Category Archives: Adoption

Partnering with health microinsurers to increase Kenya’s healthcare coverage

Kenya’s public health insurance scheme—the National Hospital Insurance Fund (NHIF) provides much of the country’s health insurance. However, the percentage of citizens covered by the NHIF falls short of Kenya’s national goals related to healthcare access. One key way that the NHIF can improve participation rates is by partnering with health microinsurers (HMIs).

In his article “Benefits of public-private partnerships in health microinsurance: the Kenyan context,” Milliman’s Mitchell Momanyi provides an overview of the NHIF and the reasons for low participation in the program. He also outlines several ways it can work with HMIs to enhance its benefits and increase its health insurance coverage.

Here is an excerpt from the article:

HMIs offer simple and affordable benefits that, when paired with public schemes such as the NHIF, can encourage beneficiaries to participate in and use their public insurance benefits when necessary. An example of such a benefit offered by many HMIs is ‘hospital cash.’ Hospital cash pays a fixed amount of money to the beneficiary when a qualifying inpatient hospital stay is triggered. This money can be used to pay for costs related to seeking treatment such as transportation, food and partial replacement of lost income. These costs aren’t covered by the NHIF and would present a barrier to some individuals seeking treatment. The SAJIDA Foundation in Bangladesh and the Microfund for Women in Jordan are examples of organisations that have successfully launched hospital cash products.9

A second way in which the NHIF can increase its reach is by pairing its benefits with an HMI policy that provides value-added services. Examples of such services may include access to discounted medication and access to preventive services such as free health check-ups. Value-added services are included in some HMI policies in order to increase client value by making the benefits more tangible. Beneficiaries don’t have to wait for catastrophic events such as an inpatient admission in order to use their benefits. An example of an HMI that has successfully implemented value-added services is Uplift in India. Its ‘dial-a-doctor’ service is popular among beneficiaries.10

The government can also partner with HMIs in order to increase awareness of the NHIF programme. The Impact Insurance Facility describes the lack of awareness of public benefits as a key emerging lesson in Ghana. In discussing a field test conducted to gauge citizens’ awareness of the country’s National Health Insurance Scheme, the Facility states that the test group did not know about the costs and eligibility requirements of the programme. It went on to state that ‘this lack of understanding is an initial barrier to enrolment and a factor in low retention in the scheme – even with a government sponsored scheme intended to provide universal cover.’11 In order to distribute their products effectively, HMIs typically build valuable partnerships with entities such as local community groups, unions and cooperatives. The NHIF can leverage these partnerships in order to promote the programme effectively in remote areas that the government would otherwise be unable to reach.

Reduce healthcare’s long-tail problem with telemedicine

Technology has enabled many industries to reduce or eliminate the long-tail problem. Similarly, telemedicine offers the healthcare industry a solution to its long-tail problem—access barriers to healthcare services. A new article entitled “Telemedicine and the long-tail problem in healthcare” by Milliman’s Jeremy Kush and Susan Philip explores the benefits of telemedicine as a mode for healthcare delivery. The authors also analyze current levels of telemedicine utilization and identify five factors limiting adoption.

Do providers face an electronic health record learning curve? (Part I)

Jim Schibanoff of the Milliman Care Guidelines, Scott Armstrong of Group Health, John Hammarlund of CMS, and Joe Scherger of Lumetra discuss physician adoption of electronic health records.


Q: Jim Schibanoff, we’ve talked a bit about the cost and investment requirements of adopting these systems. I’m curious also about the impact on providers of learning these new systems, learning how to use them effectively. Is this potentially a larger burden for healthcare providers?

Jim Schibanoff: Well, it’s great to hear Scott describe Group Health’s experience, the after, because most physicians are dealing with the before, which they see as great disruptions to their routines of care, more inefficiencies in their practices. They feel under financial pressure already and here it’s taking more time to use this electronic health record. So getting over that hump is a significant issue. And in systems like the VA, Kaiser, I believe Group Health, there is much more of a group culture. There’s a financial mechanism, a delivery mechanism. The physicians are more integrated into the system, as opposed to all the physicians in private practice who are in one or two physician offices and may go to one or two hospitals.

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How can state government encourage care providers to implement EHR?

Ed Boyle submitted a question via Facebook:

“With so much focus being placed on hospitals and clinics implementing electronic patient information systems, what – if anything – can state and/or federal government do to help support/alleviate the sometimes significant amount of time it takes physicians and clinicians to learn and become proficient at using a clinical information system – thus amounting to less time for patient care during that learning-curve period?”

For submitting this question, Ed Boyle is a finalist in our question contest. Congratulations, Ed.


Q: What can the state and/or federal government do to help physicians learn the clinical information systems without detracting from patient care?

Mike Kreidler: The answer is “yes, there is.” We’re working on administrative simplification so that physicians and payers can process claims in a timely fashion in  a common format. The current system is antiquated. Even the rules that have been put forth for the various coding (by federal definition) have significant variations. There are format interpretation differences between one carrier or another. You’ve got to standardize that. Continue reading