project: Microinsurance innovation grantee
Country of Operation: Nigeria
Sub Topics: Data analysis and processing, Client interface, Policy and regulation, Renewals, Claims, Enrollment, Impact, Health, Transaction processing
Type of Risk Carrier: Other self-insurance scheme
Type of Distribution Channel: Non-governmental organization
 

Organizational Overview

Hygeia Community Health Plan (HCHP) is a not-for-profit organization that provides access to medical care for previously uninsured low income communities through donor-subsidized health insurance schemes. Since 2007, the HCHP has been working in rural communities in Kwara State and markets in Lagos to provide access to designated private and public healthcare providers. It currently serves 90,000 clients. HCHP performs marketing, provider management and claims processing for the insurance schemes. HCHP also supports quality improvement at enlisted healthcare providers through training and mentoring support. HCHC is part of the Hygeia group, which also serves Nigerian formal workers via their Health Maintenance Organization (HMO) activities and runs a hospital in Lagos.

 

Project Description

PharmAccess Foundation (PharmAccess) is a Dutch not-for-profit organization dedicated to improving access to quality basic health care in sub-Saharan Africa. Among other activities (such as providing access to credit, and supporting quality improvement for both private and public health facilities), PharmAccess supports private health insurance for low-income groups.  In Nigeria, PharmAccess is partnering with Hygeia Community Health Care (HCHC). HCHC is a not-for-profit organizatio...READ MORE
 

Beneficiaries

The project will target two groups of low-income workers in Lagos insured under two schemes: Lagos Market Women and CAPDAN scheme. While HCCP also covers groups of artisans and fisherfolk in rural Kwara, they will not be targeted in the project.

The Lagos Market Women scheme targets low-income beneficiaries located in markets in Lagos. This community consists of individuals involved in retail trading of consumer goods, food products, textile, utensils and house hold items. The vast majority of the target beneficiaries are women. The target population consists of 92,000 women and their family members. The CAPDAN scheme targets members of an association of SMEs involved in selling and servicing of computer hardware, software, mobile phones and allied ICT products. The target population consists of 21,000 employers, employees and their dependents. The vast majority of the target beneficiaries are male. 

 

Learning Agenda

The project will attempt toanswer the following key questions:

  • To what extent can biometric identification system reduce benefit leakage (unjustified excess medical costs)?
  • To what extent can a mobile-based payment system improve renewal rates?
  • To what extent can renewal rates be increased through process improvements that optimize premium collection and policy administration?
  • To what extent can an integrated claims and utilization application for data capture at the health provider reduce delays in claims payment, benefits leakage, and increase data quality?
  • To what extent can a GPRS link between the health provider and insurer reduce the time lag for claims payment to the providers?

Project Status

Key Performance Indicators

Performance indicators[1]

                   

 

 

2008

2009

2010

2011

2012

2013

 

Overall KPIs

 

Target group size

Total (including Kwara state)

157,000

219,992

219,992

219,992

254,992

261,992

 

CAPDAN

 

20,992

20,992

20,992

20,992

20,992

 

Lagos Market

 

77,000

77,000

77,000

77,000

77,000

 

Number of beneficiaries

Total (including Kwara state)

49,991

61,378

66,526

95,218

98,443

87,242

 

CAPDAN

NA 

1,187 

 9,140

13,473

8,802

4,884

 

Lagos Market

17,967

18,575

13,969

24,915

22,702

9,280

 

Growth rate

Total (including Kwara state)

 NA

23%

8%

43%

3%

-11%

 

CAPDAN

NA 

 NA

670% 

47%

-35%

-45%

 

Lagos Market

NA

3% 

-25%

78%

-9%

-59%

 

Penetration rate[2] 

Total (including Kwara state)

32%

28%

30%

43%

39%

33%

 

CAPDAN

NA

6%

44%

64%

42%

23%

 

Lagos Market

23%

24%

18%

32%

29%

12%

 

Renewal rate[3]

Total (including Kwara state)

40%

33%

47%

69%

62%

57%

 

CAPDAN

 NA

NA 

52% 

68%

63%

53%

 

Lagos Market

37%

35% 

36% 

48%

50%

49%

 

Claim ratio[4]

Total (including Kwara state)

 

 

 

117%

55%

54%

 

CAPDAN

 

 

 

98%

42%

66%

 

Lagos Market

 

 

 

 

85%

80%

 

162%

 

 

2008

2009

2010

2011

2012

2013

 

Project specific KPIs[5]

 

Annual number of visits per year

Lagos all

47,371 

89,693 

96,366

141,691

144,667

            117,978

 

Average medical payout[6]

CAPDAN (NMG)

 

 

  880

       3,462.00

                5,460.00

          8,292.01

 

Based on month paid

Lagos Market (NMG)

 

 

  9536

    10,039.00

                8,283.00

          4,969.24

 

                             
 

[1] Unless otherwise stated, data is sourced from direct data captured by HCHC (in green)

[2] Penetration rates calculated as “total number enrollees divided by total population of target area (estimated)”.

