ICICI Lombard has a vision for health insurance sector, wherein the entire claim process can be made paperless and capable of providing results in real time, according to company’s N Eswaranatarajan, the Head of Operations & Technology. In conversation with Dhirendra Pratap Singh, he sheds light on the role of IT in Indian health insurance industry
Tell us about your views on Rashtriya Swasthya Bima Yojana (RSBY).
Technology is the most effective tool that is utilised to reach the masses. We were the pioneers in using a Smart card which is the base product on which technological interventions are done to ensure it reaches the right beneficiary in the BPL segment through Rashtriya Swasthya Bima Yojana (RSBY).
One of the largest mass health insurance programmes in the world, RSBY provides health insurance to five members of every BPL family. The biggest USP of the RSBY scheme is the empowerment it provides to the beneficiary. By being an RSBY smart card holder, the beneficiary has the freedom to choose from the empanelled private as well public hospitals to avail the best possible treatment for his family. The scheme has been successful in delivering health cover to the economically challenged households across India.
This scheme provides health insurance cover to the head of the household, his spouse and up to three dependent children or parents. As part of this scheme, smart cards embedded with biometric technology are issued to the beneficiary family. The fingerprints and photographs stored on the smart card facilitate accurate beneficiary validation and ensure that they get cashless access to medical care across empanelled public and private hospitals.
The usage of biometric technology guarantees that each beneficiary has a unique identification, enabling validation of the medical claim balance available and foolproof authentication. The smart card reduces hospital and other administrative costs and the need for cumbersome admission procedures at hospitals, thereby providing a sustainable platform for the delivery of cashless health insurance at remote rural locations. RSBY also has a robust monitoring and evaluation system that can track all transactions happening across the country and provide periodic analytical reports.
We received The Golden Peacock Innovation Award, 2011 for the RSBY scheme. ICICI Lombard was recognised for deployment of biometric card technology to implement the scheme, which helped the Government of India to execute rapidly.
We have utilised an in-house claim settlement team to take care of the IPD claims and small sized OPD claims from every part of the country and ensuring timely claim is paid to beneficiaries, Hospitals and OPDs. Also, rural POS has been placed in OPDs to ensure OPD Claims are settled in a cashless manner. Various Innovation projects like OPD on RSBY platform or Smart Card for Weaver policy with Ministry of Textiles are underway to ensure scalability of such policies and widening of the coverage
What kind of opportunities do IT vendors have in health insurance sector?
The health insurance industry provides various opportunities to the IT vendors. As market leaders, we have pioneered the use of technology to most rule-based tasks in the insurance servicing space. From policy administration systems and underwriting solution to providing online access to the products sold by the industry, IT is driving the wider outreach of our services and driving down the costs. This obviously is for the benefit to the consumer. Today the industry provides products on-line without a human interface. E-channel has emerged as a formidable marketing platform for insurance solutions.
Health IT has also led to connectivity solutions that connect health providers to insurance companies, hence speeding up the underwriting process. Technology today provides a seamless health profiling and risk assessment tool that also has long-term archiving and easy electronic recall. ICICI Lombard has a vision for the health insurance business wherein the entire claim process can be made paperless and real time between the healthcare providers, beneficiaries and insurance companies. This would be only possible through an efficient Health IT system.
What kind of growth is Health IT witnessing? What is your market share?
Hospitals and other healthcare businesses are realising that IT is a necessary ingredient for ensuring quality healthcare delivery and providing distribution width to reach new markets. The uses now range from enabling basic tele-medicine to the electronic sharing of complicated medical diagnosis between continents. Technology has also solved the previously existing heath limitations imposed by geographic segmentation.
Today, IT companies are offering wide ranging solutions from simple connectivity to cutting edge medical interventions. The high quality imaging resolution in the medical diagnostic environments are enabling early diagnosis and precise interventional care. There is tremendous scope for further use of sophisticated technology in the healthcare space.
We are the largest health insurance player in the private sector space. Our constant endeavour in developing our IT efficiencies through significant investments in technology has been one of the major contributors in achieving this position.
What are the challenges being faced by the healthcare companies in India today?
The current healthcare infrastructure in India is inadequate and underdeveloped. The overall number of beds, physicians and nurses is low compared to other developing countries and international averages. The situation is worse in the case of tertiary beds and specialist physicians. The quality of healthcare is poor due to the dominance of unqualified practitioners and sub- optimal facilities. An additional 750,000 beds are required (from 1.5 million today to 2.25 million in 2013), of which 150,000 beds need to be tertiary beds. The number of doctors and nurses enrolled in medical colleges and nursing schools will have to triple over in the next 10 years. Moreover, the IT infrastructure available in 60 percent of the provider networks in the country is basic and mostly primitive in its versions.
Today, the preventive healthcare market for over 160 million people largely funded by the corporate or government sector. To overcome these challenges and bring about the necessary changes, bulk of the investment will need to be made by the private providers.
The current healthcare infrastructure in India is inadequate and underdeveloped. The situation is worse in the case of tertiary beds and specialist physicians
How do you think IT in healthcare has transformed the way treatment procedures are carried now?
Technology has had a major positive impact in specificity, efficiency and quality of patient care. In India where the Health Industry lacks hugely in man power, video conferencing by specialists in case of complicated cases has assured spread of apt medical advice even to remote locations. Doctors now have instant access to patients’ medical records on the go. The diagnostic reports are directly emailed and messaged to the doctor in case of abnormal findings, facilitating quick response. Technology today has even created the ability of beaming vital statistics from an ambulance to the ER team prior to the arrival at the casualty ward.
What is your prediction for health IT market in the next 5-10 years in India? What are the growth contributors in the industry?
As per Zinnov Management Consulting, currently, annual IT spends in hospitals in India is approximately $191 million and will touch $1.5 billion by 2020. A mid-size hospital in India spends between 1 and 1.5 percent of its turnover on IT, while a large hospital spends nearly 2 percent on the same.
As the healthcare sector becomes more receptive to technology, numerous opportunities will open up for SCC (secondary care centers) and new entrants focusing on this space. SCCs can create a niche for themselves in areas like mobile health, embedded systems, developing low cost advanced devices, interface solutions, medical imaging, telemedicine and cloud based solutions. Enterprise mobility will be a major growth driver. Opportunity will also be created through the Cloud. The cloud enables a mid-sized company to develop a technology that can address a large audience, without investing upfront in expensive infrastructure. At the same time the cloud can enable smaller units like nursing homes to access and use technology generally available only to large enterprises.
The phenomenal success of the telecom sector has set the stage for a similar explosion in the healthcare technology sector. Major government initiatives like the UID, the state data centres and broadband present a great opportunity for the Indian IT industry to provide the much needed quality and reach in healthcare delivery