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Healthcare is one of the largest sectors of the Indian economy in terms of revenue as well as employment. In recent years, with an increase in disposable income and lifestyle disorders, the sector is growing at a fast pace - expanding its coverage, services and ultimately expenditure. Having said that, India follows a decentralised approach when it comes to the penetration of health insurance as merely 37 per cent of Indians are covered under the present health insurance schemes while nearly 400 million have zero access to health insurance.
Amidst the growing discrepancies in the decentralized healthcare insurance industry which is plagued by non-digitised and non-standardised processes, the interlude of the health claims exchange platform epitomizes a revolution in healthcare. Moving beyond merely being another digital lending platform, HCX is a community-driven initiative in alignment with the government’s Ayushman Bharat Digital Mission, aiming to offer universal health coverage via the aid of HCX data exchange.
Having emerged from the increasing need of a more accessible healthcare system, which is characterized by standardized schematics, in order to offer equal healthcare opportunity, the HCX acts as a platform geared to transform the management of health insurance claims with efficiency. It leverages cutting-edge technology, namely cloud computing, which allows all the parties involved in the process to access real-time, and secure information related to insurance claims. With standardized communication, it further enables seamless interoperability of health claim data between different systems, whilst safeguarding sensitive medical information at all costs.
Addressing the Challenges Associated with the Current Framework
Standing on the crossroads of cumbersome approval processes, and navigating the rules of different healthcare providers and insurance institutions, the insurance framework calls for an interplay of standardized process and communication, enabling smooth interoperability of health claims. On the same note, the current framework also continues to operate on manual paper-work methods, which has hampered the ascent of digitisation. This not only delays the claim process but also results in an operational overhead surge, leading to increased costs per claim. Having said that, the advent of health exchange (HCX) makes affordability a reality by reducing the burden of administrative tasks which subsequently lowers the overall cost per claim.
Access the Perks of HCX
With digitisation attached to its very essence, HCX opens doors to electronic health records, which at the disposal of healthcare professionals enable them to access a patient’s comprehensive information, including insurance coverage and other essential details. Along with a seamless flow of data exchange amongst multiple systems, HCX is the key to unlocking an improved patient experience, whilst mitigating the possibility of any discrepancies.
Leading the move with automation, HCX has been instrumental in creating value in healthcare transactions, as it expedites the settlement process from pre-authorization to discharge which
lowers associated expenses. Simultaneously, it enables the healthcare landscape to turn over a new leaf, in terms of accessibility, which becomes imperative as nearly 6 out of 10 patients don’t have enough monetary capacity or insurance coverage, which creates a significant disparity in accessing healthcare.
Fostering a Refurbished Healthcare Insurance Network
Being a digital claims platform, HCX is poised to transform the healthcare insurance sector. It brings together multiple stakeholders under one unified pool, from policyholders to healthcare providers. Primarily, policyholders will be able to enjoy real-time updates of the claim through a simplified flow of information. Eventually, this will enable them to have greater control over the network.
It is already certain that an efficient and transparent insurance claim process fosters better decision-making for individuals who pay for that policy. It is also important to note that reduced overhead costs empower healthcare providers to pivot their focus from administrative tasks and capitalize on delivering enhanced patient care.
Empowering Fintechs and Lending Startups with Improved Credit Decisions
While the financial world has been undergoing seismic shifts, with Fintech lending startups moving the needle on innovation, the inability to accurately assess the creditworthiness of potential borrowers has acted as a major roadblock in healthcare insurance penetration. Going beyond traditional credit scores which present an incomplete picture of an individual's financial health, HCX data offers a dynamic layer of information on the borrower’s spending habits, enabling lenders to have a more holistic view of the potential borrower's financial responsibility.
Moreover, HCX can also help FinTech and lending startups in making better credit decisions. These companies can use this additional data layer which can either help in building alternative sources of data for better decision making or use this as another layer to develop underlying risk assessment algorithms. With refined assessment algorithms in their midst, fintechs can have more nuanced creditworthiness evaluations, leading them to offer competitive rates and terms to not only low-risk borrowers, but also opening financial access to the underserved segment of the population.
Pivoting the Focus on the General Population
Having worked its strategic wonders for the fintech and lending institutions, the HCX at every move continues to empower the general populace, enabling them to make informed financial decisions with a clear understanding of the spending patterns. Individuals can analyze their HCX data and use that to identify areas where they can streamline their spending making room for improved budgeting, debt reduction, and ultimately, greater financial security.
Followed by the platform’s ability to optimize borrower's financial health, HCX distinguishes itself via its capacity to help individuals traverse through the financial landscape with confidence. By inculcating them with a comprehensive understanding of their financial situation, it imbues individuals with a confidence, which can be seen as they strive to look for loan options that are tailored best to their financial needs.
Final Thoughts
At the very core, Health Exchange intends to curate a healthcare insurance ecosystem which creates greater value for the policyholder. From nurturing a standardized health insurance framework that opens the door to accessibility, inclusion and greater opportunities, to leveraging automation for creating higher value in healthcare transactions, HCX truly has refined the settlement process from pre-authorization to discharge. Apart from building an open community amongst policyholders, payers, stakeholders, healthcare providers and other involved entities, the platform is focused on enhancing the insurance experience altogether by empowering the general populace with better financial health and informed decision-making.
The author is Co-Founder and CEO, CarePay
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