“Robust data is essential for health insurance coverage”

28th June 2016

Robust data is essential for health insurance coverage

5 June 2016 —Adesimbo Ukiri is the Managing Director/Chief Executive Officer of Avon Healthcare Limited (Avon HMO). As CEO, she oversees all aspects of the company’s operations and, under her guidance and vision, Avon HMO has become one of Nigeria’s leading healthcare maintenance organisations. A trained lawyer, Adesimbo holds an LLB from Obafemi Awolowo University and is a Sloan Fellow of London Business School, where she obtained an MSc in Management. In this interview with SADE MOMOH (Sunday Telegraph), she talks about her over 20 years of professional experience within a number of sectors including financial services, FMCG, telecommunications and healthcare

Less than 10 percent of Nigerians have health insurance. What can we do to expand coverage?

The lack of progress that we, as a country, have made in terms of universal health coverage is a source of great distress to people like me. We see the opportunities and know the achievements that are possible. Increasing coverage requires a collaborative effort, one that can and should be driven by leadership that comes from the top.

The first and most important thing that is needed is a regulator that is able to implement the right operational framework, monitor the operators (HMOs) and ensure that the ‘ecosystem’ actually works. The next requirement is a legislation that makes it compulsory for every employer to provide health insurance for their workers. The current law is an Act: it states that a company with over 10 employees should make provision for health insurance. This is not enough as only mandatory participation will avoid the lukewarm uptake that was previously seen with pensions. Health insurance is just as important, if not more important, than pensions and we should be more decisive. With the right leadership from the Federal Government, the sky is the limit. Once the right regulatory environment is in place, we (Avon HMO) have the capacity to manage enrollees in the millions.

Nothing stops us from doing so now for we have invested heavily in a strong information technology (IT) backbone. Most, if not all, of our operational process are technology- based. We are therefore able to achieve scalability while guaranteeing excellent, responsive customer service.

You have spoken of the availability of robust health data as key to improving coverage. Tell us more.

In Nigeria and across the continent, we are seeing an increase in chronic diseases and escalating healthcare costs. We therefore need to rethink how we deliver healthcare products and services that truly cater to the current and future health needs of our people. In most sectors, such decisions would be guided by rigorous data analyses and the insights gained from them. The health insurance and managed care sectors in Nigeria should not be different. Data is king.

This is why we launched our Provider Incentive Programme in 2015 that encourages the accurate collation, availability and use of robust medical utilisation data by our Provider Hospitals. This data will identify and track disease prevalence and patterns, especially at primary care levels and inform our disease prevention and wellness initiatives. Ultimately, it will help improve better patient experience, minimise disease reoccurrence and reduce re-admission rates for the same diagnosis.

In regards to improving universal health coverage, comprehensive medical data will guide our product development initiatives so that we are able to offer health plans that are more consumer-centric. Presently, many of the health plans, products and services available in the marketplace are essentially the same in all but name – platinum, gold, silver, bronze. Many people are unable to find health plans that are relevant to their different stages in life. Medical data provides us with the ability to understand the needs of the different segments of our society so that we can create health plans that are able to cover the benefits that people actually need.

Considering that we (Nigerians) do not have data for several health indices, how feasible is this?

I don’t think it is a question of the absence of data, more that it has not been mined and analysed. For example, the NHIS will certainly hold data for all the people enrolled onto a Federal health insurance scheme. Let us not forget that the NHIS has been in existence for over 10 years and has the largest number of enrollees in the country. They cover Federal Civil Servants which make up 6 million of the 7 – 7.5 million (roughly 90 per cent) of all enrollees covered by a health plan in Nigeria. We therefore expect that their utilization data also sits with the NHIS.

The questions should be – how robust and granular is this data? How accessible is it? How can it be used to grow and strengthen the industry?

And finally, how can we use it to develop health plans that are appropriately priced and meet the needs of different customer segments. We cannot adopt a one size fits all approach.

Being the CEO in such a competitive field must be challenging. What inspires you?

I am inspired by people who dare! Dare to be different …dare to pursue their dreams…. dare to take the road less travelled. People who are able to inspire and secure the long term engagement and followership of other people and together with them, achieve phenomenal and trans-formative changes to the world and the way we live.

I am inspired by people who come back from seemingly crushing public defeats only to achieve higher levels of greatness. It’s no wonder that I’m inspired by the late Steve Jobs and Tony O. Elumelu (CON).

You have over 20 years of professional experience under your belt. What have you learnt in this time?

One of the key lessons I’ve learnt is, don’t be hard on yourself, spend more time focused on your goals and getting there and less on regrets on what you have been unable to achieve. Also, practice mindful perceptiveness; and very early on develop a repertoire of behaviors to help you engage and build valuable relationships with all types of people. Adhere to this and not everyone will like you but most will admire you.

How relevant is HMO to the present day Nigeria?

HMOs and the services we provide are extremely relevant, probably now more than ever with Nigerians feeling the pinch. We all face the challenge of spreading our income across many daily, weekly and monthly expenses. Subscribing to a health plan and paying premium once a year, ensures that unexpected medical bills are covered especially because medical bills can become financially debilitating depending on the severity and complexity of the illness. Based on the current economic climate, I strongly believe that it is crucial that people subscribe to a health plan as soon as they can. This way, they will be rest assured that come what may, taking care of your health is not something that you need to worry about.

How far have you gone in terms of public awareness/ enlightenment?

Our mission is to empower people to live healthier, fuller lives. For us, empowerment is through education, knowledge and giving people access to the tools they need to make more informed health decisions. Therefore we never pass up the opportunity to educate people; be it on the importance of subscribing to a health plan or raising awareness of the chronic illnesses that affect so many Nigerians.

With teledensity at over 100%, we recognise that the easiest way to engage and inform people is through their mobile phone. We regularly send out health awareness messages via SMS, emails and our social media platforms. We have a very active social media as we have built a strong health and wellness community. In addition, we also work with our corporate members to implement internal health awareness campaigns and health screening initiatives to drive education. We also regularly share health information and hold educational sessions with our members.

What are the benefits and can this be accessible in the rural and remote areas?

Everyone should have access to good quality health care and it is with this in mind that we designed our health plans. Our health plans cover everything from primary care to tertiary care and includes the treatment of our most common ailments, maternity, optical and dental care and major surgeries. Health care is personal so we have taken particular care to ensure that no matter your age, stage in life, income bracket or health risk, we have a plan for you. It is also very important that healthcare is accessible.

This is why we have a robust Hospital Provider Network that has a healthcare facility in every major city and town across the country. We don’t have the biggest Provider Network but we are confident that all our hospitals provide our members with high quality service and value.

What is your mode of relaxation?

I spend the day unwinding with a good book.

What is that one thing you cannot do without?

My phone!