1) Optimising business process for telehealth services 2) Business process management in healthcare 3) Medical claim for healthcare (EDI 837) 4) Remote patients monitoring system 5) Noval drug approval for 2021 (FDA) 6) How covid-19 accelerated healthcare

1. Healthcare Data Analytics Platform
US Health Care System
Sumitesh Kumar 16 July 2021

2. Optimizing Business Processes for Telehealth Services
Business process management in healthcare
Medical claims for healthcare | EDI 837
Remote patient monitoring system
Novel drug approvals for 2021 | FDA
How COVID-19 accelerated telehealth
Table Of Content
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2
3
4
5
6

3. Optimizing Business Processes for Telehealth Services
The Future: Telehealth Patient Journey/Influence Map
1. Telehealth Companies
2. Technology Delivery Service (ISPs)
3. Health Care Players
4. Government Regulations (HIPPA)
Telehealth Enablers
Primary Care (PCP)
Occupational Health
Specialty Services
(Phych,GI, Radiology)
Emergent Care
(Telestroke)
Post Acute
Care (PT, OT, RT,
HH)
Preventive
Care/Coaching
(Nutritionist,
isolation)
Drug Therapy
(Recruitment,
Clinical Trials)
1. Chronic Disease Management
2. Undeserved Communities
3. Emergency Intervention
4. Infectious Disease Management
5. Remote Monitoring
6. Site-less clinical trials
Telehealth Capabilities and Outcomes
Increased Access Store/Forwarding Imaging Device/Wearable Integration Drug Rep Tele visits

4. • Transfer to other
Hospital
• Bed Management
• Patient Flow
• Drug Supply
• Medication
• Admission
• Emergency Room
Operations
• Infection Control
1
Documentation
Business process management in healthcare
2
3
4
5
6
7 8

5. The claim information
includes the following
data for single care
encounter between a
provider and a patient:
• Patient Descriptors
• Condition for which
treatment was provided
to patient
• Services Provided
• The Cost of Treatment
Medical claims for healthcare | EDI 837
Payer
EDI 837 Process Workflow
Provider
B2B Exchange
Admitting
Utilization
Review
Billing &
Collection
Treasury
Verification
function
Utilization
Review
Claim
Processing
Treasury
Generates EDI eligibility
enquiry 270
Receives EDI Eligibility
271
Send EDI Certification
request 278
Receives EDI 278
Certificate Respo
Send Claims/encounter
EDI 837 and Status
enquiry 276
Receives EDI status
response 277
Receives EDI pay
remittance 835
Receives EDI eligibility
enquiry 270
Send EDI Eligibility 271
Receives EDI
Certification request 278
Send EDI 278 Certificate
Respo
Receives/Claims/encoun
ter EDI 837 and Status
enquiry 276
Send EDI status response
277
Send EDI pay remittance
835
The EDI 837 transaction set is an electronic version of a paper Healthcare Claim Payment and
Remittance Advice that complies with the ANSI X12 EDI specification. The EDI Health Care Claim
Transaction set (EDI 837) is used in HIPAA EDI transactions to submit health care claim billing
information, encounter information, or both.

6. Remote patient monitoring system
The Global Remote Patient Monitoring Devices Market Size is anticipated to reach over USD 1,882.75 Million by 2025
On the basis of region, the global Remote Patient Monitoring Devices Market is segmented into North America, Europe, Asia
Pacific, Latin America, and Middle East & Africa. North America was estimated to dominate the global Remote Patient
Monitoring Devices Market.
All-in-one healthcare device TOD Data Center
Patients vitals are
monitored by probe
attached to All-in-one
healthcare device
The record data is
transmitted from the All-
in-one device and
transmitted to TOD
Mobile app using
Bluetooth
The Mobile app pushes
the data to the TOD data
center using cellular/wifi
internet connectivity for
analysis
Any breach in the
threshold values (set by
physicians) send an
instant SMS alert to the
physician’s cellphone
The physician logs to the
TOD system to check the
actual reading and may
initiate a teleconsultant,
if necessary, or contact
the patient via inbuilt
call option
TOD

7. Novel drug approvals for 2021 | FDA
Insurers and PBMs Have a Lot of Leverage to Hold
Down Medicine Costs
Retail and Physician-administered Medicines Represents Just
14% of Health Care spending
91% of All Medicines Dispensed in the
United States are Generics
Medicine Spending is Projected to
Grow in Line with Health Care Spending
Through Next Decade
Nearly Half of Spending on Brand
Medicines Goes to Entities Other Than
the Manufacturers Who Developed
Them
Insurers are Increasingly Shifting Costs
to Patients Through the Use of
Deductibles and Coinsurance
We are in the new era of medicine where breakthrough science is
transforming patient’s care
53 new medicines were approved by FDA in the year 2020
24%
32%
21%
23%
TOP 3 MARKET SHARES
Optum Rx (United health
Group)
CVS healthcare (Caremark)
Express Scripts
All others
8
12
14
17
14
4
31
US HEALTHCARE SPENDING
Admin cost
Home health & nurshing home care
Prescription medicine
Physician & clinical health services
Others
Dental services
Hospital care

8. How COVID-19 accelerated telehealth
US consumer using telehealth
Jan 2019 : 11%
Jan 2021 : 46%
Revenue from US telehealth
Pre-COVID-19 : Estimated $3 billion
During COVID-19 : Up to $250
billion
0 50 100 150 200 250 300
Telehealth
Revenue
US healthcare
Jan-21 Jan-19
4 5 7 6 4
8
5 5
23
12
1
6
23
13
16
12
17
40
84
79
71 70
83
75 73
78
37
0
10
20
30
40
50
60
70
80
90
Specialist Urgent care
center
Health center Pediatrician Gynecologist Non annual visit
(GP/FP)
Annual visit
(GP/FP)
Routine visit
(GP/FP)
Psychiatrist
Modality Trend During Covid 19
Telephone Telemedicine In-person
Jan 2019 Jan 2021

9. Thank you!!