We see TPAs pushing technology boundaries in making administration peaceful and seamless

What are the biggest changes in India’s health insurance sector since the outbreak of the COVID-19 pandemic? Please elaborate on their impact

The Indian health insurance market is different from the traditional healthcare market. While government provisioning of care is available, most care is delivered by private care providers. Even employer-led health coverage is very limited and sparse. Since most of the onus is on individuals, there is a strong need for organised financial systems to cushion the financial impact of healthcare incidents.

The level of awareness of the nuances of this sector is very low among customers, this has led to a trust deficit between insurers and the insured. Customers then perceive these products as opaque. The pandemic has however opened up the market and a lot of customers (individual and corporates) want to know and understand more to be able to be better equipped to support their employees. Insurers responded well and quickly launched COVID policies which significantly increased penetration.

The TPA is the service delivery arm of the industry. We had to re-orient ourselves very quickly to handle a three-fold impact

Employees: The impact of lockdowns and COVID exposure on our staff’s well-being was of immediate concern for us. WFH protocols were established quickly and rosters prepared for rotation of teams. Investments were made in tech support and platform development to support WFH so that neither the employee nor customers were inconvenienced.

Customer process: We moved quickly to establish new pre-authorisation and claim submission processes. A massive communication exercise was taken up to help customers understand how to submit claims, get alerts, and get money.

Industry process: Insurers and partners were locked down too. We had to work with insurers to meet the requirements of claim submissions, ensure data/MIS was submitted promptly. Regulatory requirements on COVID tracking required us to set up real-time monitoring and data submission to Insurers for them to collate and submit to the government.

How has the level and pace of penetration of health insurance improved in the Indian Subcontinent?

The pre-pandemic levels were very low in comparison to the Western countries.

True. But, that was the pre-COVID mindset. The pandemic has accelerated a decade’s worth of growth in the industry and packed it into a few months. Customers are actively seeking information on health insurance and are more receptive to taking it up to ensure their own and their family’s wellbeing.

Tell us about the transformations in consumer behaviour? What are the trends that these transformations predict?

Information glut: There was an enormous overwhelming amount of information about the infection that caused concern and anxiety in a lot of customers. And yet people want more. We find people asking us multiple questions but in the wrong context. Setting them straight for their benefit has become a huge part of our job now. This trend will continue till every one of us is vaccinated.

Health obsession: This is a good one. Consumers are now becoming more conscious of their health. There is a huge shift in consumer mindset towards mindful living that starts from their health regimes to their families.

Future planning: A strong trend that emerges out of this pandemic is our need to regain a modicum of control on circumstances that are beyond our control. This year has thrown so many unseen challenges at people that most are re-evaluating the way they plan their future.

How is the adoption of technological, digital innovations in healthcare, affecting the health insurance sector?

Technological and digital adoption and innovations in the industry are at an all-time high. Both have seen massive growth this year. Those that had the technological processes in place along with the technical know-how have taken the lead. We are among them.
Faster and seamless processes linked via technology, AI-driven data management along with digitised and automated processes will create improve speed and accuracy in the field.

How is the use of big data and analytics in insurance transforming the industry? Please elaborate on the advantages, efficiencies they have ushered.

Insurance holds importance for everybody as it deals directly with the safety of our lives and assets. Bid data analytics is an innovation that helps companies in taking the correct decisions by providing them with intuitive insights.

Big data use cases in the field of insurance exemplify what an industry can do, given the right insights. With the unprecedented proceedings in 2020, technology like big data and analytics can help us through these adversities. It is an exciting spectacle as well to see evolving technology find its application across various sectors.

The abundance of data collected from customers at varying formats is streamlined by Big Data and analytics gives us granular insights to our progressions. Not just customer information collection, but also enabling fraud detection, offering threat mapping and informing policy formation form an integral piece.

How did COVID-19 impact TPAs like Vidal health?

Like rest of the industry, we had multiple challenges.

Our employees felt the same anxieties as rest of the country. We had to support them and their families while ensuring that our core processes continued to deliver top-class service. We also bore the responsibility of ensuring prompt cash-less hospitalisation as well as helping customers get reimbursed for expenses they had already made.
We invested in tech and processes.
It impacted us like the rest of the industry. However, we were quick to bounce back. Our existing and flexible HR policies ensured that our workforce transitioned seamlessly into the hybrid model. The technology investments we had made held us in good stead and helped us encourage customers and industry partners to adopt and accept a more digital work mode. We pivoted and kept tweaking our work policies to ensure that they kept up with the changing circumstances.

How do you foresee the role of TPAs changing in an evolving medical insurance landscape that is also seeing several regulatory reforms?

TPAs stand as a catalyst in health insurance space. They are the key enablers amongst stakeholders. We see TPAs pushing technology boundaries in making administration peaceful and seamless.

What are the new growth opportunities and challenges for TPAs, in a post-pandemic scenario? 

Healthcare as an industry has seen huge growth across the spectrum this year. For the TPA industry in particular:

Challenge: The cost of care in pandemics need to be dealt with carefully. Managing social stigmas and making sure the care is delivered correctly is the essential part
Opportunity: The inclusion of technology to ease and create more seamless processes that will make customer interaction more hassle-free opens up a world of opportunity across the value chain. We are already seeing more awareness in health insurance and spurt can be seen.

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