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What health insurance companies need to do to put patients first
What health insurance companies need to do to put patients first
What health insurance companies need to do to put patients first
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
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
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
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
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
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 !
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
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
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 .
Information Therapy
 “Information is the best prescription”
 Information therapy ( the right information
 to the right person at the right time) can be
 powerful medicine !
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!
Patients are smart
Give them the tools to take care of
 themselves
They have the most at stake !
Insurance companies as heroes
 Trusted source of healthcare
  information
 Information which is evidence based,
  updated and reliable
 Insurance companies should act as
  patient advocates !
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
The problem with PHRs
• Patients will not bother to fill in their
  PHRs!
• This is why google health failed
• The solution ?
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? “
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
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)
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 ?
Health insurance companies
can help to put it all together !
What health insurance companies need to do to put patients first
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
Kal, Aaj aur Kal - what can you do
            right now ?
What health insurance companies need to do to put patients first
www.informationtherapy.in
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.
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
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”
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
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 !
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
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 !
 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
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 !
Please come to HELP !
www.healthlibrary.com
Let’s start a HEAL India movement !

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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!
  • 15. Patients are smart Give them the tools to take care of themselves They have the most at stake !
  • 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 ?
  • 23. Health insurance companies can help to put it all together !
  • 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
  • 26. Kal, Aaj aur Kal - what can you do right now ?
  • 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 !
  • 38. Please come to HELP ! www.healthlibrary.com
  • 39. Let’s start a HEAL India movement !