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Rajiv Aarogyasri Health Insurance Scheme: Quality Medicare For All
Rajiv Aarogyasri Health Insurance Scheme: Quality Medicare For All
Rajiv Aarogyasri Health Insurance Scheme: Quality Medicare For All
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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