How Managed Care helps Optimize Medical Spend

Prashant Jhaveri, Chief BusManaged_Careiness Officer, Medi Assist  recently wrote an article for the Silicon India in which he discussed about the concept of Managed Care Organisation (MCO) and its importance in the Indian Healthcare Ecosystem. He also discussed about the various techniques deployed by MCOs to promote informed decision making and reduce overall cost of care for consumers.
Scroll down to read the complete article, or click here.

The concept of managed care, aimed at reducing cost of providing quality healthcare, is still in its nascent stage in India. A popular concept in the United States, the need for managed care organizations is perhaps far more acute among developing nations such as India. Medical inflation in India stands at 12-15 percent as against a global average of 6-7 percent. Despite the steep rise in cost of healthcare, the IRDA Annual Report 2014-2015 indicates that only two percent of the Indian population is covered by individual health insurance policies; and only another four percent are covered under group medical policies. In the absence of any medical cover, the average Indian family today grapples with high out-of-pocket expenses on account of healthcare.

A recent report by FICCI suggests that primary healthcare accounts for over 70 percent of all medical spend and that the per capita spend of urban households on outpatient care is approximately Rs. 4,250 per person, a typical urban family of four adults, therefore, spends an average of Rs. 17,000/- per month on doctor consults, medicines and diagnostic labs. Add to this the inherent lack of transparency within the healthcare ecosystem. While it is, for example, easy for one to compare myriad options, choose and book holidays, travel, stay and so on, consumers do not have such deep visibility into the options available to them when planning their medical spend. Managed Care Organizations (MCO), therefore, have a significant role to play in the Indian healthcare ecosystem. Not only do they bring all the stakeholders of the ecosystem together, they also work towards deploying techniques to promote informed decision making and reduce overall cost of care for consumers.

MCOs Negotiate Early

Managed care organizations partner with healthcare providers to obtain preferred tariffs and discounts for their members. While the preferred pricing helps increase visibility and footfalls for the provider, it helps reduce cost of care for the individual. MCOs also deploy various loss control measures to ensure that, in the event of a hospitalization, members are provided most optimal care at the most optimal price point at their chosen network medical centre.

MCOs Tech-enable early

Managed care organizations, which collaborate with all stakeholders in the healthcare ecosystem, are best placed to invest in technology for transformation. Technology allows all stakeholders to come onto a common platform to improve speed of access and quality of delivery. Our technology platform, MediBuddy, for example, allows hospitals to provide seamless cashless access to in-patient and outpatient services to their patients; it gives insurers and corporate decision makers deep visibility into the performance of their health benefits portfolio; and importantly, it gives every individual member the power to compare, choose, and schedule healthcare services using just their mobile phone from the comfort of their home. The predictive analytics capabilities help decision makers spot trends and take informed product and service delivery decisions for the future.

MCOs Help Plan Early

Planning is the key to optimal decision making. For example, a planned maternity can help the family ensure greater comfort for the mom-to-be and also help the young couple reduce their out of pocket spend by optimally utilizing their health benefits. Similarly, a managed care organization can help senior members planning an elective surgery to opt for cashless hospitalization at a preferred network, at a discounted preferred pricing. Innovations such as e-Cashless allow members to choose their preferred network medical center and obtain a provisional preauthorization using a mobile app for a cashless hospitalization. E-Cashless also gives the family full visibility into the expected cost of treatment, amount covered under their policy and the corresponding out of pocket spend, if any.

MCOs Intervene Early

Fraud and abuse control is critical to the success of any health benefits program. Managed care organizations play a significant role in ensuring that the benefits are availed by genuine beneficiaries and as per the terms and conditions defined by the benefits policy. New-gen MCOs use a combination of technology and professional expertise for risk detection and mitigation. MCOs have been credited with generating significant savings for the industry on account of their diligent interventions. Managed care organizations are poised to play a crucial role in these transformative years of the Indian healthcare industry. With deep understanding of the often divergent needs of all stakeholders in the industry, technology leadership and an optimistic vision for the future, MCOs are here to bring about disruptive change in how we think about healthcare spend.

Budget should enhance limits available under Section 80D

Prashant Jhaveri, ChieUnion Budgetf Business Officer, Medi Assist, shared his thoughts on the various reforms to be considered with regard to the Health Benefits industry in the upcoming 2017-’18 budget.

Scroll down to read the complete article, or click here.

The Union Budget will be a crucial one in the light of reform initiatives undertaken by the present Government. It is expected that there will be a slew of changes on the taxation front and policies for financial services sector. When it comes to health insurance sector, the Budget should take into consideration the below reforms.
a) With rising insurance costs, the budget should actively look at enhancing the limits available under Section 80D for deduction of Insurance Premium.b) Online healthcare aggregators do not get benefit of the provisions of “aggregator” under service tax Act as healthcare is an exempt service. For new innovative business models to thrive it will be important to take a consistent view on applicability of service tax.c) More clarity should be provided on applicability of service tax on auxiliary healthcare services rendered by service providers. While healthcare services are exempt from service tax, if the same services are rendered by a non-clinical establishments, it is subject to service tax. This presents a disparity in levy of service tax on essential services like healthcare diagnostics and preventive healthcare.

