The Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) formerly known as Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) renamed from 01st April 2017 is a unique PPP model Health Insurance Scheme tailor made to meet the out of pocket health expenditure requirement of BPL / APL families for identified diseases. The scheme is introduced with the guiding principle that insurance schemes should be targeted at catastrophic illnesses and the benefit in the primary care should be addressed through free screening and outpatient consultation. The government health system combined with MJPJAY is able to meet the entire health requirements of population in the state. The scheme is implemented through effective use of IT based solution which is unique to the scheme in reaching out to the beneficiary. The scheme has many unique features to its credit to proactively reach beneficiary and guide the beneficiary to avail the services in a cashless manner.

1. Arogyamitras (Facilitator services)
2. Round the clock Call Centre with Toll free help line.
3. Health Camps conducted by network hospitals.
4. Follow up by elaborate field mechanism.
5. End-to-end cashless packages.
6. Services of MCO (Medical Coordinator) and MCCO (Medical Camp Coordinator) in the network hospitals.
7. CUG (Closed User Group) connectivity to all the field staff, MCO and MCCO.
8. Placement of MJPJAY kiosk with Network connectivity.
9. Robust IT based solution, capturing patient details right from reporting to the Hospital till claim settlement and follow up.
10. Social auditing through feedback letter from the beneficiary.

Since the scheme is very unique, Society has decided to provide a strong facilitation mechanism under the scheme not only to guide the beneficiary right from his door step but also to create awareness among rural illiterate poor for effective implementation. Further it was contemplated that the facilitator may be selected among the local populace for effective communication among these rural poor. Accordingly, the concept of Arogyamitra (The friend of Health) was evolved and effectively trained these facilitators. A detailed note on the Arogyamitra services is given below.

1. Arogyamitra is Friend of Health. Arogyamitra is a concept unique to Mahatma Jyotirao Phule Jan Arogya Yojana. Arogyamitras act as facilitators for the patients. In fact they form face of this scheme in the villages and in the network hospitals.

2. There are two categories of Arogyamitras

1. Arogyamitras in PHCs/RHs/GHs /SDHs/WHs/DHs
2. Arogyamitras in Network Hospitals

3. (i) Arogyamitras in PHCs/RHs/GHs /SDHs/WHs/DHs Arogyamitras are recruited by TPAs from local area of each PHC in order to ensure performance efficiency and acceptability among local communities. The following qualifications are prescribed for a PHC Arogyamitra:

• Graduate
• Native & Resident of the same PHC area
• Good communication skills
• Prefers to move around the villages
• Functional knowledge of computers

The working of the Arogyamitras will be monitored on a daily basis by the District Coordinator of the SHAS, PHC Supervisors, District Heads and Area Managers of respective TPA���s. All the Arogyamitras are provided with cell phones (CUG connection) by respective TPA���s for instant communication and networking. Arogyamitras are also provided with uniforms (Aprons) for easy identification by patients.

(ii) Arogyamitras in Network Hospitals: Apart from the Arogyamitras in PHC/RH/GH/SDH/WH/DH TPA���s has to select and post at least three Arogyamitras in each Network Hospital under the scheme to monitor the patients round the clock.

4. Training of Arogyamitras Training for Arogyamitras will be carried by respective TPAs training department. The concept, content and training material is prepared by respective TPAs in coordination with Society/ NIC.

5. Role of Arogyamitras in PHC/RH/GH/SDH/WH/DH

Role of Arogyamitra inside PHC:

• Patient Registration: The Arogyamitras are responsible to register patients with the help of their ration card.
• To counsel the patients: The Arogyamitra needs to counsel the patient as a friend or a guide regarding the entire process through which the patient would be treated. This is the initial point of contact so Arogyamitra should try to gain patients trust and should assure the patient regarding the cashless facility.
• Verify the Beneficiary criteria (Eligibility Criteria): The MJPJAY scheme (formerly known as RGJAY) is meant for BPL (below poverty line) Yellow card holders, APL (Above poverty line) Orange card holders, Antyodaya Anna Yojana card (AAY), and Annapurna card and orange ration card. It is the responsibility of the Arogyamitra to verify the beneficiary criteria.
• Facilitate consultation with Medical Officer: After successful verification of the documents the Arogyamitra needs to arrange for consultation with the MO.
• Fill up the referral card: Arogyamitra should fill up all the details in the referral card and should educate the patient regarding the further treatment.
• To guide the patient to Empanelled hospital: As per the instructions given by the Medical Officer after successful diagnosis of the patient , Arogyamitra needs to guide the patient to the Empanelled hospital as referred by the MO depending on the specialty of the hospital.
• Facilitate Patients in procuring medicines: Arogyamitra should help the patients in procuring medicines and provide explanation regarding the dosage and use of drugs and medicines as suggested by treating doctor/MO.
• Guide Patients for Clinical Tests: Arogyamitra should also guide and help the patients in case when patient has been advised to undergo certain clinical tests.
• Follow-up the referred cases: Arogyamitra needs to keep a check on the follow up schedule of the patient as suggested by the doctor after the surgery. The purpose of follow up could be either prescribing further medicines or keeping a check on patient���s condition.

