The TPA arm of the Medi Assist group offers health benefits administration services including cashless claims management, reimbursements, pharmacy benefits, planned hospitalization and more. The healthcare services arm offers a range of wellness programs and value added services to corporate employees and individuals.
Medi Assist is transforming the Indian healthcare ecosystem by making healthcare more accessible, affordable and actionable for millions of people around the country. It is changing the way the various stakeholders of the ecosystem – insurers, insured and medical service providers – interact with each other; while influencing the ecosystem to cover many more lives that today remain unserved.
A Red Herring Asia award winner in 2014, Medi Assist has been widely recognized for the innovative use of technology in the healthcare industry. The company has also been listed as one of Forbes India’s Hidden Gems in 2014. The company has recently strengthened its leadership position in the preventive care and wellness segment with the strategic investment of US$ 1 Million in Goa-based mobile fitness venture, MobieFit.
With technology and digitization being on an upsurge, the face of almost all sectors is gradually changing, which includes the healthcare sector as well. However, the sector is still grappling with issues like out of pocket expenses and cost of care, which are emphatically, hitting the roof. Considering the dire need to digitize operations in healthcare so as to make it more conducive for people, Medi Assist aims to bring in cashless hospitalization at reasonable tariffs, in addition to necessary optimization of processes.
Replying to Arpita Saxena of IIFL, Prashant Jhaveri, Head, Products and Strategy, Medi Assist Healthcare Services Private Limited spoke about how the future of healthcare is being redefined with the use of technology, and the role his company is playing in the same.
What inspired the inception of Medi Assist?
Medi Assist was incorporated in 1999 and we were among the first few organizations in the country to receive the license to set up a Third Party Administration (TPA) company, from the Insurance Regulatory and Development Authority (IRDA), in 2002.
Today, Medi Assist is a managed healthcare organization that aims to deliver informed healthcare decisions to a billion lives connected by our technology, partnerships and human touch. The TPA arm of the group, Medi Assist Insurance TPA, is India’s largest TPA touching over 11% of the country’s population, servicing corporate, retail and government policy holders; and the wellness arm of the group, Medi Assist Healthcare Services, is the preferred healthcare and wellness partner for a swathe of corporate customers across the country.
How does Medi Assist plan to use technology to redefine the future of healthcare?
A Red Herring Asia 2014 award winner and the winner of the CIO 100 award 2016, Medi Assist has been acknowledged as a leader in using technology in the health benefits space. Technology is at the heart of all our initiatives to elevate customer experience and simplify the often complex world of healthcare.
Our award-winning technology platform, MediBuddy, provides a range of tools that empower every stakeholder in the healthcare ecosystem. The MediBuddy portal and mobile app help members access and manage their healthcare needs online, in real-time and on the go.
Hospitals use our MediBuddy+ portal to manage all cashless claims, from origination to settlement, online and in real-time. MediBuddy+ also allows medical centres to manage the booking and scheduling of wellness services, such as health checks, online.
The MIS reporting and analytics capabilities of MediBuddy allow decision makers to make informed choices and effectively manage their healthcare portfolio.
Who are your competitors in the healthcare space?
Today’s day and age is all about collaboration rather than competition. We, at Medi Assist, pride ourselves on the strong partnerships we have built with all stakeholders in the ecosystem. We work with over 21 insurer partners, are the health benefits and wellness partners for over 6000+ corporate customers and have over 10,000+ hospital and medical centres in our network. As a result of our collaboration with service providers, our members enjoy significant discounts and preferred pricing that help them reduce their overall costs of medical care.
What is the USP of Medi Assist?
Our USP is our “tech and touch” approach to delivering a superior customer experience and outcome. While MediBuddy leverages technology to enable self-help and superior decision making, we believe that the magic of the human touch is irreplaceable, priceless even.
We run several innovative programs that help us personally touch the lives of our members. As part of our CareRangers program, we visit our members and their families at their bedside at the hospital to enquire about their well-being during hospitalization. Our ProRangers program strengthens connect with retail policy holders and the wide network of agents who service them personally. ChampCamp is our interactive onsite corporate event that combines wellness with fun, games and social engagement. We leverage ChampCamp to improve awareness about health benefits and increase employee participation at onsite wellness events.
What is the long term vision of the company?
Our vision is to deliver informed healthcare decisions to a billion lives connected by our technology, partnerships and human touch.
What are your key initiatives to improve efficiencies, reduce healthcare costs and enhance patient outcomes?
