Indian healthcare industry to grow at rapid pace

BANGALORE, INDIA: There is a lack of a coherent and sustainable plan that addresses the healthcare needs of the masses. There are no national standards either.

Manoj Malhotra, CEO, Salient Business Solutions Ltd, Pyramid Health Solutions, USA and president - The Business Process Industry Association of India (BPIAI), elaborates. Excerpts:

CIOL: How is the revenue cycle management in Indian healthcare provider systems inefficient? How can Salient help?

Manoj Malhotra: The Indian healthcare industry is expected to touch $40 billion in 2012-13 with an annual growth rate of 15-20 percent and GDP share of 5-6 percent. Given the population driven additional demand of almost 1.5-2 million beds by 2025 from the current 1-1.25 million, the industry size is expected to continue to grow at a rapid pace.

Akin to the US healthcare industry, a lion's share (almost 80 percent) of this growth will be provided by the private sector, where a typical revenue cycle management workflow is mostly managed in house and with limited use of technology and process. There are some other reasons for an inefficient RCM system that exists in Indian hospitals today.

There is a lack of a coherent and sustainable plan that addresses the healthcare needs of the masses. There are no national standards by which physicians, nurses, pharmacists and hospitals are trained.

Financial incentives between specialists and hospitals from referring doctors govern the way a substantial proportion of patients are treated. Guidelines and protocols for the management of disease, including the length of stay, are virtually non-existent and so is the ability of hospitals to determine the appropriateness of medical and surgical therapy seems years away.

Further, lack of an Electronic Health Record (EHR) prevents the development of transparency throughout the healthcare system. Above all, there is not enough historical evidence of what it costs for the treatment of a particular condition for insurers to adequately set their premiums.

Few suggestions if implemented can improve the overall scenario of Healthcare Industry and specifically the revenue cycle management within hospital:

1. Develop and implement national standards for examination by which doctors, nurses and pharmacists are able to practice and get employment.

2. Rapidly develop and implement national accreditation of hospitals; those that do not comply would not get paid by insurance companies. However, a performance incentive plan that targets specific treatment parameters would be a useful adjunct.

3. Obtain proposals from private insurance companies and the government on ways to provide medical insurance coverage to the population at large and execute the strategy. It is healthy to have competition in healthcare, and provide health insurance to the millions who cannot afford it.

4. Utilize and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient settings. This is possible though the implementation of the EHR; this will, in time, encourage healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care.

5. Given our expertise in working across the revenue cycle for large healthcare providers in US, we can assist the regulatory bodies in creating a medical coding and billing protocol. This will help regulate and standardize the way in which healthcare providers charge for treatment and reduce ambiguity and adhocism in the way billing is carried out presently.

Some areas in which Salient can help improve RCM for medical care providers in the country:

A - Patient intake Registration - Intake /admission services, if efficiently performed, lead to reduction of bad debts as well as generation of critical data repositories for the providers based on its expertise in performing these functions for US hospitals, Salient can assist in onsite/remotely managing the intake and registration process.

B - Medical Records Management - Diligently maintaining the patient records and digitizing them for usage during the billing process will be a key process augmentation for Indian hospitals. Salient can provide these services using a mix of onsite and remote services.

C - Customer Service - Salient provides an integrated CRM platform bundled with services to its hospital clients and offers services like

* Appointment Scheduling

* Ambulance Services

* Complaint Registration

* Billing Query Handling.

D - Billing Services - Salient using billing expertise generated by working in a highly regulated and process driven US Healthcare industry, can reduce typical billing related revenue leakages in a hospital environment, inpatient and outpatient. These services are provided by trained medical representatives with knowledge of medical treatment and diagnosis.

E - Supply Chain Management (SCM) - Salient can provide SCM services for all the inventories that are used in a hospital (Medicines, Hospital Supplies). These services will ensure usage of optimal processes for procurement, storage, issue and disposal of such inventories.

CIOL: Could you elaborate on the Indian retail paradigm shift from offline to online as well as towards customer centrality? What is the role Salient plays in providing value added, end-to-end services and technology bundled offering?

MM: The size of the Indian e-commerce market has reached $15 billion in 2012-13 with expectation to touch $50-60 billion by 2025. However, even at this impressive pace of growth, the Indian e-commerce market is only 0.1 percent of the total retail sales while developed economies like the US and UK stand at 5-6 percent.

The growth drivers of internal commerce in India, besides the penetration of the Internet and growth expected there, have been the m-commerce revolution as well as increasing reality driven cost of physical storefront in major cities. Added to these factors is the growing prominence of Tier 2 & 3 cities when it comes to online commerce transactions as well as the demographic profile of Indian internet users.

At 73.9 million home and work internet users, the Indian online population currently ranks as the 3rd largest in the world after China and the US With 75 percent of its Internet users under the age of 35, India has the youngest skewing online population among BRIC countries. Out of 19.6 million who accessed internet (in the year 2012), for finding details related to a specific product or a service, nearly 73 percent (14.3 million) actually bought a product or a service in the end.

Due to the above reasons, the retail paradigm has shifted from a single physical connection point with customers to a multi-pronged approach that crosses both physical and digital channels. The traditional bricks-and-mortar retail store is no longer the dominant medium for purchasing goods. Instead, it serves as one of many potential connection points between customers and a retailer's brand.

While physical stores may have once enjoyed the advantage of crafting cool shopping experiences, the aesthetics of the iPad and all the social sharing surrounding online shopping today are now shifting that advantage to online retailers.

