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 businessopportunity, but…Most health insurance companies are still losing moneyScrabbling for market share.Great opportunity for a health insurance company, which is willing to think out of the box
Internet - game changer for thehealthcare systemEmpowered patients havebecome a fact of life in IndiaThey 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 worlds largest selling patient education book, the Healthwise Handbook, to all their customers!
Patients are smartGive them the tools to take care of themselvesThey 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 companiescan help to put it all together !
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 ?
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 thedoctor patient relationshipby 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 !