By: Vijai SR, AVP - Leader for Insurance, Consulting and Transformation, CST

Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.
Marie Curie

This thought about sums up the current transformations being planned in the entire healthcare system globally triggered by the COVID-19 pandemic. COVID-19 related insurance expenses are pegged to be in the region of USD 90+ billion.

Swift differentiation of service quality

The Healthcare ecosystem comprises Payers (insurers), Providers (hospitals) and Patients. Here’s an attempt to analyse and get to an industry overview globally:

In the US: Most healthcare is privately managed, except Medicare for the elderly (65+ or below 65 with a disability) and Medicaid for low-income patients.
UK, Europe, Canada: Higher provision from state funding.
Asia Pacific: National health systems lean more towards maternal and childcare, and the primary-to-tertiary care is in the domain of private hospitals.

In the current situation, lack of rapid testing, patient facilities and questions about coverage under existing policies are key concerns. The Healthcare industry must overcome the challenges below; with Insurance cushioning some of the associated costs:

• Cost-effective care to patients with comorbidities and underlying pre-existing diseases
• Loading on premium during policy renewals not increasing – especially for senior citizens
• Rapid patient response with accurate testing results and precise diagnosis
• Ability to handle heavy volume surges and provide faster, accurate testing results for quicker case disposal

The dream tech that can transform

To deliver on the above, the Healthcare industry must adopt a “patient-centric” approach by redefining its operating processes, customer engagement models and underlying systems.
Key suggested remedial options are –

Leverage data

Building consensus among all ecosystem players to “share data for improved leverage.” Move away from fragmented silos of private, public and all care giving institutions, including insurance carriers. Work consensually on getting better patient insights whether it is for underwriting or for settling claims post treatment. This can be achieved by:

• Sharing patient data keeping in mind regulatory mandates and security
• Facilitate tele-medicine using EHR/ EMR with standard industry data models
• Leverage blockchain for secure, encrypted data sharing with reduced fragmentation from wearable data providers, pharma cos and other sources.

Artificial Intelligence and advanced cognitive technologies for automation and decision support

Mimic human thinking and cognition capabilities for simple or complex tasks:

• Machine learning for disease patterns, symptoms and cures to help doctors provide more accurate diagnosis, procedures to reduce re-admission rates and curtail long duration hospital stays.
• Simulating wisdom of experienced doctors from data of previous diagnosis notes using a taxonomy & ontology structure that bots can learn and apply.
• Delivering high-precision, zero-error “Robotic surgery” to reduce the risk of surgical and post-surgical complications.

Healthcare-Insurance – the silver lining of the coronavirus dark clouds

Technology innovation will include cloud-hosted platforms integrating hospitals and payers with patient data including sources such as wearables, to help deliver personalized patient care services that are faster, cheaper and more accessible. Here’s a phased, planned roadmap to achieve this:

• Automation, starting with simple tasks (billing reconciliation) to medium (Prior Authorization) and then complex (Appeals & Grievances)
• Integrate data sources with the entire community using API-driven digital fabric with interface adaptors for flexibility and scalability
• Advanced Analytics for insights on patient care and detecting patterns for better risk selection.

The final goal is to deliver simple, convenient and transparent services, doing away with input data fragmentation, complex and human-intensive processes, non-standard templates, subjective data points, and siloed info that can be made more efficient and SLA-driven. For this, ML & automation can augment human judgement and enable data-driven decision making, leading to superior healthcare outcomes and optimal settlement of claims.

Stay tuned for COVID-19 Impact Series: The New Insurance Economy – Challenges and Solutions

1. COVID-19 Impact Series: Property & Casualty Insurance Revisited
2. COVID-19 Impact Series: Growing Life & Annuity business in crisis times
3. COVID-19 Impact Series: Trying Times for Broking Sector
4. COVID-19 Impact Series: Navigating the Turbulence in Reinsurance

Visit LTIMindtree’s Insurance page to find out more about our capabilities in this vertical.