Sanjay Datta
Chief “ Underwriting and Claims,
ICICI Lombard

With years of experience in general insurance, Sanjay Datta, Chief “ Underwriting and Claims was part of the start-up team at ICICI Lombard in 2001. Since then he has grown the business into a market leader. Rachita Jha, ENN, reports

Tell us about most exciting phase to be in the insurance sector now.
It is exciting to see the level of awareness and acknowledgement of need for insurance among citizens to plan for the future. They are now aspirational and responsible now “ with safeguards for the future. If we want to improve healthcare dramatically year-on-year, we need to begin on PPP models of collaborations. This will result in big gains.

What are the ways on fraud management?
Fraud has many manifestations “ one is that the treatment has not taken place at all and a claim has been filed; second is about wastage and abuse which includes over-medication, overdiagnosis, etc. The first step is to set standards across the country wherein we can verify claims. So we as an industry have started to collaborate and share data and learning on frauds.
There is also a need to work together with hospitals to benchmark treatment processes, as it is the patients right to get optimal and quality healthcare at any hospital. We should start to measure health outcomes and adopt accreditations to have checks on quality, so that there is peer review of doctors as well as facilities. The healthcare ecosystem will need to work together instead of competing with each other.

In what ways are you working with hospitals?
The relationship is strengthening as we move ahead; we have begun with working together as partners. Initially we began with simplifying of processes of working together with authorisation mechanism and understanding of each other, claim application and approval processes. The first challenge in the last few years has been addressed with regulations coming in and acceptance of insurance as a benefit of the patient. Secondly, we need to understand what is good of the patient that needs alignment of the patient treatment modality and insurers to work together. The regulators have reduced the friction between the insurers and healthcare providers and have thus standardised the processes of giving finance such as cashless authorisation, agreements have been standardised and considerable work is on by regulators to form a health insurance forum where hospitals and insurers are represented. And soon we will be working on treatment guidelines.

Your views on the RSBY scheme and some take-away for the insurance industry
From a design perspective it is one of the most well-designed schemes in the world, which caters to scale. The entire paperwork is eliminated at it uses the simple technology of a smart card. It has revolutionised the health insurance for Indian citizens the way ATMs have changed the ease of banking for citizens. From a transaction architecture perspective, it is one of the easiest solutions created for the patient. The only drawback is that it now in the government space and is based on the mission to deliver insurance to the poorest of poor in the country where there is empowerment of access of healthcare with a smart card.

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