Rajiv Aarogyasri Health Insurance Scheme

Quality Medicare For All

N.Srikanth I.A.S,
Chief Executive Officer, Aarogyasri Health Care Trust . 29
th
July 2011.
Background Hospitalization Expenses in AP
Escalating health care costs: leading to rural indebtedness
Large proportion of people, especially below poverty line borrow money or sell assets to pay for hospitalization
Below Poverty Line
Other 6.10%
Borrow
63.10%
Saving
12.00%
Current
Income 6.10%
Sell
assets
12.60%
1
st
April 07
29
th
July 2011
PROGRESS OF THE SCHEME
Main Features & Progress
UNIVERSAL COVERAGE All BPL Families 1.97 Crores
CASHLESS TREATMENT Up to Rs 2 lakhs in a year
HEALTH WORKERS 3528 Aarogyamithras
SIMPLE PROCEDURE Health Card / White Card
COST Borne by the Government
DISEASES Identified
PACKAGES For end-to-end treatment
CHOICE OF HOSPITALS Left to patients
MONITORED On-line : 24 hour basis
IMPLEMENTATION
*Aarogyasri I (23 Districts) &
Aarogyasri II (13 Districts) through
Insurance Co.
** Aarogyasri II (10 Districts) through
Aarogyasri Health Care Trust.
HEALTH CAMPS 28,008
PEOPLE SCREENED 47,51,105
CASES REGISTERED 43,95,303
OUT PATIENTS 29,64,364
IN PATIENTS 12,70,318
PREAUTHORIZATIONS 11,23,210
SURGERIES / THERAPIES 11,15,834
AMOUNT PREAUTHORIZED 3128.04Crs
Expansion of the Scheme
Aim & Implementation
AIM
Financial protection to Below Poverty Line (BPL) population for medical treatment
requiring Hospitalization
IMPLEMENTATION Public Private - Partnership (PPP) Mode
AAROGYASRI HEALTH CARE TRUST REGULATOR
INSURANCE COMPANY RISK COVERAGE
NETWORK HOSPITALS
SERVICE PROVIDER
DISTRICT ADMINISTRATION MOBILISATION
HEALTH WORKERS
AAROGYAMITHRAS
SOFTWARE COMPANY TECHNOLOGY SOLUTIONS
Cashless Packages
Health Camps Quality Service Free Diagnostic Service
Free Food Service Free Follow up Medicine Transport Charges
Disease
CRITERIA OF SELECTION
Emergency and Life saving in nature
Requiring Specialist Doctors & Special Equipment
Not ordinarily available in Govt. Hospitals (Area/CHC )
Verifiable Diagnostic and Post treatment Protocols
Not covered by other Government schemes
938 procedures in 31 systems
SURGICAL (779 PROCEDURES)
General Surgery
ENT
Ophthalmology
Orthopedics
Surgical Gastroenterology
Cardio Thoracic surgery
Pediatric Surgery
Genito-Urinary surgery
Neuro-surgery
Surgical Oncology
Medical oncology
Radiation Oncology
Plastic Surgery
Polytrauma
Prostheses
Cochlear Implantation
MEDICAL (159 PROCEDURES)
Critical care
General Medicine
Infectious Diseases
Pediatric Intensive Care
Neonatal Intensive care
Pediatric General
Cardiology
Nephrology
Neurology
Pulmonology
Dermatalogy
Rheumatology
Endocrinology
Gastroenterology
Health Card, Sum Insured
BPL family covered means the group of individuals as indicated in Health Card or White ration card (BPL
card).
Sum insured per family - Rs.1,50,000/-
Benefit on floater basis, can be availed by individual or family
Additional Rs. 50,000/- in case of need from Buffer amount
Patient Facilitation & Beneficiary Choice
Aarogyamithra
Help Desks in PHCs/Government Hospitals
Assistance Counters in Network Hospitals
24 hour call center Toll free line for this Scheme
BENEFICIARIES
DIRECTLY TO
NETWORK HOSPITAL
(25%)
CMCO
REFERRALS (5%)
MAKE A PHONE
CALL (5%)
GO TO PHC
AAROGYAMITHRA
(20%)
ATTEND HEALTH
CAMP NEARBY (45%)
Highlights of the Scheme
Initiated as a pilot project.
