Modicare: Worlds Largest Healthcare Coverage Social Security
PM Speech on #PMJAY Launch on 25 Sep 2018
#PMJAY #AyushmanBharat a.k.a NHPM a.k.a Modicare will bring an era of Digital HealthTech platforms [read IHIP] with EHR and MDDS for Health Interoperability Standards to Deliver the worlds largest Health coverage.
Big opportunity for global Health Insurance companies, FinTech and InsurTech to line up and get listed for the program. With Govt acting as a Payer, Provider and Re-Insurer.
Healthcare is a state subject. Centre govt funds 85% of most public health programs. However all the regulation and execution authority is with States. The states are free to accept or totally reject any healthcare ruling from the center. India is too diverse to expect a single Healthcare solution across all States. Unity in diversity is elusive. Hence MDDS for Health based IHIP Exchange platform is required to deliver Health insurance coverage across India.
#PMJAY > Health Insurance will be the driver for the shift to Standard Code Sets based HIS/EHR e.g. ICD-10, SNOMED, LOINC, NPI, etc. As defined in EHR and MDDS for Health Standards. This was the missing link in the Healthcare Ecosystem thus far in India.
JAM (Jandhan Aadhaar Mobile) coupled with NIN HFI Registery will be the delivery model to reach every beneficiary. Similar to Pradhan Mantri Ujjwala Yojana.
#PMJAY > Health Insurance will be the driver for the shift to clinical protocols, pharmacogenomics and precision medicine driven managed care. I can see the end of the 'Doc Sahib Bhagwan hai' era.
#PMJAY > Health Insurance will bring a check on unnecessary tests, expensive drugs, high end procedures and overcharging frauds. Machine learning and Analytics on the EHR data will be valuable in making the system adhere to protocols.
The Hospitals, Doctors and all other medical establishments are concentrated in Tier 1 and Tier 2 cities. #PMJAY will shift the demand to Tier 2 cities and below. It is a no brainer that the supply side will follow.
Big opportunity for EHR, Telemedicine, global Healthcare providers to line up and get listed for the program. Takeover the District Hospitals and upgrade them and convert 24 of them to Medical Colleges. With Govt acting as a guarantor in PPP model.
Big opportunities for global, online and organised Pharmacies to line up for listing in the program. Drug supply chain is set to be completely redefined. 70% cost of any treatment is drugs. Govt has started restructuring the NPI and essential lists.
India's private hospitals jack up prices of drugs and consumables up to 18 times. A study by National Pharmaceutical Pricing Authority shows that hospitals in Delhi-NCR routinely make a margin of 350-1,700% on consumables, and 160-1200% on drugs outside price control. The modus operandi? Pressuring manufacturers to print higher MRPs on products in lieu of bulk supply orders, and profiteering from sale of such medicines at their pharmacies. “This is a clear case of market distortion... patients have to incur huge out-of-pocket expenditure,” NPPA said. Consumables, drugs, and diagnostics make up nearly half to 70% of a patient’s bill.
Let's take the example of Diabetes as a disease burden. India has 65-70 Million Diabetics. The absolute numbers make India the Diabetes capital of the world. But as a % of the population its under 7%. Per month average cost of Diabetes management is INR 3K-5K. Only 33 out of 100 Diabetic patient days will need any kind of Hospital intervention. Hence #PMJAY coverage of 10 Cr families i.e. 500 Million people i.e. 40% of India's population can collectively pickup the Diabetes disease burden and more much more...
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100 Days Report Card: In little over 3 months, #PMJAY has been able to distribute nearly 5 Million #PMJAY cards, serve about 700K patient admissions, in 16K em-paneled hospitals, > 66% claims are from tertiary care.
Going Forward: Ayushman Bharat is set to provide coverage to 40% of India's population. Millions of claims will be coming daily from plethora of unstructured non-standard HIS systems. How many claims can be processed with manual vitrification? Hence the TPA industry is ready for disruption. TPAs have been servicing merely 3% of India's population i.e. covered by the private health insurance. Now this market is shooting up to 40% of India's population. Obviously we stand at the cusp of a new paradigm of intelligent revenue cycle management [RCM]. We need a digital claims engine built on meta data Standards to automatically process the millions of claims. Hence I see MDDS for Health Standards is the logical way forward...
