Suresh Sugathan
Head “ Health Insurance,
Bajaj Allianz General Insurance
Suresh Sugathan, Head “ Health Insurance, Bajaj Allianz General Insurance interacts with Monalisa, ENN, on how digitising of processes has eliminated the need of physically the updating documents, hence saving both cost and time
What operating model have you adopted to cater to the Indian healthcare sector?
At Bajaj Allianz we are currently driving health insurance business through our bancassurance and agency channels. Bajaj Allianz has also strengthened its web-based platforms for selling health insurance products. For the ease and the convenience of our customers we have adopted the tele-underwriting process for faster decision making and acceptance of the proposals where the underwriting decisions are referred to head office.
In what ways can IT help fill the gap between insurers, TPAs and hospitals?
Automation and IT initiatives can help bridge the gap between various stakeholders. A single database storing diverse data on demography, gender and past medical records etc will bring in operational efficiency. Another initiative which is setting up hospital information exchange and linking it with Electronic Health Records with real-time access to patient health records will enable quick and effective decisions. It also help in mitigating frauds across the industry by sharing information with all stakeholders on a single platform.
Traditionally insurers had to deal with huge volumes of physical documents. Digitising of processes eliminated the need for physically updating and share documents which will save both cost and time. Use of IT will prove to be effective in disaster recovery management, i.e, all records can be easily accessed even in the event of a calamity.
What are the most pressing challenges for health insurance companies in India?
Though health insurance is a necessity with the growing health inflation, lack of awareness among the masses about its benefits and insufficient distribution are major pressing challenges for the industry. Apart from these, lack of regulation and control of healthcare providers, over utilisation of healthcare facilities by policyholders and under use of preventive care are another concern areas. Concealment of material information at the proposal stage leading to customer grievances at the time of claims and increasing health insurance frauds add to the challenges faced by the health insurance companies.
How can IT help address other issues such as frauds in claims, data management, faster claims settlement, etc?
By leveraging on technology we have created a fraud indication meter called “ Fraud-o-meter that can give automatic triggers if a fraud is detected and has proved to be very effective in preventive fraud management. We have created a unique identification number for easy verification of customer history / credentials through biometric. In terms of claim settlement real time access to Hospital Information System (HIS) can help bring down turnaround time.
How do you foresee the sectors growth in the coming years?
Healthcare expenditure will touch USD 220 billion by 2020. This presents a huge opportunity for health insurance to emerge as a viable financing mechanism. Some of the trends that shall emerge include: disease and case management for patients; disease-specific plans; employee sponsored wellness activities; empanelment of specialist physicians; and HIS and Patient Health Records
Like
Dislike
Be a part of Elets Collaborative Initiatives. Join Us for Upcoming Events and explore business opportunities. Like us on Facebook , connect with us on LinkedIn and follow us on Twitter , Instagram.