Started with 163 procedures in 6 systems;
938 procedures now covered in 31 human systems
All Trauma cases covered.
Follow-up treatment for one year provided for 125 procedures.
Cochlear implantation for children up to 12 yrs age included
Coverage of BPL family increased from 1.80 crore to 2.04 crores.
Now grown into a major programme.
Aarogyasri Implementation
Patient
Records
BPL Data
Medicines
Inventory
Health Camps
Data Inventory
Patients
Feedback
Financial Data
NW Doctors
Insurance
Doctors
Trust
Trust Doctors
Banks Citizens
Bed
Capacity
Follow Up
PATIENT
Network Hospital
Preauthorization
Admission
Preliminary
Verification
Monitoring
Claim
Processing
Billing Diagnosis
Trust Administration /Insurance Company
Payments
Claims
Aarogya-
Mithras
Treatment
PHCS/ CHCS
AREA HOSPITAL
DIST HOSPITALS
DIRECT
HEALTH CAMPS
ACCIDENT SITES
CM CAMP OFFICE
CALL CENTER
(1800-425-7788
Treated Patient
Registration
Aarogyasri MIS
Aarogyasri
Service
Intelligence
Patient Work Flow
Manpower Details
EMPANELMENT DEPARTMENT :
To empanel the hospitals as per the guidelines of
the Scheme.
24 HOUR CALL CENTER :
To provide support through toll free help line -
24x7x365
HEALTH CAMPS :
To plan, intimate, implement & monitor the camps
as per the guidelines of the Scheme.
PRE AUTHORIZATION :
To provide round the clock preauthorization's with
specialist doctors for each category of disease and
to process the preauthorization within 12 working
hours.
FOLLOW-UP-MEDICINE:
To coordinate the follow-up consultation and
distribution of drugs as per the instructions of the
Trust
CLAIMS SETTLEMENT :
To process the claims as per guidelines of the
scheme through online system
MIS :
To collect collate and report data on real time
basis Collect hourly information from the
Aarogyamithras, regional coordinators, district
coordinators etc.
INFORMATION TECHNOLOGY :
To ensure web enabled services like e-
preauthorization, claim settlements and real-
time transactions are maintained 24-hour
basis
FOSS :
To coordinate the daily activities of field staff
and monitor online
FIELD OPERATIONS :
To coordinate with the Network Hospitals at the
field operations
Manpower Details
HR :
To manage human resources for the scheme and
maintain online database of staff.
TRAINING :
To build the capacity of stakeholders and staff for
smooth running of scheme.
VIGILENCE :
To keep vigil on all services and stake holders.
ADMIN :
To co-ordinate administrative aspects
LEGAL :
To assist & co-ordinate all Legal aspects. To
coordinate with the Network Hospitals at the field
operations
GRIEVANCE - FEEDBACK :
To redress the grievances within turn around time (TAT)
FEEDBACK- To send feedback formats, collect and analyse
feedback of the patients as per the directions of the Trust.
TOTAL MANPOWER NOS
DOCTORS
183
PHC MITHRAS
1922
NETWORK HOSPITAL MITHRAS
1606
CALL CENTER EXECUTIVES
291
FIELD OPERATIONS
347
DISTRICT MEDICAL OFFICERS
25
VIGILENCE
27
LEGAL
12
HEALTH CAMPS
30
INFORMATION TECHNOLOGY
91
GRIEVANCE DEPARTMENT
37
HUMAN RESOURCE
25
OTHER DEPARTMENTS
312
TOTAL
4908
Network Hospital Responsibilities (329 hospitals Empanelled)
Organize Health Camps once in a week
Separate Reception and Registration
Free food for In-patients
Dedicated Medical Coordinator (RAMCO-Doctor), Camp Coordinator
( A MCCO)
Free Transport to In-patient from Mandal Head Quarters
Provide Computer, Printer, Scanner, Digital Camera, Webcam and 2
MBPS connectivity
Follow-up consultation and distribution of follow-up medicines provided by
the Trust
Cashless services
Free consultation, diagnostics and treatment, irrespective of surgery
Hospital Empanelment Status
STATUS NO.
