Friday, July 05, 2013

If I were the CEO of a health insurance company

Health insurance companies ( also known as health plans) don't have a good reputation in the US . They are usually considered to be villains who block access to medical care for patients in order to try to pinch pennies ; and many people believe that one of the reasons healthcare costs are so high in the US is because of the million dollar bonuses which health plan CEOs so generously reward themselves with. This money is siphoned away from funding quality healthcare services , as a result of which both doctors and patients suffer.

Things are no better in India. Today, health insurance companies are merely financial intermediaries , whose marketing promises that they will pay the medical  bills when the client falls ill. While they  are very efficient at collecting the premiums , claims settlement is a painfully slow process , and most create a number of barriers when the client wants to claim reimbursement for a medical illness.

If I were the CEO of a health insurance company in India. I would realize that this is a great opportunity to reinvent the industry , so that instead of being seen as bad boys , they would be looked upon as trusted advisors. The pharmaceutical industry has already ruined its reputation – and hopefully health insurance companies will learn from this experience, and behave in a more socially responsible manner !

The healthcare ecosystem in India is broken for multiple reasons. Patients don't trust doctors; hospitals do too much unnecessary surgery in order to maximize their share prices; and there is a lot of health insurance fraud . Everyone is unhappy with the present state of affairs , which seems to be headed in a downward spiral .

The one player in this industry who can actually stand up for the patient and fix the system is a forward thinking health insurance company , who's willing to invest the resources in putting patients first. The CEO should no longer think of his company as merely being an intermediary who helps to buffer the financial shock of medical care, but whose goal is to improve the health of its clients.

An enlightened CEO can do this, by making sure that his health insurance company becomes the first point of contact every time the customer has a health-related problem ! It’s easy to set up a call center, where people would call in when they had a health related query. Using triage software and a health knowledgebase , callers could be guided as to what they need to do. If it was an emergency, they could be referred to the nearest emergency room . If it was an elective problem, ( as most health issues are), they would be provided with information therapy about their symptoms and illness; along with details about the best doctors in their locality. This would create a positive virtuous cycle, because good doctors would be actively promoted and bad doctors would be shunned.

 If health insurance companies started acting as trusted intermediaries within the healthcare service delivery chain , not only would this improve their public image, it would actually help them to improve their bottom line as well.

A big problem with the healthcare industry today is that doctors are incentivized for performing procedures , as a result of which a lot of unnecessary testing and surgery is being done. This is obviously not in the patient's best interest , and all this overtesting and overtreatment affects health insurance company payouts , so that their claim loss ratio becomes progressively worse. As a result, premiums become more expensive , causing unhappy clients. On the other hand , if customers could have faith that their health insurance company is providing them with reliable information , which they can utilize to make better healthcare decisions for themselves , they would be able to have more educated evolved conversations with their doctors , and get exactly the right care which they need !

Not only would patients benefit , good doctors would welcome something like this , because it could save them a lot of time , as they would not need to spend as much time on patient education . Health insurance companies would become more profitable , because they would no longer be wasting a lot of money trying to prevent padded bills and paying for unnecessary surgery.

This is a great opportunity for an Indian health insurance company CEO who is willing to think out of the box. While it’s true that health insurance companies are not in the disease management space, creating these artificial barriers makes little sense today, because patients want comprehensive end to end solutions !

In India, we are at an inflection point where the health insurance industry is going to keep on progressively growing . Rather than continue to be saddled with the bad reputation which it has today - or , even worse, head down the path of the US healthcare industry , where managed care and HMOs have such a terrible reputation , a smart CEO could reinvent the way the health insurance company serves its customers . It’s no longer enough just providing clients with money in order to take care of their medical bills – they need to help their clients lead healthier and more productive lives !

This is a big, hoary audacious goal which is well worth striving for – and something which any CEO would be proud to have on his tombstone – He put patients first !

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