This Year, Appoint MediBuddy as your Personal Manager for Health Benefits

MediBuddy_corporate-logoIt’s a brand new year…are you still using the old, tedious methods to manage your health insurance benefits? Thousands of people across the country are enjoying the comfort and convenience of MediBuddy; it is time YOU switched too!

The MediBuddy platform, which is available both as a portal and an app, is a powerful self-help tool that not only helps you manage your health insurance benefits, but also helps you reduce the overall cost of healthcare for yourself and your family. It gives you access to a host of benefits related to your health insurance and wellness.

With MediBuddy, you can:

  • Explore details of your Policy
  • Enroll yourself and your beneficiaries under your policy
  • Plan your hospitalization and obtain a provisional preauthorization even before the date of hospitalization through eCashless
  • Raise and manage claims online in a hassle-free way
  • Track your claims in real time
  • Locate network hospitals through a GPS based search
  • View and download e-cards on-the-go
  • Order medicines to your doorstep, and do much more…

Still thinking? Why not give MediBuddy a try and explore for yourself!

Sign up on to activate your account or visit You can also give a missed call on 1800 3010 1696 and we’ll send the download link to your phone.

Download the MediBuddy app today by clicking these links.


Welcome to The New and Improved MediBuddy+ v3.3


As our health service provider partners, you have been using the MediBuddy+ portal for hassle-free claims management processes. We have some good news for you! We have made your MediBuddy+ portal even better!

The MediBuddy+ v3.3 has the following notable features:

Finance Reconciliation

One of the pain points for you has been offline reconciliation. The claims reconciliation cycle is now completely online, and you can accept/dispute issues in real time.

Documents Tracking

No more issues of lost documents! If you have submitted the original claims documents to Medi Assist, you can update the tracking number/acknowledgement number online.

Pre-authorization Cancellation

You can now cancel a pre-authorized claim if the patient for whom the claim has been raised is not hospitalized.

Enhanced Dashboard

View and download claims details in real time.

Enhanced Profile page

You are in for a much better experience and a faster, more responsive online portal. You can also preview your profile page and view the profile completion status.

So, log onto your enhanced MediBuddy+ portal today to explore and enjoy a superior experience.

Yet to configure your MediBuddy+ profile? Make a start this New Year! Hop on board now on!

Now Access All Your Agent Portal Features on MediBuddy App

MediBuddy app

As a health insurance agent, you are an important partner to us who ensures that the Medi Assist advantage reaches our retail customers. We had created the MediBuddy agent portal exclusively for you to make your life simpler and empower you with all the information you need to serve your customers better.

We just made the features of the portal more accessible to you, through the MediBuddy app! Some of them include:

• The ability to create your own preferred login to access the portal
• Visibility into your customers and their policies. You can also know when their policies are due for renewal.
• Ability to obtain real-time status of your customers’ claims
E-card downloads for your customers anytime and from anywhere
• Map-based search to locate a preferred network hospital or ability to filter network hospitals by insurers
• Better data management of Medi Assist and non-Medi Assist customers.

All you need to do is download the MediBuddy app and sign in with your login credentials.

So, take advantage of the improved accessibility! And take control of your customers’ health benefits anytime and from anywhere.

Go Hassle-free This New Year with eCashless

ecashlessWith the New Year here, most of us already have new health-related goals. Achieving these goals require a few lifestyle changes. It requires that we shed a few old habits and pick up a few new and positive ones. Why not begin with changing the way you plan your hospitalization?

Planning inpatient admission has gone through a sea of change over the years. People are gradually moving away from reimbursements towards cashless services in most cases of hospitalization due to the convenience the latter offers. With cashless hospitalization, people can conveniently avail inpatient services at network hospitals with minimum out-of-pocket expenses, which translates to significant savings.

This year, go one step further. Choose convenience over concern for booking your cashless admission. Choose eCashless from Medi Assist. The eCashless service available on the MediBuddy app and portal has several advantages over the traditional cashless admission. You can:

  • Eliminate spending time standing in the queue at the insurance desk at the hospital on the day of admission to get an approval
  • Obtain a provisional preauthorization from the comfort of your home or office
  • Have visibility of the estimated cost of treatment beforehand, which means that you can plan your out-of-pocket costs in advance
  • Request your preferred type of room, and
  • Track the claim status anytime and from anywhere.

So, move ahead with the times. Begin the New Year with a new way of opting for your inpatient hospitalization. Choose eCashless!