Application Applied 887
Application Incomplete 32
Application Expired 156
Ready to be Inspected 01
Inspected 698
Empanelled 506
Rejected 252
Delisted, De-Empanelled, Suspended 166
Active Hospitals 340
Active Hospitals as on 29.07.2011
Hospital Type
No.of
Hospitals
No.of
Beds
Corporate 243 38258
Government 97 27099
TOTAL 340 65357
Health Camps
Pamphlet Distribution
Public Address System
Mike announcement in Autos
Dandora / beat of tom-tom
Playing of Audio-Visual media
(Cassettes, Audio CDs & DVDs)
Health Camps
THESE GROUPS HELP TO MOBILISE MORE PATIENTS AT CAMPS BY WORD OF MOUTH PUBLICITY
MEDIUM
Patient Screening Medicine Distribution
Health Camps
For bringing the awareness amongst the rural masses about the diseases they are suffering
from and providing free medical advice and medicines to the rural people.
47.45 Lakhs people have been screened at their door step by specialist doctors of network
hospitals at 28,008 Health Camps
2,97,547 Patients referred from Health Camps to network hospitals
340 network hospitals are conducting around 984 camps in a month across the state of
Andhra Pradesh. Emphasis is been given in Tribal and Backward areas.
IEC ACTIVITIES FACILITIES @ CAMPS MEDICINE DISTRIBUTION INCENTIVES TO DOCTORS
ITDA Region Wise Health Camp Details
S NO ITDA REGION DISTRICT
NO. OF
MANDALS
COVERED
NO. OF
CAMPS
UNDER ITDA
MANDALS
NO. OF PATIENTS
SCREENED IN
ITDA
NO. OF
PATIENTS
REFERRED IN
ITDA
1 BHADRA CHALAM KHAMMAM 32 883 126168 8676
2 ETURU NAGARAM WARANGAL 11 258 49602 2274
3
KOTA
RAMACHANDRAPURAM
WEST GODAVARI
4 127 18438 731
4 PADERU VISHAKAPATNAM 18 520 82112 4983
5 PARVATHI PURAM VIZIANAGARAM 14 432 69307 3669
6 RAMPACHODAVARAM EAST GODAVARI
10 327 51940 2432
7 SEETAM PETA SRIKAKULAM 13 496 73960 4620
8 SRISAILAM
GUNTUR 6 137 26765 1259
KURNOOL 13 323 41479 2132
MAHABOOBNAGAR
10 254 37112 1661
NALGONDA 3 59 8430 354
PRAKASAM 7 143 25327 1381
RANGA REDDY 7 243 35390 1451
9 UTNOOR ADILABAD 37 925 129592 6139
Grand Total
185 5127 775622 41762
Call Center 1800-425-7788 Cond..
Consolidated Inbound & Outbound Calls From 01.04.2007 To 29.07.2011
Categories Count
Inbound
542971
Outbound
4143183
Project Office
665
Total Calls
4686819
Categories Count
General Information 530727
Doctor Advice
9457
Complaints
3978
Total Calls
542971
Categories Count
PHC 2374890
Health Camp 338399
Network Hospital 768388
Follow up 661506
Total 4143183
INBOUND CALLS
OUTBOUND CALLS
Types of Training Programs
Training department imparts training to all Network Hospitals through the programs listed below:
Empanelment Training Program
Network Hospital Training Program
Induction Program
Re-Orientation Program
Soft & Communication Skills Training Program
TRAINING PROGRMS EXECUTED FROM JAN 2009 TO JULY 2011
S. No Type of Training Program No. of Programs No. of Participants
1 Empanelment Program (EP)
12 609
2 NWH Re-Orientation Program (ROP)
17 1593
3 NWH Training Program at NWHs (NWH)
92 1176
4 Induction Program (IP)
149 3587
5 PHC Training Program (PHC)
35 2017
6 NWH On-Job Field Training Programs
6 103
7
NWH Aarogyamithras Reorientation Program 3 103
8
Departments Training Program (DT) 6 212
9 Soft Skill Training Program
8 117
Total participants
328 9517
Aarogyasri ICT - Comprehensive Solutions
BPL records
www.aarogyasri.org
Complex Application > Simple to Use > Quick & Quality service
Grievance
Accounts
Call Center
Claims
Pre Authorization
Hospital Empanelment
Online Donation
Admin
E Mail
Online Payments
Follow ups
Health Camps
Reports-MIS
Feedback
Issue Tracker
Bio Metric
Registrations
Digital Signature
TDS
SMS Gateway
