Hospitals and insurance company representatives have been meeting every month for the last four months to establish confidence-building measures, including grievance redressal mechanisms, according to Dr S Prakash, Chief Executive Officer at General Insurance Council. As reported by The Hindu BusinessLine, these monthly engagements represent the first time payers and providers are in alignment, with four round-table meetings having taken place between hospital associations like the Association of Healthcare Providers of India (AHPI), doctors and the General Insurance Council representing 32 companies. The grievance redressal platform is described as a pre-litigation conciliatory forum designed to resolve issues between hospitals and insurance providers.
Some concrete measures being discussed include standard treatment protocols for common ailments to help define pricing, as reported by The Hindu BusinessLine. Dr Prakash explained that if payers and providers have a common clinical care pathway, it prevents ambiguity and builds confidence in doctors and hospitals, paving the way for faster insurance payments. The standard protocols would particularly benefit patients by reducing uncertainties in insurance claim processing and treatment costs.
Capacity building through training on digital systems is also on the agenda, especially at smaller hospitals, according to Dr Prakash. As reported by The Hindu BusinessLine, discussions are underway with the Quality Council of India (QCI) and the National Accreditation Board for Hospitals and Healthcare Providers (NABH) to channelise what is fragmented in the system. The training focuses on better utilization of cashless insurance and reimbursement systems, with emphasis on empowering smaller healthcare facilities that provide essential care close to living areas.
These efforts come against the backdrop of several flare-ups between provider hospitals and payers (insurance companies) last year that had caused much anxiety among patients on whether their insurances would be honoured at hospitals, as reported by The Hindu BusinessLine. Dr Prakash was appointed to this role with the GI Council in January this year, marking a significant shift in coordination efforts between the healthcare and insurance sectors. Simultaneously, the CMS revised the MA Star Ratings system on April 6, removing 11 measures including call center performance metrics and administrative process measures, while analysts estimate the changes will generate more than $18.6 billion in additional Quality Bonus Payments to MA plans over the next decade.
