Ankur Gigras, CEO and co-founder, HexaHealth explains about some of the key technological advancements that have reshaped health insurance services
The evolution of medical insurance in India has been remarkable. From a negligible demand a few decades ago, the growing awareness of healthcare uncertainties has fuelled a surge in demand for insurance. This demand spike has led to a significant increase in the number of insurers entering the Indian market, fostering competition and innovation. The evolving landscape has not only benefited individuals seeking financial protection against unexpected medical expenses but has also had broader implications for the healthcare industry and the overall economy.
Furthermore, with the rising costs of medical care, insurance companies are compelled to offer a wide range of comprehensive healthcare coverage plans to cater to the diverse needs of the population. This evolution reflects India’s shift from traditional health practices to a modern, risk-conscious society, with insurance playing a pivotal role in safeguarding individuals and families against unforeseen medical expenses.
Data analytics and risk assessment
Among the most significant impacts of technology on health insurance services is its influence on data analytics. The vast amounts of data generated within the healthcare ecosystem are now being harnessed to drive insights and inform decision-making. Advanced data analytics tools are employed to analyse historical claims data and medical records. This has enabled insurers to develop more accurate risk assessment models, leading to more precise pricing of insurance policies and improved risk management strategies.
AI and machine learning algorithms can analyse vast amounts of data to identify patterns and anomalies that might indicate fraudulent activities. These algorithms can learn from historical fraud cases and continuously adapt to new tactics used by fraudsters. This proactive strategy aids insurance companies in identifying fraud at an early stage, preventing financial losses and safeguarding both insurers and legitimate policyholders.
The recent surge in telehealth services has proven to be a game-changer, and health insurers are capitalising on this trend. Telehealth enables policyholders to consult medical professionals, minimising the necessity for in-person visits and presenting more convenient and economically viable healthcare alternatives. Insurers are increasingly integrating telehealth services into their coverage plans, thereby enhancing accessibility to medical expertise.
Integration of HIS with the insurance portal
Integrating Hospital Information Systems (HIS) with insurance portals establishes a smooth information exchange channel connecting healthcare providers and insurance firms. This integration streamlines the claims process by allowing the real-time sharing of patient information, treatment details, and billing data. It reduces paperwork, minimises errors, and accelerates claim approvals. Patients benefit from a smoother experience as their claims are processed faster, while healthcare providers can focus more on patient care than administrative tasks.
Auto claim adjudication
Auto claim adjudication involves using advanced algorithms and automation to process insurance claims quickly and accurately, without the need for manual intervention. This technology leverages data analytics and Artificial Intelligence (AI) to assess claims against predefined criteria, policy terms, and medical coding standards. This not only speeds up the claim processing but also reduces errors and ensures consistent decision-making. By automating this process, insurance companies can save time and resources, leading to improved customer satisfaction and more efficient operations.
Blockchain for security
Blockchain technology is gaining traction in the health insurance sector for its potential to enhance the security, transparency, and interoperability of health data. With blockchain, patient records and claims data can be securely stored and shared among authorised parties, minimising the risk of data breaches and ensuring accurate and up-to-date information for claims processing.
The way technology is being used in global health insurance is very different from how it’s progressing in India. Worldwide, health insurance companies have quickly adopted new technologies, making things more convenient and efficient. But in India, the use of technology in this field has been slow and cautious. However, things are changing now. The combination of the digital revolution and the rise of healthtech companies in India’s health insurance industry is causing a big change. This mix of factors is likely to push the industry into a new phase of significant growth and a focus on making things better for customers.