e-Mail
Biometric
Service Intelligence tool
Solution Highlights
Completely paperless
Monitor the program from anywhere
Round the clock availability of portal
All transactions available for Public Scrutiny
Complete Accountability & Transparency
Cashless transactions
Online and Real time
Inventory of all medical records
Card verifications against Civil Supplies BPL data
Internal communication between all Users - email
Online View/Update of bed capacity available in Hospitals
Online claims, payments and Control systems
OVER 5000 EMPLOYEES
FOR
SUPPORT AND OPERATIONS
BETTER MONITORING &
CONTROL MECHANSIM
THROUGH ICT SOLUTION
CORRUPTION FREE
ENVIRONMENT
Scheme Without ICT
Fraud and Corruption at all
stages:
Hospital Empanelment
Medical Camps
Registrations
Pre- Authorization
Claims and Billing etc
Difficulty in handling Huge money transactions non-
transparent
Cannot achieve SLAs for pre-authorizations
Communication becomes non-effective
Less Accountability
Monitoring and controlling becomes a nightmare
Gain for Private
Agencies
Victims BPL Families
Service delivery is at
stake
Government objective is at
risk
ICT Solution Technology Perspective
Right Sizing of Infrastructure
Open Source technologies
Tomcat Web Server
Jboss Application Server
Oracle 10g Data Base Server
Synaptris Reporting Tool
Started with 500 Users and now
handling around 5000 User Base
Designed to handle huge data
Load Balancing at Web,
Application layers with multiple
nodes
Standard development processes
- COE
Encryption and Decryptions
LINUX based servers
Digital Certificate/Signatures
Secured Deployment of
Infrastructure Periodic
Vulnerability tests ( BS7799 )
Role Based Access and
Authentication
End-to-End ICT Solution including Hosting of the servers by TCS
Standard backup mechanism
Proven storage mechanism
Load Balancing and Stand-by
Link Redundancy
Standard J2EE
Proven Framework n tier
Huge data capture (3TB) NAS
IBM P-series H/w etc
Optimal settings of all servers
A virtual warehouse solution
High Internet bandwidth
24Mbps and High end
Clustered environment
RELIABLE ROBUST PERFORMANCE
ECONOMIC SCALABLE SECURITY
Firewall
Switch
Web Server 1
TOMCAT
JBOSS
Node 1
Database Server ORACLE
Standby DB Server
Oracle Datagaurd Configured
FILE SERVER
Internet
2 mbps
Infrastructure - Earlier
Aarogyasri ICT - Architecture
Radware 1
Firewall
Switch
CISCO 1
Web Server 1 Web Server 2
Synaptris/ModJK
JBOSS
Node 1/Node 2
JBOSS
Node 3/Node 4
Database -2 Standby DB
NAS - 2
DIGITAL SIGNATURE
REPORTING WEB
REPORTING APPS
REPORTING DB
FILE SERVER
SAS-EBI
SAS-
META DATA
SAS-
Analytics PRO &
Forecasting
CISCO 2 - Standby
Database -1
NAS - 1
RAC
SAN
SAS-WEB
Monitoring Tool
Web&App
Monitoring Tool
IS
Internet-
40mpbs
Intranet-
105mpbs
TRUST
KOTI
NIMS
Mail
STAGING ENVIRONMENT
UAT ENVIRONMENT
TRAINING ENVIRONMENT
Water fall
Spiral Model
Incremental Model
MVC Architecture
MVC Architecture
Controller Front Servlet
INCOMING REQUEST
ACTION CONTROLLER
DATA MODEL
ACTION VIEWHOMEPAGE
A Unique Application & Scenario 2008 09 Vs 2009 - 10
Centralized database (> 150 roles, > 200 workflows)
Highly dynamic & real time (Scheme demands)
Round the clock availability ( Around 500 users even @ midnight)
Complex functionality (Schemes & Phases, > 20 modules & Increasing)
Integration with other tools (Email /Sify, SBH, Call center, Bio Metrics etc)
Very sensitive (SLA based pre-auth/claims etc, High exposure)
Huge user base ( > 5000), high bandwidth (40 mbps + 150mbps-MPLS) and huge data volumes
Highly confidential (Precious data and huge money transfers, Digital Sign.)
