Over the last year I’ve participated in many research initiatives around the perception of healthcare costs & insurance needs in the Indian Market. The one single need that I have heard vocalized over and over is transparency. Transparency of expected costs, transparency of extraneous costs, cost to patient as well as cost to the insurance company.
What does transparency in healthcare entail? Overall transparency is a larger initiative, now manifested as Accountable Care endeavors across the world like the Cigna & Granite Healthcare collaboration, simply called Reform. Here is a snapshot of the report from KPMG.
The 4 different parties that are concerned with accountable care all have different meanings for transparency. Here are the questions that are opaque right now:
The Patient:
What will my true out-of-pocket costs be?
Where can I get the best care for my money?
What if I can’t pay?
If my doctor ordered this test or drug, does my insurance cover it? If not, why not?
The Physician:
What is the outcome of the treatment I am providing?
How amenable is the patient to lifestyle changes as prescribed by me?
What is the quality of care provided by my referral partner?
The Healthcare Payer:
What is the true cost of treatments provided to the user?
How can I help the patient get better quality care and thus reduce the cost of individual treatment?
The Healthcare Provider:
Patient flow information – check in to check out, consumption pattern, response to treatment etc.
Utilization of hospital resources like anesthesia and equipment
The answers to all these questions lie in data. Data that is exchanged between the patient, provider and payer. Data that is available and lying in various different places and with multiple owners. Accountable Care initiatives involve the flow of literally terabytes of information between the three entities. In the US, this data has been mined to show patterns and insights which lead to better care, credibility and outcomes. The outcomes in states which have Accountable Care show the following results
TRANSPARENCY helps lower healthcare costs.
For patients who now make a more informed choice, data shows they opt for lower cost options if given the choice and clarity of pricing.
TRANSPARENCY helps change behavior.
For Health Providers because they consume less resources to deliver better quality results all around if they know how much the resources cost.
TRANSPARENCY improves treatment outcomes.
For doctors who now have visibility on how their treatments are being assimilated and followed and can enforce compliance.
Taking a look at transparency from an Indian perspective, the first imperative for us is to introduce price transparency .
Transparency for Customers
Hospital rates, packages, estimates are not announced on websites and can only be gotten if the customer walks into the funnel. A patient or caregiver looking at medicine today finds a dark void in terms of estimated cost of treatment at different providers. No way to compare prices in a country driven by comparative pricing. This is a space where Insurance companies are in a unique position to step up and become partners with customers to reduce costs and spending.
True price transparency does not come about even if the hospitals publish their ‘rack rates’ and packages. Rates of estimate variance vary across different providers. Not even from aggregating claims data. True transparency will only come about from full disclosure on claims. Disclosure of full claim amount, net amount paid by the company as well as net amount paid by the patient themselves. Giving customers both sides of the coin.
The first one was easy. The insurance company which manages to answer the next three questions right and within context of the patient’s journey with healthcare, will be a winner.
1) The opportunity to aggregate enough unbiased data on the quality of healthcare by measuring both direct feedback and rates of readmission exists. This data will separate the wheat from the chaff easily. Who knows, the best doctor for your predicament may not be sitting in Fortis or Max, but a Moulana Azad Medical college, which is much cheaper than the former. A happy consequence for the Insurance company as well.
2) The gap in understanding of exclusions can be filled with education delivered at the right time in the right way. Be it through a chat bot or a claims calculator, or real time-rule based straight through processing with clear & transparent error messages.
3) In an eco-system tie up driven world, an Arogya Finance, which gives a medical loan on a psychometric analysis or even the 31 banks which provide a personal loan for a medical can be the next course of call for those who cannot afford to pay the provider the rest of the amount due.
Empowering the customer to make the right choices, partnering with them to ensure comfort is what endears brands to their target audience. It changes the relationship from a service provider to a partner in healthcare.
Transparency between the Patient & the Physician
This brings us to the physician’s perspective which is especially important in India. It is also tied in with the user’s goal to get the best care & the payers perspective on reducing costs by getting high quality care. In India, lifestyle choices vary by geography, culture, religion etc. Physicians struggle every day to educate the customer consistently on how they can make the changes needed for any treatment to be successful. More transparency with respect to clinical regime will give the doctors the right levers to pull to enforce their recommendations. What’s more, supported with artificial intelligence, regional and cultural behavior can be learnt and accommodated into prescribed lifestyle changes over time. Insurance companies with operations and reach spread across different corners of the country are again in a unique position to aggregate this data and to learn from it. Tracking patient compliance & outcomes data will also clean up the insights which pharmas have to plow into their research for India.
Insurance companies who are overhauling their legacy code systems or building new ones, should think about building an API bouquet. In this collaborative economy, it pays to be able to tie in with a hospital app, which all hospitals are building, to connect to wearables that patients will be wearing soon, to even encourage and subsidize medical wearables for their customers. The idea is to be able to sweep up as much data as possible, let AI learn from it, use it to garner insights and shape strategy going forward not only for themselves but also for patients, caregivers, physicians and hospitals alike. We have come a long way from when time was money, to when the money flowed to those who had the users, now the buck stops where the data lies.
Payer- Provider Transparency
There is a cultural sea change required for the payer provider relationship to become transparent. Simply because each hospital has their own pricing structure and rates. Transparency would require hospitals to be clear about what they charge and how they charge their fees. In a country where the prices offered to you by the hospital have no standard of reference, it requires a greater leap of faith towards a goal which may or may not be profitable for them. For this to happen, the authorities will have to intervene.
Price Transparency In India
The need to reduce the overall cost of healthcare is paramount in India where clinical events often tip the balance of poverty and comfort. In a study conducted amongst the migrant worker population in the cities, a large percentage of loans that weigh on Indians in the rural areas are the ones that are taken during medical emergencies. Even if they bear that, recurrent costs like medication & specialist care like physiotherapy etc are out of reach as hospitalization uses up most financial resources. The situation is no different in the cities, where the cost of healthcare is way higher in proportion to earnings and insurance. An adverse medical event in the family often puts them back several years in terms of financial planning. For Insurance companies and patients it will be a happy consequence, and that is why they are in a unique position to partner in transparency initiatives in the Indian healthcare system. As studies done across the world show, it reduces overall healthcare spending and increases accountability and credibility.
A strategy that involves increased transparency will enable the Insurance sector to tap the huge untapped market that India’s uninsured population provides. That last number showed that only 17% of the Indian populace is covered through medical insurance. Tapping it requires a change in the way Insurance companies shape their customer journeys and how they use the data that they have to increase transparency.
Here’s to increasing transparency as we go along, and to a future where the cost of healthcare comes within affordable limits for all Indians. Where Insurance providers can take advantage of the numbers that the country provides and still maintain profitability.
Ekta Rohra Jafri 