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Sunil Paikattil
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The healthcare industry has been undergoing a significant transformation since the start of the new millennium and the pace of innovation and technology adoption has gained real momentum in the last few years.
One of the major transformations in the healthcare industry has been the change in the approach towards improving population health by shifting the focus from reactive measures such as disease management to preventive measures for treating chronic diseases and other life threatening ailments. As a result, we are now witnessing increasing investments in R&D from pharma companies and surging investment in technology upgrades by medical care providers, in order to deliver superior patient experience.
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Prabhu Rangaswamy
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In addition to providing the best possible treatment to the patient, healthcare providers also need to focus on reducing inefficiencies in drug spending, surgeries and hospital admissions; while at the same time optimising the delivery of healthcare services through cutting-edge technology and best-in-class business processes.
The Affordable Care Act or Obamacare as it is popularly known in the US has quickened this process, as newer and more disruptive technology solutions are changing the landscape of patient care. Doctors now have the necessary wherewithal, in terms of equipment and test methods, and therefore the ability to diagnose patient problems more accurately and treat them more effectively than they could in the past. Guesswork and relying on previous experience, has been replaced by precise and targeted treatment methodologies that have been honed by increasingly sophisticated R&D.
Increasing reliance on technology-enabled processes
Hospitals are increasingly relying on data from a multitude of sources—from Electronic Medical Records (EMR) and Health Information Exchanges (HIEs) to wearable devices that transmit real time patient health data. The objective of sourcing data from multiple sources is to build a complete and holistic picture of the patient’s health and track record; which in turn leads to targeted and effective treatments, both before and after a hospital visit. The latest trends are ‘smart cap’ for those patients who have been prescribed specific injections (e.g. insulin) that inform patients the time from their last injection and ‘smart bottles’ which provides escalating reminders to the patients, pharmacy, physicians on the usage of the drug.
Whilst these new and disruptive technologies are transforming the healthcare provider space, they are also bringing changes in the larger ecosystem. Growing transparency in the way healthcare providers now function and the extensively available information on the internet are empowering patients to make more informed decisions about their own healthcare and seek best possible treatment within their own resources and constraints.
At the same time, payers are also questioning expensive and prolonged treatments and persuading healthcare providers to look for cheaper yet more effective solutions such as telemedicine to reduce the overall cost of delivering healthcare services to patients. They are also adapting to this tectonic shift by relooking at the way they underwrite policies and administer claims. This is where healthcare-focused business process services (BPS) companies can help by taking away some of the routine administrative tasks and bringing in technology to make transactions faster as well as simpler to execute and complete.
Analytics: The next big thing in healthcare
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Revolutionise indian medical system
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India has seen a lot of changes since the time BPS providers started with basic offerings such as medical transcription and data entry services for the healthcare industry. The offerings today have moved up the value chain and involve significant judgement, analysis and decision making. For e.g, in the US Workers’ Compensation domain, the services provided are very complex and business-critical which range from claims adjustment to adjudication and final settlement.
An example of a disruptor which will revolutionise the US healthcare treatment delivery is by way of extensively using analytics. Analytics will help in creating a three way link between the data available with the hospitals, doctors who are actually patients and finance teams who are focusing on revenue and profitability. A recent research report showed that approximately five per cent of the patients visiting a hospital in the US on an average accounted for 50 per cent of healthcare spend on treatment.
The focus in the US now is to ensure that special care is given to the ‘very sick’ through a joint collaboration between the treating doctors, finance leadership at hospitals and the payers (insurance companies); and to drive cost effective treatment plans. India’s capability in technology enabled business services and advanced data analytics will help the Indian healthcare market through similar analysis, to reduce overall healthcare spend and improve the quality of healthcare provided within the country.
BPS providers, who want to remain relevant to their clients, have to develop comprehensive domain knowledge of the healthcare industry. Most importantly, they need to have the ability to advise their clients, be it providers, payers or other intermediaries, on the most efficient and optimal way to deliver healthcare services. They have to tailor their service offerings to the changing industry needs and integrate technology seamlessly.
Smart BPS providers are actively exploring technology innovation, automation, data analytics and commercial models such as Business Process as a Service (BPaaS) in order to help their customers achieve better “value for money.”
With the customer-base varying from insurance companies (payer) or a third party administrator (TPA) to hospitals, billing companies and intermediaries such as pharmacy and ancillary service providers; the role of BPS companies is becoming significantly larger and more complex.
BPS companies are supporting customers on several activities such as vendor credentialing, complex claims intake, calling out to injured workers and providing analytical services. In addition, BPS companies are also playing a critical role in supporting customers in calling out to injured workers, doctors, making compensation decision, and suggesting changes to revenue cycle management process to improve Days Sales Outstanding (DSO) of a provider. With access to the best technical capabilities and skilled talent pool of business analysts, Indian BPS companies are actively leveraging this to transform healthcare service delivery.
Challenges and solutions in the Indian context
The expertise that has been built over the years in India through servicing payers, providers, and billing companies in the US and Europe should now be used to revolutionise the Indian healthcare sector. However, some of the current challenges in India are lack of standard diagnostic protocols, lack of standardised billing from hospitals, presence of various unorganised service providers (aiming at profit rather than service), and paucity of public information available freely to patients. This is compounded by the lack of a good regulatory framework that puts punitive measures in place to penalise those providers who provide poor healthcare services, spurious medicines or dubious treatments to patients.
The effort to form General Insurer Public Sector Association of India (GIPSA) by the four largest nationalised insurance companies in India to bring about standardised claims management process is a commendable story. Standardised billing using current procedural terminology (CPT) codes, and advising on common protocols in treatment, are areas where BPS providers can really contribute. Indian healthcare industry should learn from the development cycle that the Western countries have gone through and adopt methodologies that have been successfully implemented and have delivered efficiencies.
There is a huge effort needed to link in-patient, laboratory, out-patient, claims, pharmacy and diagnostics. Technology plays a very pivotal role here in the seamless transmission of information across the value chain, thereby creating transparency and efficiency. The vast pool of knowledge base available in the BPS and IT industries can be effectively utilised to leapfrog the intermediate development stages in the Indian context.
Indian healthcare landscape should align the way payers, providers and ancillary service providers provide service to the patient and ultimately, the patient should benefit through improved treatment and better healthcare outcomes.
Disruptive technologies – Making cutting-edge medical services a reality
The edge for India based BPS service providers reside in the fact that we are taking up more complex tasks and solving them within a defined timeframe. India’s most important asset is its ability to take on and solve big problems, which has resulted in an increased confidence in the talent of the Indian BPS industry. The healthcare industry in India has moved beyond just cost savings to innovation as the primary value creator. An example of this is the way technology is used to automate repetitive and low value business processes through the use of robotics.
Our real test lies in our entrepreneurial ability to solve the next set of challenges that the global healthcare industry is facing and find innovative ways to address some of the most ‘wicked’ healthcare problems, within the Indian context. Healthcare services in India can be developed on the lines of the booming E-commerce industry. With the potential of technology-enabled BPS offerings, we can make concierge medical services a reality. Wearable devices are touted to bring in an unprecedented change in healthcare and we are going to witness many such disruptors in this space.
By strengthening our BPS offerings, Indian companies can uniquely position themselves in a competitive global market; and at the same time leverage the knowledge gleaned from other markets to meet the domestic healthcare needs.
If you ever wondered where the next big disruptor is lurking, it is in healthcare, and the time is now!