Vidal Health Insurance TPA

Typically, health insurance policies written by insurers in India have tended to exclude pharma therapies, unless consumed during hospitalisation, during a 30-day pre-hospitalisation or a 60-day post hospitalisation period. This adversely affects effective pharma therapies that do not involve any hospitalisation (for instance, administered in an out-patient setting, or at home). Over the last couple of years, Vidal Health has helped pharma companies effectively deal with this situation.

Despite insurers’ willingness and enthusiasm to expand coverage to include pharma therapies, sometimes the extent of coverage as measured by the sum insured can be a limiting factor. Most Indians carry policies that insure low sums, which might not be adequate to cover some of the more expensive therapies—specifically in areas like oncology. In the event of the therapy duration being limited to 12-15 months, it may be possible to provide financial solutions that allow such individuals to avail themselves of unsecured loans to pay for therapy and then repay the same via EMI over a 60-month period. For individuals without any insurance, this might be a useful alternative to use up their own funds that might be deployed elsewhere or earmarked for other use. Vidal Health has excellent relationships with financing agencies like banks and other financial services companies. They can help structure programmes that bring together the pharma company, the person being treated and the financing agency to create convenience to the individual, without compromising the risk of repayments.

As insurers seek to expand coverage, there is an opportunity to engage with them to represent why coverage for certain therapies would be good for multiple stakeholders. This requires a co-ordinated approach that brings together the insurers, insurance brokers, policy makers and industry bodies. This helps evaluate and recommend inclusion of relevant therapies into insurance coverage—irrespective of location or mode of administration. Vidal Health has demonstrated expertise in this space and has the capabilities to manage such initiatives. It is already driving such efforts for multiple leading pharma companies across therapy areas.

In order to mitigate the impact of the additional financing costs to be incurred by an individual, pharma companies have the opportunity to enroll them in empowerment programmes that can deliver savings (that may compensate for the financing costs) linked to their adherence to therapy. Enrollment in such programmes will also allow engagement with the individual over the entire tenure of the loan and help mitigate the possibility of loan default. Vidal Health has the expertise to design, implement and run such programmes on behalf of pharma companies.

In the case of covered therapies for which individuals would pay upfront and submit bills to insurers for reimbursement, there is a lack of awareness about the particular therapy being already included in the coverage. By providing a helpline where individuals could call to check their eligibility, Vidal Health provides customers of pharma companies the ability to ascertain coverage for specific treatments and make their purchase decisions accordingly.

Increasingly, pharma therapies for chronic diseases require persons being treated to be on therapy for long periods of time, sometimes a lifetime, as in conditions like diabetes, hypertension etc. Most therapies will involve side effects, sometimes moderate, sometimes extreme, that will need to be monitored and managed by a combination of interventions that involve lifestyle changes like diet, exercise, sleep/relaxation, and constant lab investigations. One way to ensure good outcomes is to empower patients through a process of educating them, and being available for them to address queries, and concerns. Typically such programs must be acceptable to the prescribing physician. Vidal Health implements such programs that bring the individuals and their treating physicians onto the same platform to deliver improved outcomes to both.

Persons on therapy for chronic conditions often find themselves isolated, more often than not of their own making, and are unable able to discuss their condition even with their family members. Their physicians tend to be busy and are able to spend very little time with the individual. In a situation like this, a health coaching program that reaches out to such individuals via the phone/e-mail, and offers them the opportunity to have conversations with clinicians has been found to be very effective. During these conversations, clinicians follow a script designed to educate the individuals around a particular topic (diet, exercise etc). Vidal Health has successfully delivered health coaching programs to persons on various pharma therapies.

Increasingly individuals are being recommended a wide range of medical/health services, many of which might be delivered outside a hospital. Perhaps in another clinical setting like a doctor’s office or a diagnostics lab, or even for instance, in their homes, or over the internet. Services could include doctor consultations, lab investigations, expensive pharma therapies, counselling, preventive and well-being services, and many more. More often than not, individuals will pay for such services out of pocket (at this time most insurance policies do not include these services for coverage, though a few may be able to get this reimbursed later from the insurance company since their policies might cover these services) and will therefore seek convenient access these services. Vidal Health aggregates a wide variety of services available across the country from credentialed service providers on a Web Portal where individuals can discover, purchase and schedule appointments for such services.