Population Health with Universal Health Insurance: An integrated model for improving access to quality health care

In recent years, AMPATH has capitalized on its broad, multidisciplinary care foundation to seed a novel pathway to an integrated and quality primary health care delivery system. We call this our Population Health Initiative, which we have been scaling throughout western Kenya. With Kenya’s and our commitment to universal health coverage (UHC), we are in the process of demonstrating the effectiveness and sustainability of the integrated model.

AMPATH Population Health is characterized by the following:

• Comprehensive system of primary care focusing on preventive, acute and chronic care

• Multi-level MOH county health care network

• Protocol-based system of referral up and down the network

• Task-shifting and skill-building to empower frontline health workers

• National health insurance coverage for the informal sector and the poor

• Community engagement that focuses on upstream social determinants of health, including empowering communities to improve income generation

• Robust electronic medical record system with built-in decision support, to enable provider task-shifting, protocol-based, multi-level, multi-facility based care across a population.

AMPATH is currently piloting a model that incorporates Population Health with the provision of Universal Health Coverage. Every individual in the community will be provided access to financial protection by leveraging that national insurance product and working with the county MOH to commit to providing subsidized services for the poorest individuals.

In addition, through a strategic partnership with the Kenyan National Hospital Insurance Fund, we will ensure sustainability and a business model that builds a public health system with public financing. The national health insurance product from the informal sector will provide a baseline primary care capitation payment, and an additional chronic disease supplemental payment for each enrolled member. These funds will shift primary care coverage from donor funds to national health financing mechanisms. Funds will be dedicated to improving human resources, access to services and quality of care throughout the entire county network. In order to encourage greater enrollment of both healthy and ill participants, this benefit package has grown to include services responsive to a variety of community needs including, but not limited to, agricultural support services, co-op creation, livestock support, value chain enhancement, and facilitation of microfinance group creation.