Health Insurance in 2016: Will the consumer be king?

This story was first published in the January issue of Express Healthcare.

Munish Daga, CEO, Remedinet recommends using the mobile phone as a medium to improve health insurance coverage in the coming year

201601ehm65Keeping the current government’s Universal Health Assurance Mission (UHAM) in mind, a solution that promotes universal healthcare will have to use technology in a way that is simple and robust, as well as scalable. The focus needs to be on a solution that aims to bring the consumers – the beneficiaries into the loop and enables them with the ability to use as well as monitor their health policy with minimum hassles and maximum transparency. More importantly, this solution should be able to make a scheme such as UHAM accessible to every single citizen of the country. And, that is the prediction for healthcare insurance, not just for 2016 but also for the foreseeable future.

Considering that mobile phone users in India are nearly one billion and counting, it is already the medium of choice to deliver health insurance. Thus, there is no doubt that a simple hand held device, on a strong technology backbone has the potential to make healthcare insurance delivery simple, affordable and accessible for all. Mobile devices have already proved their mettle across other segments. While shopping, booking tickets and transferring money is possible with a few taps on the screen, why not subscribe to and utilise health insurance using a mobile phone?

In healthcare insurance, the most misguided, misinformed, and left-out member is the consumer or the policyholder. Right from mis-selling of policies to meet sales targets and falling prey to inessential medical tests, to having claims rejected at the end, the consumer is a victim of vested interests at various stages. By giving the consumer access to his/ her policy on the mobile phone where he/ she will be able to understand and utilise the policy as simply as making an e-banking transfer or even like chatting on WhatsApp, it will put tremendous power in the consumers’ hand. Not only will it curb malpractices, but also empower the consumer with knowledge and awareness.

How will the consumer be king in 2016?

For pre-empted medical treatment at a hospital, if the consumer is able to initiate his own pre-authorisation sitting at home, before he/ she is admitted to the hospital; then, not only will the hospital be well prepared for the patient’s arrival but the payer too can verify and approve the initial claim made (pre-authorisation). This would require the consumer to upload relevant documents (only once) and send the policy details using the mobile application to the doctor, who will add the treatment details through his mobile phone and send it to the payer.

The application will also ensure that alerts and notifications are sent at every stage to all parties involved. It not only ensures a hassle-free experience that does-away with form filling at arrival but also ensures that the consumer is kept in the loop of all information exchange. In this manner, if there are any queries raised, if the consumer has uploaded incomplete documents, or any other iteration, everyone in the loop is informed through chat-like alerts for immediate action.

What will this lead to?

With a platform such as a mobile application allowing data to be entered and exchanged in electronic formats, where all partners involved communicate in real time, a standard method of processing claims will emerge. The patient will enter and share his/ her information, the doctor will add medical information, the TPA desk at the hospital will add insurance claims related information and send it to the payer. The payer will respond and approve accordingly. The mobile application can very well support translation of data into suitable languages for respective partners, for example; coded data for payers.

Thus, when information goes back and forth between the hospital and payer, there will be no paper exchange and conversion of data involved which might break the cycle of information exchange.

What will be the impact?

At the end, when the patient is discharged, all data related to the hospitalisation and treatment will be available in a structured electronic format – rich data. Data scientists can crack this data to identify trends such as number of instances of a particular disease in a particular area at a particular time of the year. They can identify trends such as the most common diseases that either gender group is affected by and much more. With analytical data, research and development wings can identify and work on preventive measures for the most commonly occurring health problems and diseases.

Can the government make use of mobile solutions in 2016?

Currently, the government-launched health insurance schemes have not performed as per expectations owing to various reasons such as inadequate spending, lack of trust, inadequate coordination and communication between various subsidiaries, etc. For a scheme such as UHAM to function on a large scale and serve 1.2 billion people, standardised delivery, transparency, accessibility, affordability of healthcare services is vital.

If SMS features can be used to inform beneficiaries about health insurance schemes, eligibility, subscription, and utilisation, it will make healthcare insurance simple and a part of every mobile phone user’s life. In a similar manner, when the beneficiary arrives at a healthcare facility, he/ she need only send an SMS alert regarding his/ her policy information to avail of the treatment. Also, the patient can receive policy utilisation details such as access to information regarding the insurance amount and how the scheme is used in a particular time frame (depending on the policy guidelines) at all times.

Here too, structured electronic data will help the government tremendously to identify health-related trends in specific geographical areas where preventive action can be taken accordingly.

Once a platform and technology is established, it can be used for other educational and developmental purposes such as informing citizens about epidemics, precautionary measu res, etc.

Just like radio has reached the rural-most areas and has become a medium of choice for many, especially in the rural parts, mobile applications can be used as a tool to inform and educate. A device as simple to use and maintain as a mobile phone has the capacity to scale healthcare insurance delivery to make it accessible for a billion people, an absolute need of the hour.



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