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Increase in health insurance subscribers will have positive impact on all factors

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As hospitals all over the world re-set their operation strategies and business models to keep pace with the COVID-19 pandemic, Anita Singh Sumra, COO, Jorie Healthcare Partners, reviews the benefits of storing health records in electronic data form as Indian healthcare institutions migrate towards a digital health ecosystem as part of the National Digital Health Mission, in an interaction with Viveka Roychowdhury

You’ve been steering Chicago-based Jorie Healthcare Partners’ India arm since its inception in September 2019 in Quark City, Mohali. Since the company provides practice and Revenue Cycle Management (RCM) solutions to US-based hospitals and healthcare facilities, how are you helping your clients cope with the COVID-19 disruptions? 

We have clients from multiple specialities in healthcare services like surgery centers, clinics, labs and chiropractic centers. The US federal government has provided support to all the healthcare services by paying them in advance. However, our progressive thought process, solutions and technology has helped our clients in maintaining their patient wellbeing and their revenue also. We implemented these solutions as well.

Telehealth visits: Jorie Healthcare helped clients in facilitating telehealth services with its technology support and scheduling assistance

Patient balance management and recovery: We have supported our clients in contacting patients for insurance and patient balances. We also manage the recovery of telehealth services to maintain revenue.

Work from home: By being proactive, Jorie Healthcare planned ahead of time. We were equipped for our employees to work from home. With effective arrangements in place, our work did not suffer, and we maintained our client’s revenue. As was to be expected, there was a dip in production, but we managed to overcome it by investing extra time. We are proud of our IT and production team to provide unimaginable results in such difficult situations.

Reinstatement planning: Due to the pandemic, all day-care services and surgeries were cancelled or postponed. We kept our client’s patients engaged. Once we received an update about surgery centers opening, we planned our physician’s days in advance to ensure an optimum utilisation of their time. We were able to cover the revenue loss of three months with no reduction in day-care services and surgeries.

While your RCM solutions are tailored for the US healthcare system which is insurance driven, in general, how can healthcare facilities expect to improve ROI with RCM solutions in a country like India which is moving towards a national digital health id etc as part of the National Digital Health Mission? 

The US healthcare system is based on an international system of classification. These are the benefits of adapting to this system:

Firstly, consistent and digitisable data. Any disease or treatment data if written in words is difficult to interpret or analyse by computers/technology. The challenge doubles when it is handwritten. However, if the same disease or treatment is mentioned in ICD (International Classification of Diseases) and CPT (Current Procedural Terminology), it is easy to read and conduct an analysis by computers. A standardised version is also easy to manage.

Secondly, working with world standards. ICD is an international classification created by WHO. Adapting to this terminology will bring us on par with other countries providing advanced healthcare services to their citizens.

And thirdly, better and faster health services. Adapting international standards of storing records in electronic data form will help physicians diagnose faster. This is because all reports will be readily available, along with all data pertaining to previous visits.

Physicians will be able to keep a track of their patient’s health online, which in turn will assist them in selecting more effective treatment options. It’s an upwards spiral from thereon which results in better healthcare services and better health of our citizens. E-data helps our government conduct analytics to create better health plans and allocation of funds and medicines based on different segments be it geographically or by need, so maximum effective use of resources is achieved.

Here’s an example: if we have data that shows us that three cities of Punjab feature more heart patients as compared to other cities, it will help us mobilise medicines availability and resource planning more effectively.

The COVID-19 pandemic has given a boost to the health insurance sector. How will this impact the way hospitals in India are managed? 

Health insurance is not a regular practice in the Indian subcontinent, primarily because we have not realised its utility. As much as COVID-19 has made us more aware about it, there still is a long way to go. An increase in health insurance subscribers will have positive impact on all factors like economy, health and healthcare services pricing standardisation.

On the economy front, if most Indians have invested in their own health insurance, it instantly decreases the expenditure on healthcare services. Also, the business generated for insurance organisations will ensure less costs: as we know about insurance calculations, the more the subscribers, the lesser the cost.

In terms of health, when an individual has already spent money on health insurance they are driven to utilise that facility. That encourages them to show up for regular pre-appointed check-ups, thereby taking better care of their health (For this we need to improve our health plans in India).

And thirdly, in terms of healthcare services pricing standardisation, different hospitals have different rates. Imagine a situation where most of the Indian population in has health insurance, and it ensures one standard classification method that has a specific allowed cost for each service.

Do you see a consolidation, with smaller nursing homes, clinics being taken over by larger regional and national hospital chains?   

This is a complete business decision. However, if we look at it from the perspective of digitisation and standardisation, then it will not have this impact on our healthcare structure. As I mentioned earlier, our health plans will also change.

For example, five years ago health insurance companies in India were not covering day services, a patient had to be admitted for at least 24 hours to claim services, and now most of the health plans do cover day services even if the patient is not admitted for 24 hours because technology and economic structure has improved.

So, if we will move towards progression and adapt to world standards, then our health plans will also adapt to that situation, and will start covering services being done in smaller nursing homes or even clinics.

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