Why health insurance companies get bad press

General perception – seen to be greedy villains !Happy to collect the moneyReluctant to settle claimsPatients 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 systemEmpowered patients have become a fact of life in IndiaThey are “internet positive”This shift represents a huge opportunity for clever health insurance companies

Kal, Aaj or KalIndian 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 canProvide 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 smartGive them the tools to take care of themselves

They have the most at stake !

Insurance companies as heroesTrusted source of healthcare information

Information which is evidence based, updated and reliable

Insurance companies should act as patient advocates !

Disruptive innovation - 4 stepsStep 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 onlineHow do you get doctors to change their

habits ?“What’s in it for me? “

Disruptive innovation – 4 StepsStep 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 stepsStep 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 stepsStep 4

Create online patient communities around the PHR

Allow patients to talk to each otherFacebook for HealthWeb 2.0 has arrived ! Your

customers are online – can you afford to lag behind ?

Health insurance companies can help to put it all together !

IT for ITDr Google is a fact of lifeIt’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 ?

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 – USPSeen to be patient-friendly – good press

and good PRYou can improve the doctor patient relationship by being doctor-friendlyReduces 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 toolCost 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

innovationData 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 dataVery valuable for

Pharma companies and Medical device manufacturers

Additional source of revenue !

Patient Education Resource Centers in Hospitals

At your Help Desks !Great branding

opportunity

Sell policies to patient’s relatives – very aware of their mortality in a hospital setting !

Patient education is a powerful tool

Promote healthManage chronic diseasePrevent medical mistakesAchieve 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 !