industry overview: Healthcare payers are the entities which finance or
reimburse the cost of health services spent on the patient. These include
insurance carriers, health plan sponsors or other third party payers.
of the top healthcare payers are Apollo Munich health insurance Company
limited, star health and allied insurance corporate limited, future generali
India insurance company limited, Bajaj Allianz general insurance corporate
limited and Cigna TTK.
Market size of
The global healthcare payer industry market was valued at INR
2074 billion in 2015 and is forecasted to grow at a CAGR of 8.5%. This growth
is based on the increasing demand for advanced yet cost effective technologies.
The growing implementation of digital technologies in payer operations and growing
involvement of a wider population are anticipated to boost the market in the
Trends in healthcare
communication between payers and providers
Increment of care coordination between providers can reduce
the expense of healthcare. Healthcare providers and payers for care
coordination are needed as these healthcare systems continue to grow. For
healthcare payers it’s essential to have visibility into diagnoses. Therefore, it
is important for the care providers to interact with as many doctors each year.
2. Growing government
Healthcare regulations are increasing around the globe. From
increased coding standards to the various reauthorization acts, healthcare is
turning into an industry focused on compliance and regulation rather than
patient care. With the right level of visibility and centralized
communications, healthcare payers will be better able to manage these increasing
advancements are transforming healthcare industry
The proliferation of new technology in healthcare is
exploding. Some opportunities and concerns for rapidly evolving technological
advancements are wearable Tracking Devices, Patient-Centered Care,
Increased Data Demands, Attaining Meaningful Use and
Switching to ICD-10, Data Security.
4. Creating Higher
Value at Lower Costs
future, the healthcare industry is striving to create a better system that
achieves higher quality at lower costs. The formula to get there is simple, value
equals quality over cost. Higher the quality, higher is the value.
Government plans and
schemes to finance in healthcare
Swasthya Bima Yojana (RSBY), begun in 2008 under the ministry of labor and
employment is a good initiative for making health care accessible and
affordable. It mainly provides health insurance coverage to families living on
incomes below poverty line.
State Insurance Scheme is another healthcare coverage scheme for factory
workers in India to which both employers and employees contribute.
Government Health Scheme is for civil servants. In addition, railway and
defense employees have their own schemes, and states have schemes for their
employees as well.
Improvement: 3 modern Healthcare Payer/Provider Financial Arrangements
There are modern healthcare payers or provider of financial
arrangements who are competing in the market.
1. Pay for
Pay for performance is straightforward incentive system that
rewards improvement based on established metrics and penalizes if the provider
fails to hit the metric. A percentage of patients in a population get a preventive
screening during the year, the provider will receive the incentive payment.
2. Bundled payments
In a bundled payment arrangement, a payer gives a single
payment for all provider services for an episode of care, regardless of number
of providers involved in that episode. The conditions include congestive heart
failure, urinary tract infection, sepsis, diabetes and a variety of orthopedics
procedures. Employees who have their procedures done at those centers will
receive full coverage including travel costs.
3. Accountable care
Establishing an accountable care arrangement with a payer
means entering into a total-cost-of-care system that rewards or penalizes based
on the total cost of a patient population. It may be wise for some
organizations to ease into the ACO world incrementally by starting with P4P and
Role to develop home
Home healthcare is provided by skilled practitioners to
patients in their homes under the direction of a physician. Home healthcare services in Philips include
nursing care, physiotherapist, doctor’s visit at home, wounds management, nurse
supervisor for weekly audits along with doctor on call. The goals of home
healthcare services are to cut down the hospital expenses, provide a hygienic
and infection free environment at patient’s premises and improve patient’s experience
of care including quality and satisfaction.