-- Dr Pankaj Gupta is the Managing Partner @ Taurus Glocal Consulting --
References:
# MDDS for Health Domain Standards Notified by the STQC, Meity, GoI
#PMJAY #AyushmanBharat a.k.a NHPM a.k.a Modicare will bring an era of Digital HealthTech platforms [read IHIP] with EHR and MDDS for Health Interoperability Standards to Deliver the worlds largest Health coverage.
Big opportunity for global Health Insurance companies, FinTech and InsurTech to line up and get listed for the program. With Govt acting as a Payer, Provider and Re-Insurer.
Healthcare is a state subject. Centre govt funds 85% of most public health programs. However all the regulation and execution authority is with States. The states are free to accept or totally reject any healthcare ruling from the center. India is too diverse to expect a single Healthcare solution across all States. Unity in diversity is elusive. Hence MDDS for Health based IHIP Exchange platform is required to deliver Health insurance coverage across India.
#PMJAY > Health Insurance will be the driver for the shift to Standard Code Sets based HIS/EHR e.g. ICD-10, SNOMED, LOINC, NPI, etc. As defined in EHR and MDDS for Health Standards. This was the missing link in the Healthcare Ecosystem thus far in India.
JAM (Jandhan Aadhaar Mobile) coupled with NIN HFI Registery will be the delivery model to reach every beneficiary. Similar to Pradhan Mantri Ujjwala Yojana.
#PMJAY > Health Insurance will be the driver for the shift to clinical protocols, pharmacogenomics and precision medicine driven managed care. I can see the end of the 'Doc Sahib Bhagwan hai' era.
#PMJAY > Health Insurance will bring a check on unnecessary tests, expensive drugs, high end procedures and overcharging frauds. Machine learning and Analytics on the EHR data will be valuable in making the system adhere to protocols.
The Hospitals, Doctors and all other medical establishments are concentrated in Tier 1 and Tier 2 cities. #PMJAY will shift the demand to Tier 2 cities and below. It is a no brainer that the supply side will follow.
Big opportunity for EHR, Telemedicine, global Healthcare providers to line up and get listed for the program. Takeover the District Hospitals and upgrade them and convert 24 of them to Medical Colleges. With Govt acting as a guarantor in PPP model.
Big opportunities for global, online and organised Pharmacies to line up for listing in the program. Drug supply chain is set to be completely redefined. 70% cost of any treatment is drugs. Govt has started restructuring the NPI and essential lists.
India's private hospitals jack up prices of drugs and consumables up to 18 times. A study by National Pharmaceutical Pricing Authority shows that hospitals in Delhi-NCR routinely make a margin of 350-1,700% on consumables, and 160-1200% on drugs outside price control. The modus operandi? Pressuring manufacturers to print higher MRPs on products in lieu of bulk supply orders, and profiteering from sale of such medicines at their pharmacies. “This is a clear case of market distortion... patients have to incur huge out-of-pocket expenditure,” NPPA said. Consumables, drugs, and diagnostics make up nearly half to 70% of a patient’s bill.
Let's take the example of Diabetes as a disease burden. India has 65-70 Million Diabetics. The absolute numbers make India the Diabetes capital of the world. But as a % of the population its under 7%. Per month average cost of Diabetes management is INR 3K-5K. Only 33 out of 100 Diabetic patient days will need any kind of Hospital intervention. Hence #PMJAY coverage of 10 Cr families i.e. 500 Million people i.e. 40% of India's population can collectively pickup the Diabetes disease burden and more much more...
------
100 Days Report Card: In little over 3 months, #PMJAY has been able to distribute nearly 5 Million #PMJAY cards, serve about 700K patient admissions, in 16K em-paneled hospitals, > 66% claims are from tertiary care.
Going Forward: Ayushman Bharat is set to provide coverage to 40% of India's population. Millions of claims will be coming daily from plethora of unstructured non-standard HIS systems. How many claims can be processed with manual vitrification? Hence the TPA industry is ready for disruption. TPAs have been servicing merely 3% of India's population i.e. covered by the private health insurance. Now this market is shooting up to 40% of India's population. Obviously we stand at the cusp of a new paradigm of intelligent revenue cycle management [RCM]. We need a digital claims engine built on meta data Standards to automatically process the millions of claims. Hence I see MDDS for Health Standards is the logical way forward...
-- Dr Pankaj Gupta is the Managing Partner @ Taurus Glocal Consulting --
References:
# MDDS for Health Domain Standards Notified by the STQC, Meity, GoI
Labels: #AyushmanBharat, #Digital, #Healthcare, #NHPS
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