Imperative for adopting Digital Health Framework

One of the core facts of the current health status in India and globally is that given the projected increase in chronic disease burden, there will be an ever increasing out of pocket health expenses burden. For a country of Indias size practically impossible for physical health care networks to keep pace, especially in Rural India. The government rolled out the NDHM (now ABDM) to enable an open digital health data framework that would help democratize health data and making Health Care more accessible across digital and physical channels.

 Making health care more accessible (especially for Rural India) along with the health data analytics helps Health Service Providers do early detection and active management of the underlying health risks. So with all these positives, would it not be imperative for all the health ecosystem stakeholders including Insurance companies to jump on the bandwagon? Lets start with an understanding of use cases and scenarios of challenges faced in the current world

 From the perspective of consumers

 1.      Physical prescriptions and reports, if lost then largely the entire previous medical history is lost. This has a key impact in care management especially for those with chronic diseases

2.      Even with digital prescriptions and lab reports, there is no common structure basis which once uploaded on a platform RPA can be used to extract data. It is also difficult to enable cross platform data exchange.

a.      For e.g. Econsult on MFine, but preferred partner for medicine delivery is Pharmeasy

b.     Visited my neighborhood clinic, but have to scan and upload prescription into health record of clinical nutrition app I use

3.      Booked a lab test online, but received a separate PDF copy. Now how do I compare the parameters that have changed over time? Is there any specific health parameter I need to immediately worry about?

4.      When I do telemedicine consult on eSanjeevani platform, how do I enable the doctor to access the past prescriptions and lab reports seamlessly. This especially is a challenge for Rural consumers who are not digital savvy

5.      I want to buy health Insurance and life insurance, but I am not sure the conditions to declare and is the policy suitable for me? Will my claim be denied due to non declaration or lack of coverage of my condition?

6.      The Insurer is asking medical questions I don’t understand, if my health history were available digitally including past records, then the data could be pre-filled?

7.      OPD claims are painful, can not the claims be submitting digitally to my health insurance company

 From the perspective of Health Service Providers

1.      Why should I enable data exchange? I can loose customers and / or revenue on add-on products and services to other platforms?

2.      I want to have digital format lab test reports but no entity is enabling same? also making separate API integrations with individual labs is a time consuming and costly affair

3.      Why do I invest in ABDM compliant framework now and wait till ecosystem matures?

4.      Can I save the effort of integrating with individual medicine ordering platforms? Also when I do so they are unable to consume the eobjects for eprescriptions

5.      Can we digitally refer the patient to hospital with due records and then get back post hospitalization edischarge summary and eclaim object to facilitate filing digital insurance claim for consumers who have purchased insurance on my platform?

 From the perspective of the Insurance Companies

 1.      Can there be health data comprehensive enough to enable a real time digital underwriting engine to be built for STP ?

2.      Is there a clinically validated basis to the care pathways of the digital health service provider basis which assumptions of health risk projections can be reliably made?

3.      The ecosystem of players compliant with eclaim objects is not ready, why invest now?

4.      If ABDM open health data ecosystem is the future, then preference for health services tieups would be with those compliant with ABDM framework. Are there any players who at scale are ready for same?

There are no easy and ready answers to some of the above, however looking at learnings from telecom and UPI growth

1.      Walled gardens don’t work eventually as consumers prefer players who will facilitate data exchange

2.      Digital Health Startups at the tipping point of scale, will suddenly see that the data they have cannot be leveraged for meaningful analytics and will need significant investment and GTM delay to make the change

3.      Consumers will start preferring players who enable health data exchange under the ABDM and also provide a superior digital experience.

4.      Opportunity for digital health startups to build business models targeting larger health ecosystem with increased health data mobility

5.      For specialist networks like lab test providers, diagnostic centers etc imperative to migrate to ABDM enable framework vis a vis integrated players like Tata IMg & Pharmeasy that own primary and secondary care infrastructure. SRL Diagnostics becomes the first player to be available on ABDM framework

6.      Insurance companies can play a pivotal role in nudging the health ecosystem of HSP’s, hospitals, lab test providers, medicine ordering etc to come together – the one who takes the lead will see market share growth as customers will come to expect better experience

 The above is an evolving thought process and may not have complete coherence to plan strategy, however my belief is that’s important to start having the conversations to prepare for scale and also that this framework can help users access better healthcare services and hence be more productive

 Sachin Aggarwal

 (The Author is ex Head of Finance Services at Airtel Payments Bank with a background in telecom, Retail, Technology and Digital Payments. Currently work on contract as Digital Partnerships consultant at Care Health Insurance Ltd. Views are personal)