“The need of the hour in healthcare is to establish a network of OPD service providers that can provide a cashless experience in real-time”, said, Ravi Chandra, Co-founder & CEO, MedPay
India’s healthcare sector has grown to an estimated USD 372 million industry, as per NITI Aayog. Of this, OPD services, including clinics, pharmacies, and labs, account for close to 70% of health spends. Yet, most Indians do not have insurance coverage for such healthcare expenses; medical insurance that covers hospitalisation-based treatments remains the most common type of coverage for most urban, middle-class Indians. “There is a need for the industry to acknowledge the value in making OPD coverage default when it comes to health insurance. It could help both, patients, and insurance providers, bring down expenses. Medicines, doctor consultations, and diagnostics are the top three spends when it comes to OPD costs. By extending coverage, we can speed up access to diagnosis and treatment, which is likely to impact the nature of treatment and medication and therefore, costs in most cases,” offers Ravi Chandra, Co-founder & CEO, MedPay.
The case for going cashless
This is set to change with the rise of healthtech; companies like MedPay are leveraging technology to set up an integrated network for comprehensive and cashless OPD coverage. So far, even in the case of insurance policies that offer OPD coverage, claims are cleared basis reimbursement; this only eases the pressure on middle-class patients in a deferred manner; even after paying hefty insurance premiums, they must spend on out-of-pocket bills on expensive diagnostics, consultations with super specialists, and medicines. “It is not the most feasible solution, especially if we have to improve the quality of service offered by the healthcare and health insurance industry. The entire claim submission process can get cumbersome at both ends. Insurance companies too, must conduct a post-facto risk analysis before processing the reimbursements,” explains Chandra.
Digitally integrated OPD networks on the other hand, help insurance companies extend cashless OPD in a seamless and profitable manner. By integrating network APIs, insurance companies can help patients access the entire network of cashless healthcare providers and book appointments, including at home services. Using intelligent technology, the app evaluates eligibility criteria to process the cashless feature.
The digital networks are also effective in acquiring new customer segments and bringing down cost per transaction to a great extent for insurance companies and healthcare providers. “At MedPay, we have been able to unlock new customer segments in tier ii and tier iii cities for our partners. In fact, 65% of our business is from non-metros. More importantly, we have been able to drive repeat business for our partners,” says Chandra. The company has a network of 35,000+ pharmacies, 21,000+ doctors, 4000+ diagnostics labs and OPD health centres across India.
The opportunity ahead
In a country where health insurance has been largely limited to middle-class urban and semi-urban homes despite initiatives such as by Ayushman Bharat and PM-JAY by the government, integrated OPD networks offer a promising future. Private health insurance companies and OPD care providers can provide critical services to a mobile-savvy rural India via cashless OPD integrated networks. For many such rural patients, access has been about both – affordability as well as connectivity. And platforms such as MedPay, which already operates in 500+ locations, promises to address both these challenges to unlock timely, and cost-effective OPD services. “Patients can choose OPD service providers basis their preference or past experience or opt for one basis proximity and convenience,” shares Chandra, referring to the choice OPD-focused healthtech has to offer.
To sum it up, integrated, pan-India OPD networks are the push India’s healthcare industry for effective, affordable, and comprehensive care.