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Ayushman Bharat & Disha: Winds of Change for the Indian Healthcare

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Sumit Singh, CIO, Wockhardt Hospitals Ltd.,,

From the ramparts of the Red Fort, Prime Minister Narendra Modi formally announced perhaps the most ambitious healthcare initiative the country has heard in a very long time. In the 72 years since independence, India has progressed tremendously in many aspects of life; however quality healthcare is still out of reach for most. The fact is, if someone from a moderate or lower income falls ill with anything serious, the financial impact could be back breaking perhaps pushing the individual and the family into deep economic stress. The Ayushman Bharat plan envisages that with a small annual insurance premium, it will provide a coverage value of INR 5 Lakhs annually and hopes to cover over 10 crore families or 50 crore individuals of the nation. While the creamy layer is fortunate to be able to manage this necessity of life, this policy aims to provide a security blanket over those who had been left out by the current system far too long. It is imperative for one and all to work together to make this a success. Even though lot of the details are yet to be released, it is clear that such a massive initiative will create opportunities for various players.

The Prime Minister himself mentioned the critical role for Information Technology and Digital Platform that would be required for it. First, the enrolment process itself will be enormous and it has to ensure that while no one is left out and the on boarding process is streamlined and hassle free while taking care of possible fraud and duplication of beneficiaries. The current capacity will be unable to cope up with demand for quality healthcare that would needed, opening up opportunities for infrastructure as well trained work force. Further, it is assumed that the funding will be 60:40 split between the central government and the state government and the state schemes would be merged into it. The coverage would be provided by multiple insurance companies that would have to scale up not only to the new enrolments but also to share data for various purposes.

Standardized Treatment Guides (STGs) along with Package Rates are likely to be the norm for the care providers to follow. Quality, Consistency and Outcomes will be required and then recorded, measured and analysed by the payer, the provider would have to optimize the costs involved and manage the claim management process would require enhanced attention while doing similar analytics. With the claim amount fixed, any leakage would cost dearly.

Process improvements would have to pursue vigorously to provide differentiating quality at an affordable cost while maintaining the viability of the enterprise. EHRs and EMRs along with HMIS will play a critical role as the starting point for this affordable care to start for a patient and this will improve adoption, standardization and interoperability of between disparate systems. The entire ecosystem is expected to generate a huge amount of data that will open up and analytics will play a crucial role in multiple areas such as disease related such as environmental, concentration or outbreaks, fraud prevention and detection, drugs and consumables usages, equipment utilization, work force utilization, cost optimizations, claim processing and settlements from multiple perspectives.

WITH THIS LARGER DATA AT THE HAND OF THE PATIENT, IT IS EXPECTED FOR A FAR BETTER CONTINUITY OF CARE OF THE PATIENT AS WELL AS REDUCING COSTS


Moving on, the other major change heading is the Digital Information Security in Healthcare Act or DISHA. While still in draft stage, its key objectives relate to provide framework for data governance from various perspectives. It aims to provide clarity the ownership of medical data making it clear that is the patient above anyone else or entity. The usage of this data then requires explicit consent of patient or from the legal guardian. As the Act rightly puts the patient in the centre, it puts specific requirements for exchange of patient data between various healthcare providers and other entities. With this larger data at the hand of the patient, it is expected for a far better continuity of care of the patient as well as reducing costs such as eliminating duplication of diagnostic tests. As some of the data at the wrong hands could possibly cause personal harm, embarrassment or discrimination, the privacy concerns play a critical role in this act governing storage, sharing and transmission with severe penalty provisions in case of breach of this trust. The Act envisages significant usage of this data for the greater good of the society. With de-identified data, i.e. without patient demographics information, research from various perspectives could be carried out that could among other things improve on early detection and prevention, treatment standardisation, outcome analysis, intervention planning, policy formulation to name a few.

With these two major government led changes for the Indian Healthcare in the near future, the practice is likely to see a sea change with dramatically improving the access to quality healthcare and putting the patient at the centre of the whole thing. It would not take a large leap of imagination to quickly realize that the Indian Healthcare system is like to also undergo a Digital Transformation on the back of the new age Information Technology solutions.

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