popularizing cashless hospitalization-sanjay datta

8/8/2019 Popularizing Cashless Hospitalization-Sanjay Datta

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Popularizing Cashless Hospitalization


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gen a

Current Market Dynamics

Future Market Movement


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rac ceAn Employer Employee Relationship

Reimbursement Mode Employee getshospitalized, gets treated, pays and then submit

ea nsurance

An Insured Insurer Relationship

Reimbursement Mode Member getshospitalized, gets treated, pays and then submitdocuments to the Insurer for reimbursement


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ar e emanEvolving Consumer demand:

No Cash TransactionsHassle free E Transactions

Led to think:From Employers

To manage employee benefits at optimum costs and moveaway from operational management of claims

From InsurersTo offer cashless facility throughThird Party (TPAs)


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gen a




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a s csIndustr Utilization Cashless:Re-imbursement

40:60Increase in costs for cashless transactions

Reason for low penetrationSpread of network hospitals across countryComplex operational methodsLow customer confidence of existing model


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a s cs

Reason for high cost of cashlessSupply demand mismatch

Lack of standard billing practisesLack of standard treatment protocolsLack os trust between providers and insurers


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ar e progress onModes of cashless mana ement

Our first practice - continuesReceive Fax for AL Manual Process Refax with approval

-Automated Process

Hassle free settlement-

100% Cashless PolicyPre-defined packages


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ey a engesO erational Mana ement for increasinpenetration

os anagemen or sus a na y


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u ure ar e ovemenO erational Mana ement

Lack of standardization across processesComplex & lengthy

Cost ManagementPackage based Tariff Preferred Provider Network

Operational Excellence leading to enhanced penetration


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pera ona anagemenLack of standardization across processes

Initiative at Industry LevelPre Defined processesPre Set TariffsCoding disease architecture

omp ex eng yE Process

Use of Bio Metric Smart CardsType of RSBY initiative


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pera ona anagemenEducation Series

Sales pitching point

Mailers suggesting and highlighting benefits of CashlessPenetrate the users mind b s readin WOM, Publicizin ,through regular feedback and interaction mechanismProvider has to encourage the end user


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os anagemenStandardization of Packages

Packaged Based Defined Cost for Surgical procedures

For cases which cannot be packagedSta Char es Professional Charges Technical Teams Negotiatesbased on historic data

and also based on discounts signed as per MOUMedicines/Implants/Consumables Challenge area as

this is based on case to case ne otiations - Needs Standardization


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os anagemenPPN Preferred Provider Network

Identify and tie up with N/W PartnersDivert Traffic at onset

Mutual Benefit

Holistic Care


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Thank You


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as ess osp a za onHow it works

ChooseHospital

Patient informs Insurance Co Patient gets advise for choosing Hospital

Admission

a en ge s a m e Pre Authorization send to Insurance Co Pre Authorization gets approved

Customer gets treated with careDischarg

e Walks out without spending any cash

N/W

Network Partners sends claim to Insurance Co

Insurance Co settles the case

Cashless not only allows the customer to benefit from no cash but also gives

e m


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rc ec ure

popularizing cashless hospitalization-sanjay datta

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