First Mutual Health promoting accessibility, inclusive health for all Zimbabweans

This year marks the 15th anniversary of First Mutual Health, a division of the Zimbabwe Stock Exchange listed diversified firm, First Mutual Holdings Limited.

In order to get insights into key developments over the years, challenges and other issues, Business Times (BT) spoke with Dr. Chris Hwingwiri, the Acting General Manager of First Mutual Health.

Below are the excerpts from the interview:

BT: What is First Mutual Health’s background

CH: First Mutual Health is celebrating its 15th anniversary this year as it started operations in 2009 came into the market when the health sector was at its lowest in terms of service delivery and needing such initiatives as employed by First Mutual to offer medical service which was accessible and offering other benefits on top of the conventional medical aid cover.

The health insurance company has been growing in terms of membership and this is a reflection that as a business, not only is it growing, but also contributing significantly to the health sector in Zimbabwe and will continue to seek new business through providing quality service, demonstrated claims paying ability, wellness campaigns, innovative products and affordable pricing to our members.

BT: What have been the key developments and innovations that First Mutual Health has implemented as part of its vision.

CH: Our strategic focus has been to find ways of increasing access to medical aid services to include all social classes and introduced a low-cost health insurance solution, Micromed, which only costs $3 (or local currency equivalent) per member per month. As part of ensuring access to health care, we have engaged a network of service providers who accept Micromed thus improving service to our members.

We believe in continual product improvement for the benefit of our members and have  revamped our existing medical aid plans to ensure they remain relevant in these changing times. The Coral plan, for example, can now access service at Group B private hospitals. The Topaz plan, which originally could only access service at public facilities, can now access primary care services at First Mutual Health Services facilities.

We have an exciting new product designed to address a key customer pain point which will be launched at the beginning of the fourth quarter. Further details of this exciting change will be communicated via our digital platforms.

BT: How do high medical care costs impact Zimbabweans both with and without medical aid cover?

CH: Since medical aid is designed to address the burden of out-of-pocket payments when faced with high medical care costs, I will answer your question looking at those without medical aid cover first. Many among us are aware of someone who failed to access the healthcare that they needed because they could not afford it. Perhaps the condition that they had worsened as a result of the delayed care, or even resulted in loss of life. At times people requiring medical attention resort to borrowing money for treatment, and the loan may take years to repay which can result in significant mental stress. Others sell property that they will have worked their entire adult lives to accumulate – just so that they can get treatment when they fall sick. We have heard about catastrophic health expenditure which happens when a given household spends an unsustainable proportion of their income (some say 25%) on health.

Medical aid covers a material portion of some of these out-of-pocket payments to mitigate the problems However, the more healthcare costs continue to run away, the more difficult it becomes to collect enough money to keep out-of-pocket payments (or shortfalls) at levels that the average person can manage. It is imperative, therefore, that there be a meeting of the minds to keep healthcare costs as low as possible. Once that is achieved, chronic conditions can be detected earlier, and the population will become healthier – unleashing their productivity and therefore the wider national economy.

BT: What is managed healthcare?

CH: Managed Healthcare is a health insurance approach which addresses both the financing and service delivery aspects within the healthcare space. For a long time, those who finance healthcare services have stayed out of the health service provision space, and vice versa. The rapid escalation of healthcare costs has changed this dynamic. The intention is not for one side to make the other irrelevant, but for the two to coordinate better with the goal of keeping healthcare costs at a sustainable level. These cost-savings that we talk about are evidence-based. A 10-year study conducted in Switzerland demonstrated that managed healthcare contributed to significant and sustained cost savings with considerable reductions in mortality, hospitalisation and length of stay in hospital.

There have been several iterations of the managed care approach. What we have chosen as First Mutual Health – the Point of Service managed care plan – achieves a good balance between ensuring sufficient options of service providers for members and efficient management of scarce resources.

BT: What are the key considerations and challenges in implementing a managed healthcare model?

CH: If you are setting up a managed healthcare model, I think you must think about three main things. Firstly, it is important that the access to healthcare services by your members is not negatively affected. You do not want a network which is limited in either its geographical reach or in the service disciplines that are available. Perhaps just as important is the fact that you want exceptional quality of service among all your network of service providers. Quality of service is best measured from the perspective of your members, and it should never be sacrificed at the altar of cost management. Number three, it is important to have the buy-in of health service providers so that you do not create unnecessary antagonism from a constituency which, in reality, should be a partner.

Having said all the above, it is imperative to get the fundamentals correct. The right patient-centric health outcomes must be measured and rewarded accordingly within the network so that the intended winner – the member – reaps the benefits. Effective and timely monitoring and evaluation of outcomes is therefore critical.

BT: How has your implementation of the managed healthcare model impacted regulators and other non-client stakeholders?

CH: We operate within the confines of the law and any regulations that govern our industry. This is very important for us as a responsible corporate citizen. We have not had any issues with the regulator. We have been pleasantly surprised by the cooperation we receive from health service providers who, in the main, understand that the way healthcare costs have been escalating is neither fully justifiable nor sustainable. We look forward to deeper relationships with this important stakeholder group.

BT: How does your expanding comprehensive healthcare facilities network support your implementation of managed healthcare?

CH: The healthcare facilities that the First Mutual Holdings Limited group has set up in the last few years aim to bring affordable healthcare services to members of all medical aid societies in Zimbabwe, as well as to the general uninsured public. The participation of the group in health service provision ensures that it can leverage on its relationships and economies of scale to keep health care costs down. It is not a sign of First Mutual Health seeking to distance itself from third-party health service providers. These will remain part and parcel of the solution going forward because for any managed healthcare program to be effective, it needs the insured members to retain freedom to choose service providers of their choice.

BT: How does First Mutual Health gather and analyse information on healthcare interventions and outcomes to guide managed healthcare initiatives?

CH: We have an IT system in place which gathers information on the healthcare services that our members in their various locations are consuming. The system is robust and secure, and we are confident that our members’ sensitive data is secure. Access rights to that data are restricted within our organisation and is only retrieved on a need-to-know basis. We have also taken advantage of artificial intelligence tools to help us with some of the data processing that helps us make decisions on the initiatives which are likely to have the highest impact on the wellbeing of our members.

BT: What do you see as the potential downstream opportunities that your implementation of managed healthcare may open for First Mutual Health?

CH: Our managed healthcare initiatives have already started bringing down out-of-pocket payments for our members, and healthcare services for our members has already become more coordinated and integrated. We envisage that the potential reduction of costs within our entire ecosystem will lead to a maintenance of our premiums at affordable levels. This opens the door for greater financial inclusion for our population, and greater access to healthcare services. The care monitoring tools we have put in place will ensure that there are constant improvements in the care that our members, both present and future, will receive. We will not allow short-term business considerations to compromise the type of care our members receive.

BT: How can clients get in touch with you and find out more about First Mutual Health and your approach to healthcare?

CH: We have branches in the major cities for those who may want to walk into our offices. Apart from that, we have a 24-hour contact centre on the following numbers: 077 891 7309; ‎+263 8677 007432, +263 24 2251440.

We also have a digital presence on LinkedIn, Facebook and X. We will be launching a WhatsApp chatbot in the coming days. We decided to name it “Thuso” – which means helper in Venda.

Conversations with all our stakeholders help us improve our products and service, so we are looking forward to wider engagement with them.