The economically weaker sections of the Indian society often find it difficult to afford quality healthcare. Indian population living below the poverty line does not have necessary financial means to avail quality healthcare services. According to various studies, India has abysmal record on health care spending and one of the world’s poorest populations. India is home to the largest number of poor with one-third of the world’s 1.2 billion extreme poor living here. With 4 percent of GDP expenditure on healthcare, India ranks among the bottom five countries with the lowest public health spending globally.
With a view to provide affordable treatment to economically backward sections in Tamil Nadu, the Government of Tamil Nadu has introduced a scheme called the “Chief Minister’s Comprehensive Health Insurance Scheme”. Members of families whose collective annual income is less than Rs. 72,000 are eligible to avail benefits under this scheme. The scheme currently covers 1.32 crore families in Tamil Nadu, where beneficiaries can get cashless treatment across 800+ hospitals for a set of pre-defined medical conditions. Each member is issued a card by the government, which can be used to avail medical treatment at any of the participating hospitals. This scheme is entirely cashless, and the premium is paid by the Government of Tamil Nadu on behalf of the beneficiaries to the Insurance Company.
To make this scheme a success, there was a need to address the following issues relating to the current claim settlement process:
• Health insurance adjudication process involved a lot of paper exchange – starting with patients filing in forms at the time of admission and ending with insurance companies and TPAs sending hard copy records of the amount settled at the time of discharge. Reams of paper were required for collecting relevant data which was then keyed into computers for maintaining records.
• Physical copies of the data collected were preserved in warehouses for reference. • If there were any discrepancies or the patient had to go for an interim enhancement, the entire cycle of physical data collection to tying it and storing it electronically was repeated.
• Inaccuracies on the part of data operator in keying the data on the system resulted in rejection of the claims or duplication of the entire process.
• The back and forth transmission of information, through emails, faxes and courier of physical copies, elongated the duration of the claim settlement cycle substantially.
To make the process accurate, hassle free and paperless for its intended beneficiaries, a strong technology support was required for transferring the entire process of claim settlement from offline to online. With a view to manage the entire process of capturing and transmitting data in the claim settlement process electronically, the government roped in Remedinet Technologies as their partner for providing software solutions and the relevant IT infrastructure support.
Assured delivery of all crucial information to various participants in the claim settlement process
Remedinet Technologies provided end-to-end technology support for making this scheme paperless. Their solutions made the data gathering exercise structured and accurate. The ways in which Remedinet solutions have enhanced the overall efficiency in the administration of this scheme are mentioned below:
• As all patient records were maintained electronically, the time involved in the claim settlement process was reduced drastically. Remedinet made it possible to close up to 400,000 claims per year from 2012 by improving the claim settlement turnaround time.
• The time spent in feeding the data and then taking a print out for processing the request was curtailed by half.
• Accuracies in maintaining records improved exponentially as the manual process of filling forms was done away with.
• A transparent dashboard showed all relevant details for monitoring the claim settlement process.
• Real time monitoring of claims made it possible for hospitals, TPAs and insurance company to expedite the settlement process by identifying the stage at which the process was held.
• Automation of various caps for different medical conditions made it simpler to process the requests.
• Need for warehouses to store the physical copies of the records done away with.
• Complete disaster recovery mechanism to make all the records accessible with minimum downtime.
• Maintaining almost 1 Terabyte of data every month for the scheme thereby saving tones of papers which would otherwise be used for storing data.
• The gigantic volume of transactions being managed with a response time of less than five seconds.
• Assured delivery of all crucial information to various participants in the claim settlement process.
• Faster claim settlement process resulted in minimizing the waiting time for patients.
• Patients could access their hospital records through a simple and easy to use member portal.
• Archive of treatment history made it possible for patients to refer this information for further treatment without actually furnishing the report copies.
Remedinet solutions have been the technology backbone for this scheme. To make the government healthcare schemes beneficial for the target group, it is imperative to embrace latest technology. With the central government planning to introduce universal healthcare scheme, Remedinet solutions can go a long way in ensuring the success of such initiatives.