Heavy MIS usage (Operational Analysis)
July 17
th
2008 Current % Growth
Number of users <1000 >5000 400% - 4 times
Concurrent users <200 >2000 900% - 9 times
Size of data transacted /day ~10GB ~200GB 1900% - 19 times
Size of the data addition/day ~2GB ~20GB 900% - 9 times
Page Hits/day ~9,00,000 ~1,60,84,836 1100% - 11 times
Bandwidth 16 mbps ~ 40 +105 800% - 8 times
TCS Considers - One of the sensitive and technically challenging project
Details Daily Average
Number of page hits/Views ~1.98 Cr / 38 lacs
Size of the data appended ~15 GB
Size of transactional data ~200 GB
Total Users ~4000
Number of concurrent users logged ~2000
Internet Link Bandwidth
40 Mbps /
105mpls
Details
Number of various Roles 169
Number of Workflows ~ 250
Number cases worked upon ~8000 per/day
Number of patient
registrations
~ 4000 per/day
Number of pre-authorization ~1400 per/day
ICT Solution Usage of Web Portal
User calls the Aarogyasri
Toll free number
1800-425-77-88
Modems-6
BSNL Exchange
(Lakdikapool, HYD)
PBX SERVER
BSNL Terminal Room
Modems-6
APPLICATION SEVER
DATA BASE SEVER
Voice Recording
STORAGE SEVER
POP UP
. . . .
POP UP POP UP POP UP
Aarogyasri
Web server
(Located
at TCS )
SIFY/VPN
Diagram for In Bound Call Centre
. . . .
PBX SEVER
BSNL, Tata, Reliance
Airtel, Vodafone,
Aircel , Idea, etc
Agent 1
Agent 2
Agent 3 Agent 50
Users
Application web server
located at TCS
PRI CARD
DATA SEVER
APPLICATION SEVER
STORAGE SEVER
TOTAL 6 MODEMS IN BSNL
Terminal Room
TOTAL 6 MODEMS
Voice Recording
AUDIO CODE
Diagram for Out Bound Call Centre
CCTV & Access Control System
1) CCTV (Closed-Circuit Television )
Cameras
DVRs
2) ACCESS CONTROL SYSTEM
Solus Access Control System
Solus Attendance Management System
Solus Visitor Management System
Solus Lift Access Control System with
Stair Cases
3) SERVER
Application server
Testing Server
DataBase Server
Closed-Circuit Television (CCTV) is the use of video
cameras to transmit a signal to a specific place, on a limited
set of monitors.
Why Need of the CCTV: It is used to Capture the each
and every moment of the employee in our Organization.
you have CCTV can be enough to prevent any crimes
occurring in the first place, helping keep your staff safe but
also preventing you from losing business due to a large
accident that may result in your having to close up.
CCTV System
Cameras
DVR Internet
Monitor
Remote
Client
Route
r
Access Control System
Access Control System ( ACS) :
This Application designed and Modified specific to project where user details are updated in
application database and sent to all the Mifare readers enabling access rights for calling lifts on
successful authentication. When you entered the Employee Information into the SACS Application
we Required the bellow things.
4k Mifare Access Card
Access Card Writer
Finger Enroll Kit
Access Card Reader
Finger Enroll Kit 4k Mifare
Access Card
Other Technology Partners
ORACLE Oracle Database
REDHAT Linux Servers
SBH Online Payment
SYNAPTRIS - Reports
IBM - Servers
SIFY - Mail Solution & MPLS VPN
VSNL - Internet Link
BHARTHI - Internet Link
BSNL - Internet Link
HCL CC Cameras
SOLUS Access Management
FORTINET Firewall
XEROX Printing Services
HP Servers
MICROSOFT OS
SYMANTEC Antivirus
EZSMS SMS Services
CORAL & CONVOX Call Centre
PRECISION SOFT - Bio Metrics
TCS CA Digital Signatures
RADWARE Link Proof Load Balancer
RADWARE Link Proof Load Balancer
CISCO Routers & switches
EASYMEETING Video Conference
SAS Service Intelligence Tool.
