Paving the way for innovation in Healthcare Insurance

This story was first published in Medgate Today’s November-December 2015 edition. 

Healthcare in India is in a state of transition where state governments as well as the government at the centre have launched several initiatives to make healthcare affordable and accessible to all. However, given the low penetration of health cover in India, there is huge scope for the sector to innovate and introduce best practices using robust technology as a backbone and make basic healthcare accessible to all citizens. The sector also offers huge scope for leveraging technology to standardize procedures and make delivery systems efficient thus ensuring reach, growth and profitability for the sector.

The Provider is Key

A key player in the healthcare chain is the provider – the hospital. Without the right hospital infrastructure, it will not be possible to cater to the scaling healthcare needs in India. It is thus, crucial for hospitals to constantly evolve and adopt latest innovations and be on par with the global best practices.

One major area where technological implementation is lacking is the healthcare insurance claims adjudication process. Currently, majority of the health insurance claims are handled manually where all information from the first stage of filing a claim to the last stage of settlement is entered and processed manually. This practice leaves a lot of scope for errors and misinterpretation of data, and also requires physical storage of tons of paperwork that is always at a risk of getting destroyed or lost. Further, manual processes leave more scope for continuous back and forth between the hospital and the insurance company/TPA, adding to the inefficiencies and delays.

The Impact

In order to efficiently serve the needs of the consumers, hospitals need to ensure a quick turnaround time in healthcare insurance claims adjudication. It has a direct impact on the time taken to discharge a patient and have beds and other resources available in time for the incoming patients. The need is of a platform supported by strong technology that is standard, automated and scalable. Implementation of such technology can plug the loopholes at every stage; enhance over efficiency and in turn lead to customer delight as well as profitability.

Reduced Turnaround time: Quicker approvals enabled by a standardized electronic platform speeds up the time taken to process discharge significantly. Owing to rising demands for hospitalization needs, hospitals have a huge influx of incoming patients and the ability to make discharges faster will enable them to manage bed utilization and other resources better thus, reducing the waiting time for incoming and outgoing patients. Making optimum use of resources also, add greatly to the profitability of hospitals.

Hospitals adopt various Hospital Information Systems (HIS) to enable the internal processes and administration. However, to make the claim adjudication process completely efficient, HIS needs to be integrated with the electronic platform where the data that needs to be sent to the payer is exchanged directly from the HIS without the need for human intervention to enter data or fill forms at the hospital thus, reducing the possibility of errors. Integration of Remedinet with HIS enables the hospital to implement a seamless electronic channel for exchange of information with the payer. It not only eliminates the need for human involvement but also increases efficiency and accuracy, enhances reliability, and leads to profitability for the hospital.

Improved overall efficiency: A technology platform such as Remedinet makes it possible to identify lags or delays and fix the error in real-time. Quick responses to queries raised, real time tracking of the claims process, and retrievable archives become possible too. Handy SMS and email alerts based on pre-defined trigger points add to the hospitals and payers ability to manage the entire claim processing cycle better. Since, such platforms allow all data to be exchanged electronically, the need to store data physically is also eliminated as all data history will be available with the click of a button and will be easily retrievable, which also helps to save costs.

An effective digital platform is one that can make thousands of patient experiences useful beyond one hospital and one insurance company. To cater to the second largest population in the world, technology such as cloud technology can be used to create a modern healthcare system that requires reliable data, and clear standards and procedures for using and transferring such data. The accuracy and reliability of this data will be of tremendous value in predicting the future trends of healthcare delivery in India. It will enable the right decision-making regarding appropriate premiums thus, bringing the incurred claims ratio below 100%, making the sector profitable and bringing it on par with the global best practices.


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