NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
What health insurance companies need to do to put patients first
4. Why health insurance companies
get bad press
General perception – seen to be greedy
villains !
Happy to collect the money
Reluctant to settle claims
Patients are fighting back ( Times of India
consumer redressal forum stories)
Hospitals and doctors are refusing to
accept cashless policies from TPAs
5. Why health insurance companies
get bad press
The last thing patients want to worry about is
medical bills after having paid for a health
insurance policy !
Patients feel entitled to getting full and prompt
reimbursement. Hate having to argue
with an insurance agent about
preauthorisation
Exclusions ( fine print) are a sore point !
Too many grey areas
6. Why health insurance companies
get bad press
Doctors don’t like dealing with
insurance companies.
Don’t like filling up forms or being
questioned by
agents.
TPAs are
considered to be
evil
7. India is a huge business
opportunity, but…
Most health insurance companies
are still losing money
Scrabbling for market share.
Great opportunity for a health
insurance company, which is
willing to think out of the box
8. Internet - game changer for the
healthcare system
Empowered patients have
become a fact of life in India
They are “internet positive”
This shift represents a huge
opportunity for clever
health insurance
companies
9. Kal, Aaj or Kal
Indian health insurance companies are
still stuck in the past . Role limited to
paying the hospital bill
Focus limited to
Sell more policies
Reduce the medical loss ratio by
curbing fraud
Not health policies, but illness
policies !
10. Time to evolve – learning from
ancient India…
The doctor was paid as long as all the
family members were healthy. If anyone fell
ill, the payments stopped until they
recovered.
Innovative health insurance companies in
India need to come up with a modern
version of this model
11. Time to evolve – learning from the
West…
Spending on medical care after a
person falls ill is expensive.
Much more cost- effective to educate,
counsel and motivate people to remain
well
These interventions ( for example,
health coaches) reduce claims
12. Help your customers save money
on medical care
Promote SelfCare
Help them to do as much for themselves as
they can
Provide Evidence-Based Guidelines
so that they can ask for the right medical
treatment that they need – no more and no less
Provide Veto Power
so they can say No to medical care they don’t
need, thus preventing overtesting and
unnecessary surgery .
13. Information Therapy
“Information is the best prescription”
Information therapy ( the right information
to the right person at the right time) can be
powerful medicine !
14. Patients are the largest untapped
healthcare resource !
Partners Health Initiative (PHI) in
Anderson, South Carolina saved $34.5
million in 30 months – by gifting a copy of
the world's largest selling
patient education book,
the Healthwise Handbook,
to all their customers!
16. Insurance companies as heroes
Trusted source of healthcare
information
Information which is evidence based,
updated and reliable
Insurance companies should act as
patient advocates !
17. Disruptive innovation - 4 steps
Step 1
• Give all your customers a prepopulated
PHR - their personal health url.
• Piggyback on the UID smartcard ?
• Use this to connect with the patient
regularly. Creates stickiness and
loyalty
• Cost effective - reduce transaction
costs
18. The problem with PHRs
• Patients will not bother to fill in their
PHRs!
• This is why google health failed
• The solution ?
19. Need to nudge doctors so that
they go online !
Remember - patients will do what their
doctors tell them to – not what their health
insurance company tells them to
Give doctors an EMR ( electronic medical
record)
Doctors are slow to move online
How do you get doctors to change their
habits ?
“What’s in it for me? “
20. Disruptive innovation – 4 Steps
Step 2
• Give doctors their own personal website –
www.drmalpani.com
• Online doctors will use EMRs ; and they
will get their patients to use PHRs because
this improves their productivity !
• This is an actionable item which is the key
to creating an online healthcare ecosystem
- valuable digital real estate !
• www.websitesfordoctors.in
21. Disruptive innovation - 4 steps
Step 3
Provide customised Information
Therapy based on this PHR
Tailored to the patient’s personal
needs !
System-driven and delivered ( based
on keywords and patient activity)
22. Disruptive innovation - 4 steps
Step 4
Create online patient communities around
the PHR
Allow patients to talk to each other
Facebook for Health
Web 2.0 has arrived ! Your customers are
online – can you afford to lag behind ?
25. IT for IT
Dr Google is a fact of life
It’s inexpensive to develop web services and
applications in India. Leverage this opportunity by
providing clever value added services
29. Makes business sense – excellent
investment
Patient education has been a neglected area
in India
This lacuna represents a major opportunity
for the insurance company which has the
vision to realize the importance of owning
this area by becoming the “first-mover” in
this field.
30. Why this is good for you !
Increase your market share – USP
Seen to be patient-friendly – good press and good
PR
You can improve the
doctor patient relationship
by being doctor-friendly
Reduces your administrative
costs
31. Better customer services
Online patient communities allow you to
listen to your customers
You can provide better service by solving
their pain points
“ Every complaint is a gift”
32. Great marketing tool
Cost of customer acquisition is much lower
when you do this online !
Customers will come to you when you
provide value added services to help them
take better care of their health
33. Solves your pain points!
• Prevents fraud . You now have a long term record
of the patient’s medical history. Patients cannot
lie when they submit a claim
• Reduces a doctor’s incentive to perform
unnecessary surgery – well-informed patients will
push back !
• Stops the hospital from padding their bills just
because patients are insured. Patients will
compare notes and talk to each other online
• Transparency and openness helps everyone !
34. PHRs and EMRs are a very valuable
source of knowledge for
innovation
Data mining provides priceless reliable
actuarial data – will allow better underwriting
so you can offer better policies.
Reduces your medical loss ratios. Predictive
modeling identifies high risk patients . You
can focus on these to maximise health care
cost savings
Improves quality of care and medical
outcomes – pay for performance
35. PHRs and EMRs can be a very
valuable source of income
You can monetise this data
Very valuable for
Pharma companies and
Medical device manufacturers
Additional source of revenue !
36. Patient Education Sell policies to patient’s
Resource Centers in relatives – very aware of
Hospitals their mortality in a
At your Help Desks ! hospital setting !
Great branding
opportunity
37. Patient education is a powerful
tool
Promote health
Manage chronic disease
Prevent medical mistakes
Achieve patient-centered care
Improve health care system efficiencies
Create customer delight !