Health Financing/Insurance

MediAssist’s fixed reimbursement model with hospitals

In a bid to address the burgeoning cost of treatment, country’s largest third party administrator MediAssist will tie up with various hospitals for developing a fixed reimbursement model for most illnesses. MediAssist expects this to create a provider network comprising “preferred providers or hospitals” across the country. “As the Indian health insurance sector grows in leaps and bounds, a pan-India network with locally empowered offices will be prerequisite for a TPA to meet the dynamic requirements of the customers both in terms of our servicing capabilities, reach and an efficient & preferred provider network,” a source close to MediAssist said. As part of its efforts to reduce the loss ratio of health insurance, the company would be providing strategic support to insurance companies by rationalising healthcare costs and facilitate profitability of the health insurance portfolio. MediAssist would be obtaining discounts on hospital tariffs as well as negotiating with hospitals the cost of certain surgical procedures and hospital tariffs. This will primarily lead to reduction of average costs claims for the insurance company. By reducing the costs of these treatments and obtaining discounts on overall hospital tariffs, TPAs can achieve major savings (expected to exceed 12 per cent) for an insurance company. In the long-run, such mobilisation of patient traffic to the preferred provider network would positively impact the profitability of the health insurance portfolios as well as generate higher patient traffic to the hospitals in the “preferred provider network”. MediAssist’s current provider network comprises over 4,500 hospitals and 3,600 diagnostics centres.

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