Hospital Surgeries/Therapies (29.07.2011)
Age Group Surgeries/ Therapies Surgeries/ Therapies (%)
Below 45
653842 63.98
Above 45
368044 36.02
Total
1021886 100.00
Gender Surgeries/ Therapies Surgeries/ Therapies (%)
Children 120979 11.84
Women 346939 33.95
Men 553968 54.21
Total 1021886 100.00
Hospital Type Surgeries/Therapies %
Preauthorized Amount (Rs
Crs)
%
Corporate Hospitals 807552 79.03 2328.08 80.61
Govt .Institutions (NIMS, SVIMS & M.N.J) 73978 7.24 196.29 6.80
Govt. APVVP Hospitals 9990 0.98 26.35 0.91
Govt. DME Hospitals 130366 12.76 337.50 11.69
Total 1115834 100.00 3128.04 100.00
Gender - Surgeries/Therapies
Age - Surgeries/Therapies
Consolidated Month Wise Surgeries/Therapies As on 29.07.11
5
3
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Cochlear Hospital Wise Progress Report
S.NO Hospital Wise
Patients
Screened
Preauthorisations
Approved
Surgeries / Therapies
Performed
Claims Paid @ 5.20 Lacs
Cases
COUNT COUNT AMOUNT COUNT AMOUNT COUNT AMOUNT
1
Apollo Hospitals Enterprises Ltd
(Jubilee Hills)
1939 257 133640000 254 132080000 193 9650000
2 ENT Nursing Home 757 120 62400000 118 61360000 101 5050000
3 Govt Ent Hospital - Koti 498 102 53040000 74 38480000 54 2700000
4
Maa Hospitals Pvt. Ltd. (Unit Of
Vasavi ENT Institute)
1139 150 78000000 143 74360000 135 6750000
5
Quality Care India Ltd (Care
Hospitals Banjara hills)
274 43 22360000 41 21320000 26 1300000
Grand Total 4607 672 349440000 630 327600000 509 25450000
Maintenance of Heamodialysis
S. No Hospital Name NH location No of Units/ Shifts
No of
Patients
No of
Surgeries/
Therapies
1 Gandhi Hospitals Hyderabad
18 Units - 3 Shifts (Tues,
Wed, Fri & Sat) and 2 Shifts
(Mon & Thurs)
342 2466
2 Government General Hospital, Guntur Guntur 13 Units - 4 Shifts
399 2211
3 Osmania General Hospital Hyderabad 15 Units 3 Shifts
431 2177
4 King George Hospital Visakhapatnam 11 Units - 3 Shifts
290 1577
5
Government General
Hospital,Kakinada Kakinada 9 Units - 3 Shifts
216 1291
6 Govt General Hospital Kurnool Kurnool
9 Units - 3 Shifts
(Mon, Tues, Thur & Fri)
2 Shifts (Wed & Sat)
196 1267
7 Mahatma Gandhi Memorial Hospital Warangal 8 Units 3 Shifts
126 1072
8 S.V.R.R.Hospital Tirupathi 6 Units 3 Shifts
128 1063
9 Govt. General Hospital- Vijayawada Vijayawada 8 Units - 2 Shifts
191 779
10
Rims Govt. General Hospital,
Srikakulam Srikakulam 10 Units General Shifts
175 718
Grand Total 2494 14621
Heamodialysis Units at Hospitals
Heamodialysis Units at Hospitals
Heamodialysis Units at Hospitals
Follow Up Analysis
HOSPITAL
TYPE
NO OF
ELIGIBLE
PATIENTS
NO OF
PATEINTS
AVAILED
PERCENTAGE
ON AVAILED
Vs UN AVAILED
PERCENTAGE
ON TOTAL
AVAILED
NO OF
PAID
CASES
PAID
AMOUNT
APVVP
HOSPITALS
27050 5160 19% 6% 714 934051
DME
HOSPITALS
219 60 27% 0% 2 1752
GOVERNMENT
INSTITUTIONS
13224 4440 34% 5% 5733 9732112
CORPORATE
156168 75734 48% 89% 69450 109054915
TOTAL
196661 85394 43% 100% 75899 119722830
Other States Replicating The Scheme
21 States studied the scheme - Arunachal Pradesh, Assam , Andaman and Nicobar, Bihar,
Delhi, Chhattisgarh, Goa, Gujarat, Haryana, Jharkhand, Kerala, Karnataka, Lakshadweep,
Maharashtra, Madhya Pradesh, Odisha, Punjab, Pondicherry, Rajasthan, Tamilnadu , Uttar
Pradesh
Tamil Nadu
Karnataka
New Delhi
Maharashtra
CGHS/ESI
Rajasthan
Arunachal Pradesh
Kalaignar Insurance Scheme for Life saving diseases from
23
rd
June 2009. The coverage is for Rs 1 Lakh for a family for four years
Vajpayee Aarogyasri launched on 1
st
February 2010
Formed Aapka Swasthya Bhima Trust in December 2010
Government launching under the name
Rajiv Gandhi Jeevanadhai Yajona
Decided to replicate the same platform.
