Monday, January 31, 2011
Our article
HCX is an IT company and is engaged in becoming a Health Insurance Claim Information Exchange, a platform that enables Hospitals, Insurance Companies, TPAs, Customers to be connected for transfer of information on health claims submission for Pre-authorization Approvals, Filing of billing details by Hospitals as well as on-line validation of policy details at the time of admissions. The company has been able to link with more than 2500 hospitals across the country and the efforts are on-going to further expand the reach.
The company is also providing an on-line Personal Health Records (PHR) manager where people can convert and store their health records and medical history including reports from paper base to electronic form. The user has the option of sharing the records with family members or doctors for regular as well as second opinion related matters – all this on-line and anywhere. This can be self updated online or via a phone call to the company every time the user gets blood pressure or sugar level or any other health check-up done. This can be very useful even for new born babies for maintaining the health records from birth itself the system can also be programmed to act as reminder service for vaccination/immunization schedules as well as doctors visit. The reminders can be set as SMS or email.
In addition the company also offers an innovative product aimed at preventive health in which along with an on-line Personal Health Record account the buyers also get the benefit of full body preventive health checks with report on 59 various parameters at our empanelled diagnostic labs, general consultation visits at network hospitals or general physicians and visits at specialist doctors. In addition the buyers also get a health card which contains information on health including emergency contact details, family doctor, allergies, details of medicines being taken and access details of on-line PHR. These details can be very useful in the event of any emergency. This health card also entitles the buyers to get discounts at empanelled hospitals and diagnostic centers for OPD, IPD as well as diagnostic services.
Your first client (and how you landed the deal):
We are now at the stage of implementing the health information exchange platform for 3 companies – we are getting into these as pilot phase so that we are able to iron-out any implementation related issues – all these deals we are able to get by proving to the companies that by adopting a IT enabled processes – the companies can gain better work efficiencies, improve productivity of people and above all improve information flow to the customers while handling health claims.
Your lucky moment:
Initially when we brought this concept of Health Information Exchange and were in the process of building the network of hospitals – many Third Party Administrators considered us also as a TPA whereas we are an IT company and are providing on-line medium of transferring information from hospital to claim approving authorities like Insurance Company or a TPA, the lucky moment was when I received calls from many existing TPAs who showed interest in utilizing the platform for receiving the information from hospitals which actually will improve the over-all work efficiency, as TPAs utilizing this platform was initially not in our business plan . We are now in dialog with few TPAs also who may adopt this IT platform.
Describe how you got the idea. How many times did it change in year one and why?
Well the idea of initiating health exchange had been in mind for number of years – as in our current process the flow of information from Hospitals to Claim Approving Authorities has been manual which more often than not results in delays, errors and the claiming customers are always guessing weather the case had been approved or rejected etc. and this leg in the process required a robust IT driven process – our technology partner has been providing these processes for past 18 years in US markets hence the platform available with us is quite robust and has been through test of time.
The PHR is an emerging need of customers and we want to be little ahead of the curve in pioneering this concept by making the record updating processes more user friendly so that people with less know-how on computers are also able to take benefit of maintaining health records on-line.
The OPD and Preventive Health product is purely on the basis of our market study where we have witnessed that people resort to self medication as they are not aware of good doctors or they want to see another good doctor but are not aware on where and how can they find once. Here our assistance as part of our product offer can make the experience a lot better as we can also fix appointments with doctors for our customers.
Did you conduct any study/survey to assess the market?
Yes for Health Exchange before we started building the network of hospitals, we did in-depth study on how the current processes are functioning as one would appreciate despite being manual we do have processes which are functional – however our major focus had been to establish the pain points in the current process and how this IT enabled process can eliminate these pain areas. Some very interesting features came to light – hospitals are quite keen to adopt IT enabled processes but with companies wanting them to use their systems the hospitals are not comfortable to use so many login/passwords for seeking the approvals. Similarly many Insurance Companies or TPA as part of setup have developed localized systems and now with inability to upgrade with changing times are using manual processes. There is an appreciation of the need at both the ends however earlier there was no choice as well as option which could make these ends meet but now we have the system which can make both the ends smile and above all the customer gets complete information on how the claim is getting processed.
Who was most difficult to convince about the idea/jump into entrepreneurship?
The IT people in companies initially were very difficult to convince as they thought developing such a health information exchange platform was easy and could be done in no time. However over a period of time they have started realizing that this piece is not the core function as this is only an information flow system at the same time they too have realized that hospitals that are also key in the process are far more comfortable using a single window for logging claims information.
I set up a team of very few people who had excellent track record in their previous assignments and would take up the job on my word. Started building hospital network.
Customized the IT platform as per work processes prevalent in India in Health Information Flow from Hospitals. Made our presence at all potential customer locations
Name one good surprise in year one
This was when we thought of getting the customer which seemed so easy initially and later acted as most difficult
Lesson from year one that no management book could teach:
Setting up a company with new concept and driving the effort through young and less experienced people is quite a challenging task but keeping the people happy and continuously showing them that each milestone achieved can add to their overall success is biggest lesson I learnt during the year.
Well, at this juncture of life where I could have continued to enjoy life in Insurance Companies I decided to take this new role where I am also an investing partner at the same time many members in the team joined looking at me. Now I owe to them a brighter future and better career hence my plan B is “Go to plan A”.
Because I think I was able to develop a good team which is determined to carry forward this initiative.
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