(Estimated Total Population Size for 2008 is 157,000 and 2009 – 2012 (November) is 219992,  Lagos Market 2008-2012 is 77,000, and CAPDAN 2009 – 2012 is 20,992. Kwara North population is 87,000, Kwara Central is 42000, (source: house numbering study)

[3] HCHC definition: Renewal rates calculated as “total number ever enrolled divided by total number ever renewed” and have been adjusted for migration (10% for Kwara North, Kwara Central and Lagos Market, 24% for CAPDAN)

[4] Claims ratio =  Claims paid/ Premium earned based on date paid

(2012 Total claims is 352,408,654.40 and Total Premium 644,699,866.67, CAPDAN 2012 Total Premium is 105,433,600.00 and Total Claims 44,702,309.90. LMW 2012 Total Premium is 257,165,508.33 and Total Claims is 218,804,370.50. All Total claims paid as at July-2013 is 197,041,723 and Total Premium is 398,795,400. Capdan Total Claims is 30,273,170 and Total Premium is 51,766,691.67. LMW Total claims is 117,433,903 and Total Premium is 166,193,750)

[5] Source: Reports of Baseline studies commissioned by PAF (in Yellow)

[6] Average medical payout (FFS Per enrollee)= Total Amount/Number of enrollees based on date encountered

 
 
Project Updates
As of April 2012 Initially the third party sales teams were cross-selling other informal sector products with HCHC’s health microinsurance. HCHC had minimal involvement in managing the sales force, and only provided variable incentives based on numbers enrolled, rather than a fixed salary. As a result, HCHC faced declining enrolment (including fewer family members enrolled per family), declining re-enrolment, increasing utilization and medical payouts, and non-compliance with programme elig...READ MORE

Project Lessons

On achieving commitment and coordinating the contributions of all staff Regular communication with all relevant stakeholders is key for the project success.  It is important for all staff (HCHC and healthcare provider staff) to understand the IT project and its impact on the work they do. Also, It is important to gain their acceptance before the introduction of the new system.  For example, there was an incident in which adjustments were made to...READ MORE
 
 
On choosing the right technology Selecting the most suitable technology requires analysis of a range of selection criteria. At the inception of the project, a smart-card enabled biometrics system was proposed. However, after further review and cost-benefit considerations, the team opted instead to implement a system which relies on fingerprint authentication, maintains the old plastic ID cards, and works both online and offline. Key consideratio...READ MORE
 
 
On the implementation of the IT project At the inception phase of an IT project, all key stakeholders need to be identified and engaged to ensure proper project scoping and planning. The involvement of the board and management as well as the operational staff are key to ensure strategic alignment at the top level, and business users’ buy in. If the project involves several institutions, they should all be represented during the design phase, and ...READ MORE
 
 
On assessing and auditing IT infrastructure Infrastructure assessment of health-care providers for the biometric system must be very thorough to avoid future problems. The IT infrastructure assessment approach at the healthcare providers’ sites should be very thorough and rigorous. Different levels of assessment and analysis ought to have been carried out at the providers before go-live. A system test run should have been conducted on the provider’s infr...READ MORE
 
 
On the need for an industry standard open platform for health information exchange To improve healthcare delivery and increase the growth of health microinsurance, there needs to be a vendor-independent information exchange framework or standard for exchange of health and other related data. There is an on-going discussion with one of the providers selected for the pilot phase of the system roll out. This provider currently uses its own hospital management s...READ MORE
 
 
On building a research agenda Determining the costs incurred on different sales & marketing activities could be challenging.  It would have been easier to track the costs of the current renewal system if the marketing plan were based on activity based costing. For example, it was difficult to split the agents’ time and costs between new enrolment and renewal activities. Furthermore, other costs incurred such as marketing collaterals cannot be easi...READ MORE
 
 
On the effectiveness of sales force management Improved sales force structure can contribute to significant growth. In 2010, Hygeia and PharmAccess implemented a new sales strategy, including recruitment of full time sales agents instead of relying on commission based agents, and monthly performance reviews and sales targets. The strategy proved very efficient as sales increased 43% from 2010 to 2011. Changes to sales staff incentives can impact enrolment...READ MORE
 
 
On reducing adverse selection Family enrolment rather than Individual enrolment reduces the possibility of adverse selection. The scheme is facing adverse selection because families registered the members with the highest health risk. To address this challenge, a couple of other interventions were put in place such as: redefinition of the criteria (well defined market boundary, strong market leader influence, and willingness of the market leaders t...READ MORE
 
 
On the level of premium to be subsidized It is important to set the price of the insurance close to the target population’s willingness and capacity to pay from the beginning, even if subsidies are available, as increasing the premium over time is challenging. HCHC faced resistence in each increase in the co-premium from the clients, even though their capacity to pay seemed higher than the level of co-payment required to enrol in the scheme. Phar...READ MORE
 
 
Summary HCHC has drawn many lessons in the system implementation in Lagos. The lessons below will serve as guide to HCHC in the future for system implementations: Proper change management and governance needs to be in place for the project deployment. A detailed checklist of business requirements needs to be developed and maintained before, during and after the project lifecycle. Due diligence of solutions and vendor needs to be carried o...READ MORE
 
 
Project page contributor/s:  Caroline Phily (The Facility) and Dr. Peju Adenusi, Oludare Ogundipe and Opeyemi Adeyoola (HCHC)
 
 
Date of last update:  September 2014