Decided to launch similar scheme.
Studied the scheme for implementing in their state
Awards & Recognitions
e-India Awards 2010 Jury Award Health Insurance Initiative of the Year
Citizen Choice Award Health Insurance of the Year
'E-Governance Initiative in G2G category for 'E-Office
Citizen Choice Award
e-India Awards 2009 "Government Policy Initiative of the Year'
through Public Opinion
Jury Award for 'Civil Society / Development Agency of the
Year'
CSI Nilihent Award' 09
Award of Excellence - Project of the Year
2008 - 2009 Project Category G2G
Manthan South Asia Award' 09 Service Delivery Leveraging IT
Forum for Health-Geneva' 09
Skoch Challenger Award 2008 For Service Delivery
Recognition
Social Audit
Letter Feedback from patients
Results
Critical Success Factors of the Scheme
Top Level Leadership - Political & Administrative
85% Population are covered under the scheme.
All BPL families of Andhra Pradesh are eligible
under the scheme.
Coverage of 938 Procedures under 31 categories
Patients are screened at door steps by all the
empanelled hospitals by specialist doctors by
conducting Health Camps
Patient can choose the hospital of his own
Quality treatment
End-to-end Cashless Treatment
Follow up treatment for 1 year for identified
procedures
FIFO (First in First Out) in Claim Process
Transparent workflow
Online Claim Process
Evidence & Outcome Based
Free Food & Transportation for patients
5 Level scrutiny in all process
Field Verifications for all emergency Cases
24*7 Telephonic Approvals for emergency cases
24*7 Preauthorization
12 Hrs TAT for Preauthorization
Tight, real-time controls
Online pre-authorizations
Complete medical records online
Patient Satisfaction Letter
Social Audit - Individual letters sent to patients
Proactive Initiatives like scar photos collection
Reshuffling of Aarogyamithra for every 2 Months in
scientific methodology
Strong Vigilance Team
Strong Field Operations Team
Efficient Work Management by e-Office
100% Network Uptime
Simple, patient-centric process -Aarogyasri Health
Card
Extensive use of Technology, especially IT
Comprehensive Portal
End-to-end workflow application
Completely paperless, efficient, transparent
Electronic payments to network hospitals
TDS deductions, adjustment to IT dept online
Highly evolved IT system
Customized to Health Insurance needs
Partnership
Social Audit Rachabanda
Rachabanda
Started on 24
th
Jan 2011 till 12
th
Feb 2011
Covering all 23 Districts of the state of Andhra
Pradesh
Public attended 64.47 Lakhs
Public Representatives participated 1.22 Lakhs
Total Beneficiaries participated 30,433
Total of 24,383 events were conducted
Total number of Staff attended : 54,605
6.11 Lakh Temporary Andhrapradesh Cards
were distributed
3.80 Lakh Pamphlets were distributed during the
program to create the awareness on Aarogyasri
Social Audit - Prajapatham
An initiative by Govt. of Andhra Pradesh taking
administration to the door step of the people.
