India’s healthcare insurance segment remains a largely untapped market for new technologies, but its adoption rate is on the rise. Gross written premiums grew by 16% in 2012-2013 to Rs 15,341 crore. Although this rise is good news for the country, the hassle of filing an insurance claim when you/family member falls ill, still continues. The typical processes are done manually, where patients get physical copies of reports, scan them and then upload them. Cashless payments take plenty of time to be cleared and only account for about 30% of the insurance market.
Using Technology To Aid Cashless Payments In Hospitals – RemedinetPosted: February 4, 2016
This post was first published on Networked India in December.
This very problem has found a solution in Remedinet, a platform on which insurance firms or third party admin as well as hospitals can manage the processes of pre-authorised payments when a patient is admitted right up to their final settlement at the time of their discharge. We caught up with Remedinet’s CEO, Munish Daga who is of the opinion that healthcare in India can be made possible, accessible and affordable for all only by including an outpatient cashless healthcare cover. Here’s a small excerpt.
Radhika Sharma (RS): What are some of the problems or challenges that a consumer faces in the insurance industry today? Where does Remedinet fit in?
Munish Daga (MD): A fundamental problem that the consumer faces today is that he/she does not have access to unbiased information when the health policy is being bought. When the policy is being utilized, the consumer has to rely on hospital staff to share information. Second, even with the current process of information exchange between the patient – the hospital – the payer, transparency is very low as all information is exchanged manually, where the data is entered and converted manually at various stages. As a result, the process is prone to errors and dilution of information that affects the overall efficiency.
Remedinet’s core technology connects the hospital and the payer in real time on a simple end-to-end platform where information is exchanged electronically, eliminating conversion. Further, with features such as SMS escalation and notifications, every one involved in processing a claim, including the policyholder receives alerts and is informed at all times. Also, to ensure that the consumer need not rely on anyone else for a status update regarding their claims, Remedinet has installed TV monitors at hospitals for claims information and self-help kiosks that display claim status by entering a customer ID.
RS: Could you elaborate on the products offered? What is the processing time for the consumer?
MD: To make the process fluid and error-free, Remedinet’s platform is built in such a way that data can be entered and processed structurally, supported by drop-down fields. Thus, with two core technology solutions, one that initiates pre-authorization of the patient electronically and the second, that takes the process to the end, to the point where the patient is discharged, both ensure that information is exchanged and queries are raised and responded to in real time. This in turn ensures minimum waiting time. Our platform has reduced the waiting time post discharge for patients by 50%.
RS: For the users who have never even heard of real time cashless claims, could you explain the entire Remedinet process?
MD: When a patient enters the hospital for treatment with a cashless healthcare insurance policy, all patient data regarding the treatment and the policy are entered into the HIS which also flows into Remedinet’s platform integrated with the HIS. Once the information regarding the patient’s pre-authorization is completed, it is sent to the payer through our platform for approval. This information exchange involves completely electronic data that does not require human interpretation when it reaches the payer. No FAX machines or printers or scanners are required.
Our platform is built in such a way that information is received by the payer in the language (coded) supported by their back office systems. When the payer responds, the response is sent to the hospital through Remedinet again in real time. All following iterations and queries are exchanged electronically in real time. Also, if a response is not received within a stipulated time frame, it automatically sends SMS alerts to the concerned party, ensuring minimum turnaround time.
RS: Remedinet is a cloud based platform. Give us a little insight into the technology used to develop and sustain a portal like this.
MD: Being an end-to-end platform means that we integrate with both; the Hospital Information System (HIS) which each hospital or hospital chains use varieties of and with the payers who also use different types of back office systems. Remedinet’s technology is super-nimble and light-weight to seamlessly integrate with other platforms and ensure a fluid transfer of information. We have built a simple platform keeping in mind that our customers too, aim to deliver the best service to their customers.
We also, ensure about 99.9% availability and complete disaster recovery architecture.
RS: How many hospitals and insurance providers does Remedinet support?
MD: For hospitals we enable them to manage their entire commercial cashless portfolio on our platform. We are integrated (technically or manually) with 8 payers. We have more than 250 hospitals using our commercial platform and more than 1000 hospitals using our platform that support various government schemes.
RS: Tell us a bit about your app portfolio.
MD: We started with enabling end-users of the platform at the hospital to monitor claims’ status on their mobile phone using an app similar to the desktop platform. It helped insurance desks in hospitals to keep a track of the claim on the go, without having to sit in front of their systems. Going a step further, we are making the entire claim settlement process available on the mobile phone. The entire process explained earlier will be enabled on a mobile app, including scanning and uploading documents.
We are working towards building technology that will enable the patient to initiate his/her pre-authorization before entering the hospital using a mobile app. This will eliminate the need to fill forms upon arrival and help the hospital to be prepared for the patient’s arrival.
RS: What is your opinion on the Indian healthcare insurance industry today? Is it on the road to adopting a completely digital future?
MD: The Indian healthcare insurance industry is tackling a fundamental problem – only a minute percentage of the population is covered under any kind of health insurance policy or scheme. As a result of this, out of pocket expenditure increases and forces families below the poverty line.
I think that the government health insurance schemes in India are an example of how digitisation is being adopted to deliver healthcare to crores of people. Over the past decade, various state governments have launched health insurance schemes for BPL as well as APL citizens. For example, Tamil Nadu government’s Chief Minister’s Comprehensive Health Insurance Scheme is completely cashless and paperless for 6 crore individuals. As these schemes cover a majority of the Indian population, undoubtedly, they are laying the path for others to follow.
RS: What does the future hold for Remedinet?
MD: Very bright as the country is moving more towards cashless health insurance and it has no option but to embrace technology. With PM’s Universal Health Assurance Mission (UHAM) aimed at providing healthcare insurance to 1.2 billion Indians, undoubtedly there will be a need for technology that enables automation of cashless health insurance on a strong technology backbone, one that facilitates insurance cover for outpatient as well as inpatient care. At Remedinet, we are building technology solutions that connect the patient, the physician, the payer, the diagnostic center and the pharmacy on a single real-time and automated platform. We are continually progressing in a direction where, we have partnered with and supported various government health insurance schemes with our strong and simple technology platform.