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We aim to work with 9000-10,000 hospitals by end of 2020

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HealthNine, an IT firm, interconnects healthcare stakeholders to enable real-time exchange of data and transactions. Ritesh Kajaria, CEO, HealthNine Technologies explains how its system works as a centralised health information exchange for all healthcare entities, the need for such a solution in the Indian market, their growth plans and more, in an interview with Lakshmipriya Nair

How is private healthcare financing in India transforming? What are its key drivers?
Private healthcare financing in India is quite restricted, albeit there have been several Indian and foreign players who have entered the market to provide such financing. The reality today is that most individuals make direct payments at the point of services, which are usually not covered under any financial protection scheme. The highest percentage of out-of-pocket health expenditure is made towards medicines (52 per cent) which is usually not covered under any private healthcare financing scheme. Even if 30 per cent of the total health expenditure is incurred by the public sector, the rest of the 70 per cent is usually borne directly by customers, where private insurance playing a smaller role only via hospitalisations. Appropriate healthcare financing is a means to ensure adequate funds for health care with provision for equitable access to all population. This also reduces financial barriers among citizens to utilise health services. This segment is likely to be driven in the future through two factors: First, new private insurance products will expand business through deepening their offerings compared to widening the risk covered. Second, the concentration for private players will remain on urban middle and upper middle classes who have the capability to pay with an interest towards good health for themselves and their families. This is likely to scale up the insurance segment further, with growth in hospital usage and protection against growing hospitalisation expenses.

What are the major challenges in the sector? Are the processes in place? If not, how can they be better enforced?
The current healthcare industry is associated with an opaqueness when it comes to the workings behind the scene. There is also a perceived lack of connect between hospitals and patients. The aim of all parties has always been to be patient-first and patient centric, however usually the processes in place usually slow the entire system down, which then percolates down to patients and their bills and claims settlements. A PwC report points out that there is a strong need for increasing transparency and improving the connect between hospitals and patients, thus dispelling the negative perception of the industry. With the aim of balancing the need for being patient-centric and being efficient in the way hospitals and insurance companies communicate, there is a need for a gap solution provider that effectively takes care of all information seamlessly.

What benefits do you bring to the current paradigm? How will it impact the sector and the patients?
Healthnine Technologies is a health-tech startup that is working towards building a seamless and real-time transmission of information between hospitals and insurance companies. Currently 15 per cent of all claims are fraudulent claims which means that a large part of the insurance industry is invested towards recovery and fraud management. With our AI and ML enabled network, our intention is to work as a linchpin between hospitals and insurance organisations that spots frauds and minimises errors related to manual data entry. Healthnine’s network automate claims settlements and build an information exchange with comprehensive information on all parties that reduces the manual communication and labour currently required during claims settlement. This will be a respite for the 25 per cent claims that usually take more than a month to be settled. This means that Healthnine will practically automate the entire claims settlement market in India, with patients, hospitals and insurance firms having to finish up the task in a fraction of time compared to what it currently requires.

How many hospitals have you partnered with currently? Which are the geographical locations that you are focussed on? Why?
We are currently running several pilots with insurance companies for them to understand how seamlessly the Healthnine technology embeds itself into the existing system, without having to overhaul the current processes. We are also working with 1,500 hospitals in our network, with an aim to work with 9000-10,000 hospitals by end of 2020. Our current focal areas are cities like Mumbai, Bangalore, Pune and Delhi where we will initiate services in a phased manner.

How do you plan to roll out your services? What is your growth strategy for the next three years?
Since the essence of Healthnine Technologies lie in easing lives of patients, we intend to percolate down to tier-II, tier-III and other regions of the country to ensure more and more patients, hospitals and insurance companies can benefit from the reduction of manual effort and automation of claims settlement. Our long term goal is to also expand our network to other health players like imaging labs, pharmacies, etc. to electronically exchange claim information within a community and across the country in real-time. This reduces the burden on patients to lug around their files and information without the risk of misplacing it or not having all information at one place.

What is your competitive advantage?
Thanks to the array of software suites that we use, the Healthnine offering transforms the current manual process into a completely seamless workflow for patients and members if they use the Healthnine portal or mobile app. We understand the significance of privacy and safety of data, which is why our network has additional levels of security like, end-to-end encryption and compliance with HIPAA to ensure data privacy. The technology behind the platform allows a single window login for all insurance and TPA access. We have seamlessly integrated the entire workflow, from insurance intimation to final billing settlement, along with being a comprehensive repository of medical data and data analytics for patients that is completely secure and private. With Healthnine coming on-board as a partner for insurance companies and hospitals, this claims settlement process will become simpler, with the requirement of lesser resources to do the same job that was done manually earlier. With our system, the risk of fraud and errors also drop down to the negligible.

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