Medi Assist is committed to making healthcare affordable, accessible and actionable to every citizen of our country. As health benefits partners, we play the role of an aggregator in the industry. We empanel hospitals into our network to enable cashless hospitalization for our members. We leverage this unique position in the healthcare ecosystem to drive down the overall cost of care. Our members are eligible for preferential access and pricing at our network medical centres.
Our members can opt for an eCashless planned hospitalization, a feature that allows them to obtain a provisional approval for cashless hospitalization using their mobile phone from the comfort of their homes. With eCashless, not only do members get full visibility into estimated costs and the out of pocket expenses that they need to prepare for, they are also able to reduce their overall medical spend by opting for a cashless hospitalization at a network hospital of their choice. eCashless, in essence, enables patient choice, better cost of care, green channel admission, real-time visibility and optimal use of health benefits.
Elaborate on MediBuddy, the mobile app and retail portal.
MediBuddy is a revolutionary technology platform that transforms the health insurance industry at the very core. MediBuddy, with its diverse offerings for various stakeholders of the health benefits industry, makes the process of discovering, accessing, and utilizing and monitoring health benefits seamless, real-time and virtually paperless.
Members can sign-up for MediBuddy with a username and password of their own choice. They can then access, raise, manage and track their claims in real-time using both the MediBuddy portal as well as the mobile app.
They can opt for eCashless on MediBuddy to obtain a provisional preauthorization from the comfort of their homes using their mobile app. Not only does eCashless eliminate all wait time and anxiety at the time of hospitalization, it also gives members full visibility into their cost of care and out-of-pocket expenses so members can plan all aspects of their hospitalization better.
Particularly useful in the case of emergency hospitalization, members can use the GPS-enabled network hospital search to locate hospitals within their insurer network in their vicinity.
With the ability to raise claims online and save all documents in digital format, MediBuddy makes the entire lifecycle of health benefits virtually paperless by saving all records on the cloud. Members can access records anytime, anywhere, and on-the-go forever.
Cashless transactions are gradually emerging today. What according to you is the reason for this change?
Always acknowledged as a price-sensitive market, Indians are acutely aware of the rising cost of healthcare. As per the IRDA Annual Report 2014-2015, medical inflation in India stands at 12%-15% as against a global average of 6%-7%. Indians are, therefore, opting for health insurance policies to hedge themselves against the risk of high out-of-pocket expenses particularly for critical illnesses.
Cashless hospitalization is the most efficient manner in which members can utilize their health benefits. Not only does it empower policy holders to enjoy green channel admission with minimal out of pocket expenditure to be incurred at the hospital, it also allows members to reduce their overall cost of care by leveraging the preferred tariffs enabled by us as a result of our provider contracting prowess.
Features such as eCashless further elevate the consumer experience associated with planned hospitalization. Little wonder then that more and more individuals are choosing cashless hospitalization over traditional reimbursement claims.
Have you faced any challenges in managing health benefits for a large, diverse country like India? More than half of the country’s population is still indigent. Any plans to deliver high quality healthcare to rural India in the pipeline?
Many brands have come to India and found the market unlike any other in the world. The geography, the multi-lingual culture, the price sensitive nature of our people, the predominantly rural population and, for the health benefits industry specifically, the low penetration of health benefits; add to this the mobile revolution, the growing awareness about healthcare and fitness, and the predominantly young population, and you have a complex market teeming with potential.
Managing health benefits for a large, diverse and populous country like India is no easy task. Technology must necessarily be at the heart of any initiative to administer such significant public healthcare schemes.
At Medi Assist, we service several million lives under a slew of central and state government schemes such as the Rashtriya Swasthya Bima Yojana (RSBY), Rajeev Gandhi Jeevandayee Arogya Jojana (RGJAY), and Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme (TNCMCHIS), among others.
We extensively use technology to service our wide customer-base that includes several BPL families covered under a swathe of government health benefits schemes - biometrics-based e-cards for beneficiaries, paperless admission and claims management at network hospitals, SMS and mobile app-based claims tracking for beneficiaries, integration with government systems for utilization tracking and MIS reporting and data analytics that empower government decision makers to derive intelligent insights from the enormous amounts of data collected from across the nation. We are also the only health benefits organization to offer a multi-lingual website, www.mediassistindia.com, that empowers our members to learn more about health benefits in their preferred native language.
