A Health Care System Redesign to Solve for the World’s Poorest
Social entrepreneurship fuels impactful change by identifying and rectifying problems through persistent innovation. For Possible, the nonprofit health care company I am fortunate to lead with my colleague Duncan Maru, this means redesigning a health care system that solves for some of the world’s poorest people.
The health of people across the globe depends in large part on the quality of the health systems that serve them. Poignantly, the lack of high-quality, accessible, and affordable health care plagues millions every day. Worldwide, out-of-pocket health spending forces 100 million people into extreme poverty every year. In the United States alone, 45,000 deaths occur annually because of lack of health care.
The problem is multifold: The poorest are priced out of the private sector, which is often seriously unregulated and incentivized to deliver excess care through fee-for-services payment systems. The public sector often fails to deliver on quality due to poor management and limited resources. And while philanthropy can provide pockets of excellence and innovation, it often fails to scale.
Possible has implemented an innovative approach to rural health care delivery called Durable Healthcare, which is designed to solve for the poorest patients. Below, we’ve highlighted specific elements of Durable Healthcare that are deeply rooted in the values of social entrepreneurship.
A New Way of Thinking
In the social impact space, having the right mindset and culture is vital for getting remarkable work done.
At Possible, we invested heavily in defining an organizational culture that would attract the right team members and serve as a “true north” for our organizational goals. Every value that drives our work is captured in our For-Impact Culture Code, which challenges both the term and the perceptions of the nonprofit sector by listing the 10 principles by which we strive to work and live. The purpose of the Culture Code is to power some of the world’s toughest work. The document not only codifies but also demands three traits vital to social innovation and change: speed, transparency, and accountability.
Going Against the Status Quo
The harms of medical care, and specifically the fee-for-service model, loom large across the globe. Possible’s model is based on a performance-based financing system; the Nepali government pays us only if we hit impact milestones and improve the health of the population we serve.
Thus, Durable Healthcare makes a bold move by directly tackling the most dangerous yet common hazard to patient care. Fundamental to avoiding distorted incentives in health care delivery is uncoupling simply doing stuff with revenue (that is, the fee-for-service model) and realigning revenue with improving health.
Building a Model with the Tenacity to Scale
Durable Healthcare was designed to create a successful service delivery model for a rural Nepal district of more than 250,000 people. It simultaneously serves as a blueprint with an impact and business model that can be replicated and scaled at the national level. If we can prove it works in one population and has the power to be repeated throughout the country, then it also has the ability to transform health care systems across the globe.
Moreover, the entire model is based on changing the politics and financing of health care. Social entrepreneurship fuels this by creating essential relationships with stakeholders in the private, public, and philanthropic sectors.
Mark Arnoldy is the CEO of Possible. He leads overall strategy, focuses on building a remarkable team, develops partnerships, and makes sure the company never loses sight that everything is impossible until it isn’t. Prior to Possible, Mark worked closely with a Nepali social entrepreneur for three years to create an innovative way to treat malnourished children and helped create two U.S. businesses that fund nutrition programs in Nepal. He graduated summa cum laude from the University of Colorado at Boulder, completed Harvard’s Global Health Effectiveness Program, and was a Fulbright scholar to Nepal. Mark is an Aspen Ideas Festival scholar, 2014 Rainer Arnhold fellow, Cordes fellow, and Bluhm/Helfand Social Innovation fellow. In 2014, Mark was named one of Forbes’ Top 30 Under 30 Social Entrepreneurs and was recently named a Schwab Foundation Social Entrepreneur of 2015.
Possible is a nonprofit health care company that delivers high-quality, low-cost health care to the poor in rural Nepal. It is pioneering a new approach, called Durable Healthcare, that brings together the best of private, public, and philanthropic models. Possible delivers care within the existing Nepali government infrastructure and is paid by the government only if it hits certain impact milestones. Leveraging the government allows Possible to keep costs low and provide access for the poorest patients by realigning revenue with care. It is building its model to spur adoption across Nepal and act as a blueprint for other countries struggling to deliver care to their poorest citizens. Since 2008, Possible has treated more than 235,000 patients in rural Nepal through government hospitals, clinics, and community health workers.
