The complexity arises from the coexistence of multiple payment models, including cash payments, insurance reimbursement, government schemes, and out-of-pocket expenses. These fragmented payment systems often lead to inefficiencies, delays in processing claims, and confusion for both patients and healthcare providers.
Revolutionizing healthcare payments with technology involves creating more efficient, transparent, and patient-centered systems that simplify billing, payment processing, and financial interactions between healthcare providers, payers, and patients, said Vineet Mehta, co-founder & CTO at Alyve Health, one of the fastest-growing health-tech platforms in the country.
The healthcare sector is riddled with fragmentation, particularly in outpatient (OPD) services. With over 10 lakh independent doctors, 1.5 lakh pharmacies, and a multitude of diagnostic centers, the lack of integration complicates the delivery of cashless services. This disjointed structure burdens both patients and insurers, complicating transactions and reimbursement processes and often leading to errors, delays, and mistrust.
The cumbersome reimbursement process is slow, manual, and error-prone, burdening patients with delays and extensive paperwork. Digital payment solutions, such as direct payments and UPI-linked QR codes, eliminate reimbursement hassles and allow for a set of automatic plan restrictions, streamlining coverage management, he added.
We are now seeing that the digital health payment landscape is evolving rapidly due to advancements in technology, policy shifts, and changing consumer demands. The National Digital Health Mission (NDHM) can be a critical driver of this change. Regulated integration of payment information with patient health records can help in seamless data sharing between healthcare providers and insurers, expediting claims settlement and supporting the adoption of cashless services across the healthcare ecosystem, Mehta told Pharmabiz in an email.
Corporate-sponsored OPD plans and a growing emphasis on preventive healthcare are reshaping digital payments. Flexible payment models, such as subscriptions or pay-per-use, further support proactive care, reducing chronic diseases and overall costs. Adoption of digital payments in health care needs trust among users and this requires interventions at multiple levels, he noted.
The increased use of artificial intelligence (AI) and machine learning (ML) for claims and billing optimization is the focus. AI can identify and correct billing errors, optimize claims processing, and detect potential fraud by analyzing patterns. Predictive analytics streamline claims approvals, flag likely denials, and help providers proactively address issues, reducing rejections and improving cash flow.
Moreover, interoperability enables seamless sharing of payment data across electronic health records (EHRs), billing systems, and insurance platforms. This reduces duplicate data entry, improves accuracy, and accelerates claims processing. It also minimizes administrative delays, allowing providers to focus more on patient care.
There is compliance with data security and privacy standards. Advanced encryption and adherence to standards like HIPAA protect patient financial data. Secure systems prevent breaches and unauthorized access. Compliant payment systems reassure patients about the safety of their financial and health information, fostering trust in healthcare technology, said Mehta.
No doubt the digital payment solutions are set to revolutionize India’s healthcare, reducing fragmentation and improving access to quality care. By streamlining processes, minimizing fraud, and fostering trust, these innovations offer a transformative approach to enhancing healthcare accessibility. It is here Alyve Health which is a technology-driven healthcare start-up founded in 2020 aims to chip in expertise in comprehensive, cashless health plans that prioritize user well-being and simplify access to medical service, said Mehta.
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- Source: https://auroushealthcare.wordpress.com/2024/12/02/indian-healthcare-industry-turns-to-technology-to-address-fragmented-payment-landscape/