Trevor Lewis

Subscribing to Better Health: How Sevamob’s model helps patients – and its bottom line

When people think of innovative health care business models that serve the poor, they often think of delivery or supply chain innovations that improve the provision of care, or that help important health goods to reach the last mile.

But there’s also a wealth of experimentation on the health financing side, with innovators exploring how new business models allow the poor to use their limited purchasing power to access high-quality health care. These models range from innovative micro-insurance, to health saving programs, to vouchers. Recently, I had the chance to speak with Shelley Saxena, founder of Sevamob in India, which uses another innovation to help the poor pay for care: subscription fees.

Subscription fees can be applied in a number of ways in health care. But broadly speaking, this model involves a regular (generally monthly) fee, which entitles subscribers to access a certain set of services. Some models allow patients to access the given set of services just once or a few times, while others allow unlimited access. Similarly, some models will charge a small extra fee each time the service is accessed, while others provide it for free as long as the regular subscription fee has been paid.

Sevamob, founded in 2011, uses a subscription model to bring health care to the doorsteps of residents in Lucknow, India. For 100 rupees (about US$2) per month, an individual will receive a monthly visit from a doctor who can provide them with primary care services in their own home. The doctors use an Internet-enabled computer tablet to record patient data, take pictures, and send prescription requests to centrally-located specialists. Outside of these home visits, subscribers receive accident insurance and can access a 24/7 call center. For an additional 50 rupees (about US$1) per month, a subscriber is provided with insurance that covers up to 30,000 rupees (about US$550) of care at certain clinics and hospitals.

In our conversation, Saxena describes the benefits and challenges of the subscription-based model.

Trevor Lewis: What are the benefits of the subscription model for patients?

Shelley Saxena: I’ll give you an example from my extended family – my uncle had diabetes and he didn’t realize how serious his diabetes was and how high his blood sugar was. He just took it very casually, until two months ago when he partially lost his eyesight – that’s when he got his wake up call. And so now, he is having regular checkups, but his eyesight has still only been 70 percent restored. There are lots of stories like this where people don’t realize that they need care or that they have a serious condition that needs to be seen on a regular basis. Our prescription model makes sure that, on a monthly basis, basic care is happening. This is especially useful for the elderly, as well as children.

Especially in urban areas, people are becoming more aware of chronic conditions such as high blood pressure and diabetes. Our survey of a low-income neighborhood in an urban area [in India] showed a pretty high level of interest in primary health care – additionally, 90 percent of the respondents indicated that they would be willing to pay about 100 rupees (US$2) in subscription fees to receive these services on a regular basis.

TL: What are the benefits of the subscription model for your business?

Sevamob, NextBillion Health CareSS: The key benefit is that the subscription model provides us with a dependable revenue stream. Additionally, we are tracking a lot of data in our system for subscribers, and so down the line, on a Facebook-type model, we could share aggregate data with other companies, potentially for a fee, to help inform their business decisions. So for example, if a pharmaceutical company wanted to do a diabetes drug launch or trial, we could tell them which areas would help them produce the best results based on our aggregate knowledge of patients in the region. Individual patient data would of course remain confidential.

TL: Have you had any challenges in implementing the subscription scheme?

SS: Initially, when we started, we said that we would do 100 rupees per subscriber, where the “subscriber” was going to be a family in the rural areas and an individual person in urban areas. We very quickly found out that in the rural areas, when we would go to sign people up at their households, they would get their uncles and aunts and everyone else to come to their house also and join the same 100 rupee subscription. Even though we had clear policies, it was very hard to say no, and we would end up servicing ten people on a single plan. And so, even in the rural areas, we soon switched to a per-person model.

TL: Do you think subscription models are particularly well-suited to certain types of services or situations (e.g. geographic areas)?

SS: A subscription model is especially important from a business perspective when attempting a sustainable model in low-income communities. The poor often don’t show up to health centers until their condition really escalates. At that point, the emergency care can be so expensive that the low-income individual often can’t afford it, so the health care provider is forced to either turn the patient away or absorb some of the costs of the patient’s care. By charging a monthly fee and seeing the patient more often for preventative care, the provider can collect payment in small amounts that the patient can afford and help keep the overall costs of care lower, thus insuring their own financial sustainability.

TL: Do you have any advice to others trying to implement subscription models?

SS: There are companies who have tried to sell insurance to low-income people in India, but they have not been able to do so because the typical mentality with the low-income person is “I’m giving this money, but it is just going into a black hole and not getting anything done.” What that person does not realize is that if something were to happen, that’s when you see the pay-off. Typically, a low-income person wants to see some tangible benefits for the payment that he or she is giving up. So, the reason we bundle health care and insurance is because people see a tangible benefit every month. Every month, once a month, they receive primary care at their doorstep, whether that doorstep is their home, an office, a school, or whatever it might be. If they want to be successful, other organizations should make sure that patients are seeing these tangible benefits every time they pay their fees.

Health Care, Social Enterprise
public health