Beyond the line of sight, there is change

Healthcare Insurance spokespersons in India made interesting statements of intent a couple of weeks ago. Insurance now intends to cover the costs of consultation and drugs even when no hospitalization is done. They intend to make this possible over the next 12 months. On the other hand, advances in Medical Technologies and newer business models are making it possible for an increasing number of conditions, which may have previously needed hospitalization, to be treated in an out patient setting, or even at home. This is good news for every stakeholder in the Healthcare business. This is a big and profitable departure from the past, now that insurance will be the payer. While this would be heartening to doctors, patients and drug companies and even educators, in view of the long term prospects of being paid at better rates for their work, it would also put a large number of new rigors on the Medical and Healthcare Professional. They will now have to deal with processes that have multiple stakeholders instead of the simple old patient-doctor connection.

Let us discuss some of the consequences of the impending change. Changes,that are deep but do not yet appear obvious.

Increased Government Regulations

With a more organized payer (namely insurance), now picking up the tab, there is bound to be a demand for an enabling environment. This would translate into a rapid and consistent rise in regulations that medical practices would have to operate with. This will be driven by the need for the insurance companies to be able to expand the market, and also process claims in volumes and speed that would make this possible.  The need to plug leakages would also bring the need for definitive legislation. The large and young population that is India, would create the need for unprecedented scale and speed in these processes. For the Medical Professional this would mean creating records at great speed and meetingdocumentation needs that will be more demanding, standardized, quick and compliant. It would also mean Prior Authorizations may be increasingly mandated for the more expensive treatments. Documentation may need to start even before the service is delivered. Payment cycles would also change from advance to ‘after-delivery’ and would have some lag periods. This would also mean, from a doctor’s point a view, a need to track these processes. The inability to work in this complex regulated environment and its demands could be a serious impediment to the Medical Practitioners professional success. There would also be, additional needs stemming from the need of the payer’s(i.e. insurance company’s) needs to protect themselves from the consequences of deficient services, mal-practice and frauds. For the doctors this would mean getting used to work with standards, data, complex insurance policies etc.
That is a lot of behavioral change; apart from getting used to new procedures and more documentation needs – both commercial and legal.

Change in the Competitive Matrix

Word of mouth has been the force driving patient choices so far, as he was the payer. With the change in payer, additional elements would enter the decision making matrix i.e. how easy it is for the patient to complete the administrative part of his visit i.e. pre-authorizations, processing the paperwork; which will nowbe a multiparty process.  Ratings and Benchmarking of services would only be a natural outcome of this process and increasingly influence patient’s choice of his Doctor. This would mean the need for the Doctor to pay a lot more attention to Customer Relationship Management. Retaining patients will need the doctor to build trust through transparency, attention to detail, knowing the patient better and more efforts to make meaningful communication on a sustained basis. Better targeted Preventive health support through brochures, emails and social media; Support in Chronic conditions; Targeted information sessions for patients with specific conditions in preparation for procedures or in terms of after care are initiatives that are increasingly common in developed markets and inevitable in others. These will require an increased need to know or profile the patients better.

Continuous Professional Development

The patient flow coming to a Medical Practitioner is now going to depend on the perception of two stakeholders. Both will be looking at the Doctor’smedical Skills and administrative capacity. In addition, the patient is also, now increasingly informed and discerning. Regardless of what the law requires, continuous professional development will rapidly become a critical differentiator affecting the judgment of the doctor by these two stakeholders.Both would like to see Medical Practitioners they choose, pursue a path of continuous professional development on their own initiative. The Payer may, in a matter of course develop their own criterion to measure this aspect. A good understanding of Medical Standards and their acceptance by the doctor is going to be important to the Payer’s point of view, since it will mean the ability to comply with their processes.

Time and Work-Life Balance

The changed environment is going to place many new demands on the physician’s time. On the one hand physicians would now have to deal with new elements like administration and innovative marketing.  It would need a careful look at processes to ensure maximum availability of time for the core productive activity of your practice- Seeingpatients!

Technology and Business Processes Automation

Corporatization and Consolidation of medical practices is a trend that would grow and impact the average practice size. Dealing with these rigors will make the need for change inescapable, and continuous.  The use of technology both, medical and the ones dealing with business processes,are the only strategy that will help meet the new needs of effectiveness and efficiency. Adapting to technology will clearly become a key ability, considering the high degree of repeatability and reliability that these processes will require.  The emergence of more user friendly Social, Mobile and Cloud based technologies is a great enabler. These technologies are able to bridge across diverse stakeholders and their systems, which a medical practitioner will need to integrate with.

These technologies are the basis of applications that are more intuitive and tactile and also more reliable, efficient and easy to learn. An in-depth look at these solutionsis a discussion for another day though.

Arun Kumbhat


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