Conducted in 21 Districts
Started on May 19
th
2010 till June 14
th
2010
Public attended 40.94 lakhs
Public Representatives participated 1.29 lakhs
Total Beneficiaries participated 34.584
Prajapatham
Proposed Methodologies
Data recovery facility
Mobile Applications for efficient field
level operations using GPRS and
Cloud computing.
Friday, August 05, 2011 56
THANK YOU
District Progress (As on 29.07.11)
District
Health
Camps
Patients
Screened
Patients
Referred
In Patients
Out
Patients
No of Surgeries/
Therapies
Preauthorized
Amount
(In Crs)
East Godavari 1243 236683 13206 84742 189358 75786 214.14
Guntur 895 187210 11768 83663 265255 72206 214.80
Krishna 884 138594 10901 80222 181271 71899 206.52
West Godavari 1268 238432 12532 67315 206120 60963 176.85
Ranga Reddy 1245 187216 7878 64975 119051 56586 159.00
Hyderabad 920 213512 5101 65330 98470 55912 154.09
Warangal 1087 234754 11632 62263 167025 54917 145.28
Karimnagar 926 175691 9099 56362 151728 50376 130.85
Nellore 900 141244 10657 59242 150729 50239 136.16
Vishakhapatnam 1060 180603 12492 53617 105814 47340 127.49
Nalgonda 1312 178181 8169 54032 107332 47209 130.05
Prakasam 942 170495 11330 51397 137959 44828 132.54
District Progress (As on29.07.11) Contd
District
Health
Camps
Patients
Screened
Patients
Referred
In
Patients
Out
Patients
No of
Surgeries/
Therapies
Preauthorized
Amount
(In Crs)
Mahabubnagar 1409 214997 11276 49270 65639 41957 120.15
Srikakulam 1326 209767 13530 39120 59415 35987 96.50
Chittoor 1377 266494 17577 40901 146722 35140 102.47
Kurnool 1200 162637 9169 40008 52686 34270 99.03
Anantapur 1472 227669 16433 35209 65437 30854 96.55
Vizianagaram 983 153180 8688 33217 56741 29606 77.84
Medak 1145 200887 9023 33832 56256 29017 84.05
YSR 1012 180085 11336 33850 70130 29104 89.51
Khammam 1239 177403 11460 31726 90906 27948 80.50
Nizamabad 1291 228502 10326 25590 55947 22227 64.20
Adilabad 1286 177097 8031 19904 36895 17515 49.65
Total 26422 4481333 251614 1165787 2636886 1021886 3128.04
Category Wise Surgeries/Therapies (As on 29.07.11)
Category Surgeries/ Therapies
Preauthorized Amount
(In Crs)
ONCOLOGY 211255 291.47
CARDIAC & CARDIOTHORACIC SURGERY 124822 820.48
POLY TRAUMA 116744 278.85
GENERAL SURGERY 96990 250.84
GENITO URINARY SURGERIES 93162 217.93
NEUROSURGERY 71178 264.31
NEPHROLOGY 65031 76.57
GYNAECOLOGY & OBSTETRICS SURGERY 38621 104.19
CARDIOLOGY 30811 84.14
PEDIATRICS 30036 70.21
ENT SURGERY 27990 41.75
NEUROLOGY 27841 60.84
ORTHOPEDIC SURGERY & PROCEDURES 20352 48.30
Category Wise Surgeries/Therapies (As on 29.07.11)
Category Surgeries/ Therapies
Preauthorized Amount
(In Crs)
PEDIATRIC SURGERIES 16199 63.62
PLASTIC SURGERY 12282 56.19
OPTHALMOLOGY SURGERY 12102 16.77
SURGICAL GASTRO ENTEROLOGY 6389 29.88
GASTROENTEROLOGY 5586 24.30
CRITICAL CARE 4742 27.30
PULMONOLOGY 4845 14.50
GENERAL MEDICINE 2454 7.11
RHEUMATOLOGY 906 1.51
COCHLEAR IMPLANT SURGERY 664 34.43
ENDOCRINOLOGY 418 1.75
DERMATOLOGY 377 0.92
PROSTHESES 64 0.01
INFECTIOUS DISEASES 25 0.05
Grand Total 1021886 3128.04