Dr. Indu Bhushan, CEO of Ayushman Bharat
Ayushman Bharat – a healthcare scheme so large that its beneficiaries are almost equal to the population of Canada, Mexico and the United States of America combined – making it undeniably the largest healthcare scheme in the world.
Launched in September 2018, Ayushman Bharat has been touted as a ‘game changer initiative to serve the poor’. At the time of launch, 13,000 hospitals were part of the scheme, and was poised to cover 50 crore people – with no cap on family size and age. More than 8,700 public and private hospitals have been empaneled for this scheme, with 33 states having signed MoUs with the Central government for program implementation. So far, 3.2 crore cards have been issued and nearly 40% of the Indian population is covered under this scheme.
Launching and implementing a healthcare scheme of this magnitude is no small feat, yet, seven months in, and Ayushman Bharat is setting a whole new standard for large scale, national implementation of a social impact initiative.
A large part of the scheme’s success so far can be credited to technology that lies at the very core of the portal.
At the recently held Lifesciences & Healthcare Innovation Forum (LHIF) event, Dr. Indu Bhushan, CEO of Ayushman Bharat spoke about the role being played by digital technologies in making the implementation of Ayushman Bharat a success.
“Without a strong IT backbone, it would not have been possible to reach lakhs of people in just seven months. We have doled out 1,400 secondary and tertiary care packages, with a 5 lakh cover per family per year. In this time, we have provided 3.2 crore cards and services for 22 lakh people, worth Rs. 3,000 Crores collectively. Had the people availed medical help on their own, the collective spend was Rs. 6,000 Crores – through the power of collective bargaining that was accelerated by digital propulsion, we saved the system Rs. 3,000 Crores,” said Dr. Bhushan.
In addition to scaling back instrumental and systemic costs, the extent of digital reach has also managed to cross several state borders effortlessly. Each of the 33 states that have joined the scheme have varied structures such as package rates, insurance schemes and payment modes. The system has managed to serve the people of different states and varied preferences competently.
Per the 2001 census, 307 million individuals migrated within India. The portal factored this in by enabling national portability. For example, if an individual who applied for the scheme from her place of origin and moved to another city to work, she could still avail of the services without any hassle as long as she had her Ayushman Bharat card.
A stable, interoperable and scalable IT system has served as the backbone of this scheme, which is yielding quantifiable results, explained Dr. Bhushan.
Here are some of the highlights of digital intervention methods being used to implement Ayushman Bharat
- Beneficiary Identification System – This system allows for continuum of care and easy identification of patient history without impinging on security.
- Pre-Authorization Request & Approval – This is done by the hospital which selects a package and checks your account balance, following which supporting evidence is submitting for treatment to begin.
- Hospital Empanelment – The National Health Agency launched the formal process of empaneling hospitals last year, where public and private healthcare providers were brought onboard the system per the guidelines. An online registration link for empanelment is available, making it simpler for any healthcare provider to join the scheme.
- Transaction Management System – This is being used to track the treatment of the patient during discharge and after.
- The existing IT infrastructure is adding immense value to the Ayushman Bharat team by providing analytics and data on users.
This isn’t all – Dr Bhushan elaborated on the plans to incorporate further digital means to make the portal function smoothly.
Continuum of Care – While the reach of Ayushman Bharat has been impressive thus far, Dr Bhushan recommends harnessing the potential of the National Health Stack to ensure every individual can be provided primary healthcare.
Develop an Ecosystem for Health Insurance – The existing health insurance system is currently fragmented. While there are several existing systems in place, none of them effectively communicate with each other. Moreover, private sector schemes are not inter operable either. Ayushman Bharat is currently working on standardizing hospital networks, data exchange, fraud & abuse control and IT structure for health insurance claim management. In addition, Ayushman Bharat is also working on a National Health Claims Platform, which will help in monitoring efficient health claim processing and will be built on an open standard platform. This will open-up the portal for other players, and even allow hospitals to plug into it.
Increasing the outreach – Harnessing technologies like telemedicine and AI could help attract the people Ayushman Bharat hasn’t been able to reach so far.
Improving the standards – IT can enable monitoring of existing services and establish a standard treatment protocol. By improving and monitoring the quality of services, occurrences of fraud and abuse can be mitigated.
Ayushman Bharat is getting fillip from all political quarters as well, and the sustained implementation and roll-out of services with the help of digital means can truly revolutionize the efforts.
Dr Indu Bhushan was one of the inaugural session speakers at the 5th Lifesciences & Healthcare Innovation Forum held in New Delhi on April 30, 2019. You can read the report here