Health benefits administrators cannot reach their true potential by merely processing claims. As the insurance market matures and policies begin to cover outpatient medical expenses and medicines in a bigger way, the TPA industry will require investment to extend cashless services in the outpatient environment. The government’s Universal Health Coverage (UHC) agenda cannot, after all, be realised unless the entire gamut of medical expenses - in-patient care, out-patient expenses and pharmacy benefits - is covered. We must morph into technology and implementation partners for the Government of India and take cashless benefits to the masses and service citizens in a manner befitting the country that is today one of the world’s fastest growing economies.
Do you foresee any investment inflow in the Third Party Administrators (TPA) industry? If yes, what is your estimation?
The TPA industry is going to need investments to the tune of about $1 billion in the coming 5 years to gear up for the exciting future of the Indian healthcare industry. This investment would go into creating a wide-spread and yet closely-knit mesh of network hospitals and medical centres that can make cashless hospitalization a reality for every insured Indian anywhere in the country.
Importantly, the investment would be required for mapping the infrastructure of each hospital in detail to allow consumers to make an informed decision about their preferred network hospital. Investments will also be required to bring all these hospitals onto a common technology platform for seamless inventory management and faster claims settlement.
What is the magnitude of growth which the health insurance sector will witness in the next 3 years, considering soaring health inflation, and cost of medical care hitting the roof?
The IRDA Annual Report 2014-2015 has, among many other things, highlighted two crucial statistics. One, the retail segment has grown significantly in recent years. The contribution of individual health insurance premium to the total health insurance premium collected has increased from 35% in 2010-11 to 44% in 2014-15.
Two, only 2% of the Indian population is covered by individual health insurance policies; and only another 4% are covered under group medical policies. The opportunities available in the health benefits sector, both retail and group medical segments, are undoubtedly immense.
Medical inflation in India stands at 12%-15% as against a global average of 6%-7%. With the cost of medical care constantly increasing, there is little doubt that more and more people will opt for health insurance policies to hedge themselves against the risk of high out-of-pocket expenses. This will further fuel the growth of the health insurance, and as a corollary, the third party administration (TPA) industry.
What are your contributions in transforming the Indian healthcare ecosystem?
While we are proud of our innovative use of technology in the healthcare ecosystem, these are early days for us. There is so much more to do, and so much more to achieve.
Industry recognition in the form of the Red Herring award, 2014; the CIO 100 award, 2016; and the listing on the CIO Review as one of the Top 20 Most Promising Medical Technology Solution Providers, 2016, goes a long way in encouraging us to continue to invest in maintaining our technology leadership.
The true measure of our success, however, is the acceptance of our technology by stakeholders. MediBuddy has seen incredible adoption and support from our members. On an average, there are 3000 distinct members utilizing the platform on daily basis. Additionally, over 4,400 network hospitals have adopted the MediBuddy platform for submission and management of cashless claims online. The number of eCashless requests is also increasing with each passing day as hospitals and patients alike discover its beauty, simplicity and power.
Our efforts at strengthening patient choice and enabling preferential access are moot. When a Medi Assist member needs to plan a hospitalization, she logs into her MediBuddy and locates a network hospital in the vicinity. She compares hospitals based on the facilities available, doctors’ profiles, type of rooms available, peer rating of the hospital, and more. The ability to make this decision on a single platform without having to scour various websites or make multiple phone calls is a significant enabler. Once she zeroes in on the network hospital, she plans an eCashless hospitalization. Now she can choose her preferred room type and also get a provisional preauthorization from Medi Assist without stepping out of her home. She gets visibility into the estimated cost of treatment and the associated out of pocket expenses; she also enjoys the benefits of preferred tariffs on her treatment as a member of the Medi Assist family. On the date of admission, she enjoys green channel admission into her preferred room with minimal wait time!
In the months to come, the MediBuddy platform will morph into a one-stop-gateway for all healthcare needs of an individual, spanning in-patient care, out-patient services, medicines and lifestyle management solutions. In the near future, patients will book their appointment for a health service using a mobile app, state their policy number in the request to avail a cashless service for all expenses payable under their domiciliary cover, make a payment for non-medical expenses via a payment gateway and carry their appointment confirmation and policy e-card with them to the medical centre on their mobile phone.
They will be green channeled into the consultation room where the doctor will already have access to their e-records to review case history. After the consultation, the digital health records will be updated automatically with the doctor’s notes and prescriptions. The digital prescription for the medicines, also covered under the insurance policy, will directly reach the pharmacy. The patient will collect the medicines and leave the hospital after a truly cashless and paperless experience!
Discuss your expansion plans in India as also across the globe.
Currently we are completely India-focused, and we touch 10% of India’s population. We will continue to work towards touching a billion lives with our technology, partnerships and human touch.