ACCESS Health supports the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme, covering over 500 million individuals in India with annual health coverage of INR 500,000 per family for secondary and tertiary hospitalizations. ACCESS Health provides technical assistance to strengthen state-level implementation in Uttar Pradesh and Kerala by enhancing the institutional capacity of State Health Agencies. The project focuses on improving access, equity, and the quality of healthcare services through private sector partnerships, capacity building, and adoption of digital health solutions. In addition, the initiative promotes patient empowerment and demand-side interventions to increase healthcare utilization. The project also supports cross-state learning and knowledge sharing, with assistance provided to other states like Assam, Gujarat, and Maharashtra, aiming to enhance health systems and move closer to universal health coverage in India.
The program aims to contribute to the achievement of the United Nations Sustainable Development Goals (SDGs) of ensuring healthy lives and promote well-being for all at all ages in India. With a specific focus on achieving universal health coverage, including financial risk protection, access to quality essential health-care services.
Increase the availability of healthcare services through private and market-based partnerships, innovations, and capacity building.
Increase the demand and empower beneficiaries through integrated, community- based and digitally-enabled demand-side interventions.
Improve the quality of care through institution building, quality improvement, and adoption of digital health tools towards delivering value-based care.
ACCESS Health began its partnership with SACHIS in Uttar Pradesh in June 2018, initially providing technical assistance to establish key systems and processes for PM-JAY implementation. As the scheme evolved, the focus expanded to enhancing beneficiary engagement, fostering interdepartmental collaboration, and using PM-JAY as a driver for broader health system improvements aimed at improving care quality, patient experience, and reducing out-of-pocket costs. Key interventions included promoting digital tool adoption among private PM-JAY providers, strengthening clinical care, increasing public sector participation in tertiary care, and developing patient support models through integrated healthcare delivery. Additionally, ACCESS Health facilitated multi sectoral partnerships, cross-learning, and local capacity building for data analysis and research.
In Kerala. ACCESS Health has supported the State Health Agency (SHA) since 2021, by providing technical assistance focused on enhancing healthcare quality and accessibility. The support includes capacity building for institutional strengthening and offering policy advisory services. A dedicated team of four experts worked closely with SHA Kerala to understand state-specific priorities, develop and test innovative intervention models, and guide the agency in integrating the most effective approaches into their institutional framework.
Done through research (dipstick study with 100 private hospitals), targeted empanelment, and collaboration with hospital associations. Over 900 new private hospitals were empaneled in the state in one year, significantly reducing gaps in the availability of specialties such as Surgical Oncology, Plastic and Reconstructive Surgery, Burn Management, Oral and Maxillofacial Surgery, and Urology. Additionally, 25 districts with an undersupply of hospitals empaneled 67 new hospitals.
Strengthened public sector participation in tertiary care through capacity building and supportive supervision of medical colleges. The decentralization of PM-JAY fund utilization at the medical college level enhanced financial management and resource allocation.
Leveraged the existing call center resources to operationalize and scale up four patient support services: hospital appointments, grievance redressal, patient feedback and satisfaction, and measuring value and health-related quality of life. The intervention is now slated to be scaled by the state through the establishment of an Interoperable Integrated Care Coordination Call Center.
Built institutional capacities for clinical and mortality audits and established Quality Cells and Committees to oversee treatment practices. Uttar Pradesh is the only state to do this and has collected feedback from over 15,000 PMJAY patients.
Focused on building the capacity of the private hospital network. The investment has prioritized the adoption of patient-centric tools such as ABHA and Personal Health Records, encouraging private hospitals to join the Healthcare Professionals Registry and Health Facility Registry. Additionally, it supports the adoption of ABDM-integrated hospital information systems to promote the interoperability of information, generation, and use of health records, thereby enhancing patient empowerment.
Designed by the National Health Authority in 2022, the Green Channel aims to incentivize hospitals by providing 50 percent of the claim amount at the time of claim submission. ACCESS Health piloted the payment mechanism with 60 public and private hospitals and demonstrated that timely payment encourages provider participation, improves claim documentation and submission, and assisted the state in scaling it. Today, Uttar Pradesh is the only state to scale this payment mechanism.
