Paramount Health Group presents Future of Primary Care

Paramount Health Group presents Future of Primary Care in HEALTH INSURANCE

The Problems Today Lack of in depth understanding or knowledge on any particular ailment. Attributed to insufficient qualifications, not updating their skills, outdated practices. Competence Inability to carry out a complete, thorough investigation that would help them to get to the root of the problem faster. Results in conducting unnecessary tests, prolonged periods of treatment Unreasonably high consultation fees Commercialization Collusion between members of the medical fraternity – pharmacies, medical reps, diagnostic labs & hospitals Lack of care and concern in handling the patient, answering queries Unavailability at convenient times Convenience Long waiting times at clinics Distance from home. Competence issues often leading to wrong diagnosis and treatment, and perceived commercialization has lead to lowering of their faith in the medical community. The convenience issues add to the dissonance

Three Key elements of Primary care PERSONAL ONGOING COMPREHENSIVE

Paradoxical problem of Primary Care It needs to be a crucial part but is found to be weak many a times

What does primary care system lack and its outcome? Fragmented care Low quality patient experience Poor communication between Primary Care hospitals and specialists Sub-optimal outcomes

Challenges of Primary care Delivered by small independent practices with limited access to wider multidisciplinary team Is insufficiently connected to specialists, community based services, pharmacies etc. Based on a model of flexible and short appointments/slots only available within normal clinic hours Unable to offer telephonic/email/ skype or other modern technological access to medical & nursing advice Has inadequate diagnostic support

Choice Of Provider v The doctor is the first point of contact – for most ailments. Except in case of any emergencies wherein the patient is taken to a hospital. v Past association with the doctor, referrals by relatives or friends are the key factors that operate in choice of doctor. v Association with a well known hospital provides reassurance. It is rarely the reason for choice of the doctor

Their Doctor Spectrum Family Doctor Neighborhood Doctor Specialist A common factor in all households. Evokes high loyalty as a result of long association A doctor in the vicinity…primarily to tackle ‘quasi emergency’ situations Omnipresent for young children. Consulted for others , if the need arises

Visible Desire For A Facility That Eliminates Their Current Problems v A facility less than a couple of kms from their homes. v Residential locality, hygienic surroundings. v Air conditioned, friendly atmosphere, reception facility to organize stream of patients, waiting rooms, attendants. v Sound proof consultation rooms, an extra facility with bed, drips, for emergency cases v Delivery centres that offer holistic services will be definitely preferred v The time and convenience factors make it easier when general consultants, doctors from different specialties and diagnostic service facilities are under one roof. v It also assures consumers of threshold levels of competence of doctors and delivery of reliable, quality services.

Care design principles Access and continuity Management and accountability Patients and Populations Information and outcomes

Components of Primary care Prevention and screening Provision of palliative care Treatment of episodic diseases Care co-ordination for chronic conditions Assessment of undifferentiated symptoms Diagnosis Triage & onward referral

What is Comprehensive Care? Meeting majority of patients physical & mental needs including wellness, preventive, acute care and chronic care.

Advantage of Strong Primary care system Quality of Primary Care Hospital admissions by 40% Health care costs by 30% 30

Why Robust primary care? Rising patient expectations and rising prevalence of lifestyle disorders Ageing population New techniques New providers/supply induced demand Lack of access to social care

Primary care fit for the future Comprehensive Sustainable in terms of finance, workforce and public trust Person oriented Safe & high quality Population oriented Accessible Co-ordinated

Managed GP Networks Qualified GP networks Driven by Payer objectives Working as gatekeepers Paramount + Nationwide Beginning a paradigm of managed care Following mandatory protocols To preferred networks Directing objective services

REDEFINING THE GP OF FUTURE Doctor are the change managers who help patients overcome or adapt to illness, come to terms with death, or change the lifestyles to stay healthy

A managed care approach Mobile e-consultation app Online lab management services Mobile GP access app GP networks on capitated, fee for service and aggregated models Technology allowing instant access while building a gatekeeping block Leverage our strategic relationship with Nationwide Doctors www. Nationwidedocs. org Stratified, negotiated, discounted, generic medicines www. saveonpharma. com Creation of custom hospital and diagnostic networks Back

Paramount & Nationwide Doctors Way forward for GENERAL Practitioners

Sneak Peek into the Future & Challenges • Multiple list of options online, for “Once loyal Patients” • Tough competition from complementary practitioners, cyber-docs, and all sorts of healers • Internet Information overload resulting in patients “knowing more” • Change in patient attitude – “Decision about me can not be made without me. ” • Life driven by technology • Era of E-consultations • GP centric community

Future gives birth to Anxiety Will I lose my patients? Will I face competition and will I be able to sustain it? Will my growth be stagnated? Will I be overworked ?

MANAGED CARE - Background ONCE UPON A TIME, Doctors spoke and Patients obeyed (Insurance companies giving Indemnity Insurance followed) TIMES CHANGED Insurance companies spoke - Doctors obeyed Patients listened and accepted. TIMES ARE STILL CHANGING Patients are speaking up Insurance companies are listening and both are hardly bothered about Doctors.

A person spends 42% of his total healthcare spending in Hospitals, 22% to doctors, 11% for pharmacy, 11% for other health professionals & 14% for miscellaneous like home care etc.

Hierarchy Of Healthcare Needs Optimal Health (e. g. , holistic and personalized health and wellness) Health Enhancement (e. g. , cosmetic surgery and LASIK surgery) Medically Necessary Needs (e. g. , acute care for sickness or injury) Basic Health Needs (e. g. , immunizations, preventive screening) Environmental Health Needs (e. g. , clean water, adequate sanitation, clean air)

KNOWLEDGE ABOUT HEALTH INSURANCE Health Insurance is like a Woman. More you want it more expensive it becomes and at the end of it you are still not sure whether you have the right one and what eventually you will get out of it.