Customer centricity is another offshoot of the growing sophistication and size of the Indian retail industry, offline and online. As Indian customer has more choice, both within local and global brands, it becomes increasingly important for retailers to focus on customer retention and loyalty rather than just acquisition. Customer care and relationship management, run through both technology and process, is turning out to be a differentiator that provides retailers an edge in the increasingly competitive retail space in India.

In this scenario of multi channel marketing and customer centricity, SBS' E-Commerce platform is a comprehensive feature-rich, "boxed" framework for first time e-retailers in India that not only fits the standard requirements of a frontend/ online portal integrated to the backend and fulfillment services but also accommodates specific requirements like strategy and design assistance upfront, digital marketing and logistical support. It incorporates best practices and global benchmarks to provide technology enabled value added services like:

* Superior shopping experience

* Merchandising and marketing capabilities

* Order management and fulfillment

* Customer service

* Analytics

* Content management and design

* Order lifecycle management

* Campaign management.

CIOL: What do you think can be done to make the Indian youth more employable?

MM: It is a fact that India does not have problem of unemployment, but unemployability, as the graduates lack other skills beside the academic or technical skills with broad estimates that only about one in ten of India's graduates are employable call centre industry.

The National Skill Development Policy puts the number of people who need to be "skilled" by 2022 at 530 million. Keeping these things in mind, few initiatives that can be done to make our youth more employable are:

* Ensure that the educational institutes focus on improving the curriculum and teaching methods to include tools which can be used in real life.

* Encourage setup and growth of vocational institutes that offer skill based trainings rather than academic curriculum based.

* As a company, we can also tie up with various educational institutions and help develop the students by enrolling them as trainees providing them on the job trainings.

* Specific industry specific categories for skill level based training should be created to fit students across levels. For example, for the ITeS industry, these categories could be as below:

Category I - these are relevant for basic data entry processes for both domestic and international clients -Basic MS Office (Excel, Powerpoint, Word) Skills, Typing Speed , English language reading and writing skills, Ability to surf the internet and search online, Email writing and Business Communication skills.

Category II - these are voice related processes for domestic clients - All of Cat 1 skills + Customer handling skills for domestic clients + English and Hindi speaking skills + Tele sales and marketing skills

Category III - voice related processes for international clients - All of Cat II skills + Voice and Accent Training for International (mainly US/UK/Australia -English)

Category IV - Analytical processes for domestic and international clients - Advanced Excel Skills, Negotiation skills, Business Writing Skills, Communication Skills (Voice & Accent Training)

Category V - these are required for domain/industry specific processes in services sectors like financial services, travel services and healthcare services and industries like pharmaceutical, telecom, retail, airlines etc. Product Specific Training, Function Specific Training - (Travel/Insurance/Aviation/F&A/AHM/LOMA/CAPC/ Underwriter).

Besides the above, Team Leaders and Managers need to get training in areas like Team Management, Time management, Lean, Six Sigma, Stress Management, Work Life Balance, Motivational, Interpersonal relations, Behavioral, etc.

The spread of educational institutes that impart such skill based trainings should be expanded. There are a number of vocational institutes that are / can provide these services. Besides the large private sector management educational institutions can also be asked to create specific curriculum around above lines. BPO companies in India would be happy to provide guidance/support to such initiatives.

There are a number of industry specific associations in India and abroad which provide web based trainings for the type of advanced processes mentioned in Category V above.

We can also look at engaging Indian online education companies that can create specific modules for Call Center employees and then disseminate the education online and long distance.

MSMEs and startups should be incentivized to allow their employees to get upskilled through above programs. These incentives could be in form of reimbursement of training fees.

CIOL: Elaborate on the movement of ITES services to tier 2 and tier 3 cities.

MM: Tier 1 or the larger cities in India have witnessed a tremendous growth of IT and ITEs industry in the past few years. Availability of talent, better infrastructure, connectivity, and an evolved ecosystem were some of the major drivers for focusing on these larger cities. This unprecedented growth was not easy to handle.

While the large cities witnessed severe pressure on the civic infrastructure, service providers faced myriad issues around the rising cost of operation, employee attrition, employee work-life imbalance etc.

The tier 2 and 3 cities have done extremely well over the years to fulfill the requirements of the IT/ITeS service providers, issues notwithstanding. India will have 68 cities with a population of over 1 million by 2030, typically called Tier 2 or 3 cities. Many of them have demonstrated strong delivery and development capabilities to be treated as independent delivery centers.

In addition to the quality of resource available, most of the tier 2 cities boast of productivity levels that are at par or sometimes even higher as compared to tier 1 cities. High or at par productivity levels are owed to the much lesser commuting time to office and better work-life balance vis-à-vis larger cities.

Some of these cities have also started to establish their authority in niche areas (e.g. Thiruvananthapuram has a well developed animation and gaming industry and Jaipur is considered to possess good Finance and Accounting BPO resources). The service providers have also reported a much lower attrition in tier 2 cities. Some of the trends showcasing movement of ITeS services to Tier 2/3 cities.

As per PwC-CII survey, about 50 percent of the IT/ITeS service providers are looking to move or expand to tier 2 cities for perceived benefits like availability of low-cost skilled resources, lower real estate cost and lower attrition.

Around 58 percent of the IT-BPO workforce today are from Tier II/III cities, With around four million direct employees from these locations. Around 49 delivery centres were set up in Tier II/III locations in the last year, as opposed to 25 in India's Tier I cities.

The IT-BPO sector has purchased office space, amounting to around 20 million square feet. Around 23 percent of the operational STPI units are in Tier II and III cities, while nearly 40 percent of the notified IT SEZs and 30 per cent of operational IT SEZs are in these areas.