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

India will be the next battleground for Global Retail and Healthcare!

India had 60 million online shoppers in 2016, which is only 14% of the internet user base in the country. This will rise to over 50% by 2026, according to a report by Morgan Stanley.
On top of that India has over 900+M mobile phones. 60% of these are smart phones. 90% of these are Android phones. 200M Jan Dhan Accounts have been opened at the bottom of the pyramid. Digital transactions have crossed 1 Billion every month. Rupay has emerged as the largest payment gateway in India dislodging Visa and Mastercard. Electricity has reached 500K villages. All this is expected to fuel the organized retail market.

Online retail is fast catching on, not just in the larger metros but also in the Tier II and Tier III cities. This growth can be attributed to increasing internet penetration and smartphone revolution. The Indian retail industry has come of age and has emerged as one of the most dynamic industries in the world. Accounting for over 10 per cent of the country's Gross Domestic Product (GDP) and approximately 8 per cent of the employment, it is expected to nearly double to $1 trillion by 2020 from $600 billion in 2017, registering a Compound Annual Growth Rate (CAGR) of 16.7 per cent over 2018-2020. Keeping in mind the growing online potential, brands and retail chains alike are upgrading their online presence to draw customers to their e-shops. India's growing per capita income, a rising middle class, changing demographic profile, urbanization, and attitudinal shifts in the consumer spending pattern, all indicate the retail sector's potential to be the real growth engine of the country's economy.
NHPM or Ayushman Bharat has created a huge Healthcare market i.e. INR 500K cover per family for 100 Million families in India. This is a game changer and all big players will run after it. Drugs form approximately 70% cost of any treatment. Obviously this Coverage needs an e-commerce platform, telemedicine apps, and digital community to support the physical Healthcare Ecosystem.

Myntra, Online retail store for fashion and lifestyle products, acquires smart wearables devices startup WitWorks. Flipkart owns India’s largest online fashion retailers -- Myntra and Jabong -- both of which it acquired. Together, Flipkart-Myntra-Jabong has a 70 percent market share of the online fashion business in India. It also owns eBay’s India business as well as popular mobile payments app, PhonePe. With over 100 million users and these popular properties, Flipkart is a valuable asset in the global internet economy for its long-term potential. Walmart is now looking to pick up majority stake in Flipkart. Walmart may rope in Alphabet [Google] also for Flipkart.

Amazon is already in India Retail sector. Amazon is already selling its services to many in Healthcare and has also announced it's desire to do more in Healthcare markets in US. Amazon said that it is working with Berkshire Hathaway (BRKA) and JPMorgan Chase (JPM) to better control costs and reduce spending on the health insurance they offer for the 840,000 people who work for them. Amazon has invested $4.74 billion in Amazon.in, to go after the India market and compete with Flipkart, Myntra, Jabong.

For traditional physical world Retailers, this means entering the playing field with the likes of e-commerce behemoths Amazon and Alibaba, both of which are leveraging big data and powerful AI algorithms to transform the retail space. The traditional Retailer Shopping giants are feeling the heat from Flipkart and Amazon in India.

Cooper Smith, who advises retail clients with Galloway's firm, L2, thinks we may be years away from a serious discussion on breaking up Amazon, but he advises retailers to not sit around and wait for that to happen. He thinks the announcement that Wal-Mart is partnering to sell some of its products on Google Home is significant for struggling retail survivors: "A lot of luxury brands like LVMH, which has refused to touch Amazon with a 10-foot pole, are talking about banding together to create a new luxury e-commerce space. Amazon hasn't been able to disrupt that market yet. Google and Facebook are the platforms with the reach, those are the alternative platforms that would help brands and retailers reach consumers without having to partner with Amazon."

In the US, Wal-Mart shoppers can link their Wal-Mart accounts to Google Express and quickly order — either through voice on Google Home or by shopping on Google Express. By linking a shopper's past Wal-Mart purchase history, Google will be able to more quickly learn the customer's shopping patterns and recommend suitable products. Using the platform now, a customer can say, "Google, buy peanut butter." Google will then suggest the brand it thinks the customer would like the most. The same can be leveraged by many other smaller struggling Retailers in India to compete with likes of Amazon and Alibaba.
On top of that Google is betting that the future of healthcare is going to be structured data and AI. The company is applying AI to disease detection, new data infrastructure, and potentially insurance.

FinTech mobile based payments developments supported by Govt of India's Digital India, Jandhan/Aadhaar/Mobile and BHIM App are only adding to the fire. Many local startups like Paytm and All big Internet and Retail giants are jumping into the ring - Flipkart, WhatsApp, Samsung, Android...

After USA, India has the largest user base for these Internet Giants. Obviously India is fast becoming the next battleground for Retail and Healthcare?

Can you extrapolate the Dots? I can see the Trend!

#India #Retail #Healthcare #NHPS #AyushmanBharat #Amazon #Flipkart #Walmart #Alibaba #Digital #e-commerce