Healthnine: Health Information Network Partner
By Bhanu Pratap Yadav
Health insurance is a booming business in India. More and more people are getting themselves, and their families health insured. With this, they ensure financial support in times of any health emergency. However, many a time, it is during the claims settlement process when they realise it is not as smooth as they had imagined. Healthnine (h9), acts as a bridge for the insurance holders between hospitals and insurance companies making the process swift and friction-free. Read more about the enterprise's model and its analysis in this story by Bhanu Pratap Yadav.
India is a niche area for the health insurance sector. The sector has seen a leap of growth in the country. The growth is often attributed to the liberal economy and growing general awareness among the public on healthcare. With the introduction of Ayushman Bharat, health insurance has penetrated to the rural areas as well. Health insurance provides adequate financial cover to support the hospital and other medical expenses.
Ritesh Kajaria, CEO - HealthNine Technologies Pvt. Ltd.
However, the extensive documentation during the claims settlement process, one often ends up being a seesaw between the hospitals and the insurance company. Presently the claims settlement processes are much more complex and tedious. It involves too much paperwork and reiterative manual processes due to which medical records of patients are always at risk. It is hard to monitor the flow of data all the time that increases the chances of fraud.
Healthnine Technologies Pvt. Ltd.
On finding that there remains a large amount of lag in the way things are being processed between hospitals and insurance companies when it comes to claims settlement for patients, Ritesh Kajaria founded Healthnine Technologies Pvt. Ltd. It is aimed to work with insurance companies and hospitals by setting a real-time electronic claims settlement process between all parties (patients, hospitals and insurance companies). The core of Healthnine lies in providing more ease and transparency to the current system. H9 uses a proprietary set of technology, transforming the manual process into a completely seamless workflow.control.
What makes the difference
Currently, the insurance claims process is very complicated and takes a considerable amount of time. With Healthnine coming on-board as a partner, the claims settlement process becomes simpler, with the requirement of lesser resources. "We have developed a robust technological backbone for Healthnine to become an information exchange between hospitals and insurance companies. The technology ensures sharing and processing of the information at a fraction of the time that is being currently used for claims settlement" Ritesh says. "Customers' data privacy is our priority. Hence, the system keeps the errors and frauds under check. It helps in reducing costs and errors for insurance firms," he adds.
Goals
The company at present is piloting with several insurance companies to showcase their offerings. At the same time, the company is improvising self-system by strengthening data security and privacy using AI and ML capabilities. "By the end of 2020, we aim to work with 10,000 hospitals and become an exchange of data and information without the need for manual back and forth between insurance companies, hospitals and patients," says Ritesh on the organisation's growth. "One can simply log in to our website or app to go through the entire process without spending hours communicating with hospitals and insurance companies, thereby also eliminating the risk of manual error," he details Ritesh.
Challenges
The model seems kind and straightforward to all the stakeholders. However, it is not going to be an easy task for the company to take its place in the existing market. Insurance companies might get convinced to experiment with this new technology to create a more sophisticated set of offerings. But, the same doesn't reflect in the hospital space. The main challenge for the company would be to break the mechanised work and thought process of the industry. The company's offerings as information exchange are quite disruptive and clutter-breaking. So, it might take a bit of time to get sensitised and understand the model. Even Ritesh sees it as the biggest hurdle for his venture. "Most hospitals are reluctant about the implementation of new protocols and services, so we aim to introduce and generate awareness about what benefits an easier claims settlement can mean for them as well as patients," he opines.
Data security and it's privacy is another barrier for the company. The more data is getting digitised, higher are the chances of getting it stolen. In this digital era, even big technical giants are finding it hard to make a leak-proof system. Healthnine has to be very cautious as it cannot risk the medical health records of its customers. Once the hospitals are convinced of the reliable, secure system, the model can be implemented quickly for the claim settlement process. It will then gain popularity among all the stakeholders.
Impact on the overall health system
Healthnine seamlessly integrates 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 entirely secure and private. Imagine having this system across the entire Indian ecosystem of the healthcare industry, from imaging labs to health practitioners to big hospitals. Then there would be no need to lug around files and data can easily be fetched from the company's information exchange network. But does the healthnine has that vigorous system to be a centralised repository of information? Can this model be adopted and implemented universally? The future would answer these questions and decide the fate of Healthnine.