Roles of Arogyamitras outside the PHC:

• Publicity and Awareness: Arogyamitra is responsible for creating awareness regarding the scheme in their local vicinity. Publicity of the scheme is another aspect through which the reach of the scheme can be deeply penetrated in the locality and maximum people can take benefit of the scheme.
• Educate people about the scheme and distribute brochures and other material: Educating the families in villages regarding the scheme and convincing them to take maximum advantage of the scheme. Brochure and pamphlet distribution can be done to increase awareness.
• To spread the awareness about the scheduled camps: Monthly camps will be organized by the respective TPA in co-ordination with society at the Empanelled hospitals. Arogyamitras should ensure that details of the health camp i.e. date, time, location is conveyed to maximum number of beneficiaries/public.
• To coordinate with Empanelled hospitals and help conduct camps: Co-ordination with the Empanelled hospitals regarding fixing the schedule of the health camp is an important responsibility of the Arogyamitra.
• Mobilize the patients for camps: Many time patients would be reluctant to attend the health camps, in such cases the Arogyamitra should personally try to mobilize the patients and assure them that they would be treated without any charges or fees.
• Co-coordinating with MCCO (Medical Camp Coordinator): Arogyamitra needs to coordinate with the MCCO in organizing the health camps.
• To send daily MIS of the patients: Arogyamitra needs to update the MIS (Management Information system) of the patients. All the current information regarding the patient and other daily activities needs to be updated on daily basis.
• Report to the Supervisor, District Head & Area Manager: Reporting of the activities to the Supervisor, District Head & Area Manager or any other designated higher authority as per the schedule or whenever demanded.
• Any other work as assigned by the respective TPAs in coordination with Society from time to time.

6. ROLE OF AAROGYAMITHRAS AT NETWORK HOSPITAL

Arogyamitra at Helpdesk

• First point of contact person for beneficiary at Network Hospital.
• Coordinating with patients in a Friendly and Pleasant manner.
• To be in APRON during duty hours and strictly adhere to duty timings
• Maintain patience and empathy while dealing with patients.
• Always keep the CUG switched on round the clock and should attend to all the Incoming calls politely.
• Any irregularity or inadequacy noticed should be brought to the notice of their superiors.
• Maintain Help Desk at Reception of the Hospital.

Identification of patients, Verification, Enrolling & Registration

• Receive the patients, verify the documents, register them and direct them to the MCO (Medical Coordinator) for further screening and investigations.
• Manually verify patients Ration card, identity proof and referral card, if any.
• After verification of patient details in online portal search if details are not available enroll the patient first.
• If the details are available in online portal search and register the patient.
• Once the registration is done MJPJAY Patient Registration form is generated and Arogyamitra should sign and hand it over to the patient.
• Facilitate the patient for a cashless transaction.

Guiding patients to MCO:

• After registration Arogyamitra should guide the patients to MCO.
• Ensure that MCO generates DTRS (Diagnostic Test Requisition Slip) for every patient as required.
• Facilitate the patient for free diagnostics.

Counseling Out patients & Inpatients:

• On verifying the test reports MCO makes the patient as Out Patient (OP) or Inpatient (IP).
• If the patient is OP, Arogyamitra has to counsel the patient that he/she does not require the surgery and can improve the health by taking medicines as prescribed by MCO.
• If the patient is IP, Arogyamitra has to counsel the patient regarding cashless facilities available in the scheme.

e-Preauthorization:

• Facilitate early evaluation and prevent delay in approvals by submitting the preauthorization complete in all respects.
• Ensure that patient is on bed from the time Patient is admitted till the approval is obtained.

Daily Rounds:

• Regular rounds in the wards and ensure that the patient is getting all the benefits of the Scheme.
• Ensure that Hospital is giving free Quality Food to all the MJPJAY In-Patients.
• Any complaints or grievances noticed should be escalated to Superiors.

Counseling and Coordinating with patients at the time of discharge:

• Facilitate the patient to get the one way transportation charges and to ascertain whether Follow-Up Medicines are served as per the guidelines.
• At the time of discharge, ensure that NWH staff captures an ideal discharge photograph (photo of the patient standing in front of the Jeevandayee/MJPJAY KIOSK besides the Mithras with Discharge Summary in one hand and Transportation amount and slip in the other hand) and upload the same in the website.
• Obtain feedback from the patient.
• Counsel the patient regarding follow-up.

Coordinating with Arogyamitra at PHC for Follow Up:

• Coordinate with PHC/Government Hospital Arogyamitra for follow up of beneficiaries.
• Coordinate with the Head-Office and Medical officers for any clarifications.

Daily Reports:

• Inform the Call-Center immediately in case of a Death and do send the Death Reports.
• Send Daily reports as per the formats given by the Head Office to the Call-Center and to the Hierarchy.
• Facilitate Network Hospital in conducting Health Camps as scheduled.
• Facilitate Network Hospital in sending claims online.
• There should be clear communication between night shift and day shift Arogyamitras and handing over the duty roster must be smooth and complete.
• All Grievances should immediately be brought in to the notice of Grievance Department directly or through Hierarchy.

Emergency Telephonic Intimation:

• Arogyamitras should facilitate and coordinate with MCO/Duty Doctor/Specialist Doctor for obtaining telephonic intimation during emergency cases.
• The Arogyamitras should be un-biased while judging the 72hrs deadlines given for the patient in furnishing Ration Card at KIOSK to avail Jeevandayee/MJPJAY benefits. He should help the patient and facilitate the need of producing the Ration card along with identity proofs before the dead-line.
• Facilitate the hospital in giving prior phone intimation to the Specialist/ Society Doctors facilitated through Preauth Executives for carrying out the emergency surgeries.

Discharge:

• Ensure that all the updating like surgery, post-operative notes and discharge are done in time on the website by respective hospital MCO.

Follow Up:

• Arogyamitra should ensure that free consultation, investigations & medicines are provided for follow up eligible patients for the identified 121 follow up procedures.
• Coordinate with MCO for initiating and submitting claims for every 3 months during follow up process.
• Counsel the patients regarding follow up medicine and ensure that the patients get their follow up on the dates provided by MCO.