In recent days, I came across a government report on gender parity in India, which revealed a startling statistic: almost 50% of females in the country suffer from Anemia. This information struck me deeply, especially considering our exposure to India's healthcare system during our ten months on Jile Health. It has become increasingly difficult to ignore such pressing issues.
Earlier, I might have overlooked such reports, but now, I understand more about India's healthcare architecture. A while ago, Kiran Mazumdar shared an article that shed light on why the business side of healthcare stakeholders, including Providers, Payers, and Healthtech companies, seems reluctant to address these problems. While they may have been making profits, the issue of mental healthcare inclusion in insurance claims remains severely neglected, despite the Mental Healthcare Act (MHA) passing in 2017. This essay aims to explore the reasons behind this neglect. And how we at Jile Health are solving that problem.
Our experiences have made us realize that making healthcare affordable for the bottom 90% of Indians should be common sense rather than an unattainable goal. We have encountered people questioning the feasibility of solving this problem, but we remain optimistic and consider it a fundamental approach. Let us illustrate this with an example from our users.
One alarming aspect of India's healthcare situation is the high prevalence of Anemia among females. While there are six types of Anemia, we will focus on the most common type, which is often caused by Heavy Menstrual Bleeding. Anemia is characterized by a deficiency of red blood cells in the body, affecting its vital functions. The primary protein responsible for transporting oxygen from the lungs to the rest of the body is hemoglobin, found in red blood cells. To identify the root causes of Anemia, we apply a first-principle thinking approach: we ask ourselves which health vital contributes to the formation of red blood cells.
In this context, Vitamin B-12 plays a crucial role in red blood cell formation. A deficiency in this vitamin can lead to life-threatening diseases like Anemia, and it can also be associated with mental illness and abnormal red blood cell characteristics measured through MCV and MCH indicators.
Similarly, the production of hemoglobin relies heavily on iron. Anemia caused by iron deficiency is referred to as Iron Deficiency Anemia, while Anemia caused by Vitamin B-12 deficiency is called B-12 Deficiency Anemia. Understanding these underlying causes is essential to finding effective solutions.
However, it is disheartening to witness how certain companies exploit the situation by complicating the problem and inflating prices when selling health supplements. We believe that by localizing healthcare and identifying affordable supplements available within a 100-kilometer radius, we can make them accessible to everyone in the country.
Take, for instance, Bathua, a seasonal plant available for about four months a year. It stands out as an affordable superfood, with micronutrients surpassing many other costly alternatives. Bathua contains low calories, fat, and abundant Vitamin C, protein, and fiber. Surprisingly, it also provides Vitamin B-12 and other essential micronutrients. By discovering such hyperlocal superfoods, we can address the affordability issue effectively [Table-1].
This one-size-fits-all approach is not confined to supplements but extends to providers, facilities, health tech companies, and insurance providers. India's struggle to achieve universal quality healthcare is evident in the concentration of 80% of healthcare providers in just 10% of the geographical area. The solution lies in leveraging technology to distribute healthcare resources evenly throughout the country, making it personalized and affordable for the bottom 90% of the Indian population.
Let's explore the second example from Forbes's article, which sheds light on the challenges faced in including mental healthcare in insurance claims. Despite six years passing since the implementation of the Mental Healthcare Act, only a fraction of Payers have added coverage for mental illnesses. The claim process itself poses several obstacles, such as the requirement for certificates from doctors, waiting periods, and disclosure of mental illness. Healthtech companies have a significant role to play in addressing these issues.
Currently, Healthtech companies often limit themselves to facilitating interactions between patients and providers. However, this approach leaves out a crucial healthcare stakeholder - the Payers. The disjointed functioning of Payers in the healthcare ecosystem hampers progress in improving patient experiences, reducing operational costs, expanding the network of healthcare providers, and increasing insurance penetration. UnitedHealth Group (UHG) serves as a prime example of successful integration between these stakeholders, illustrating the potential benefits of such interconnectedness.
I have drawn a rough diagram of the Healthcare ecosystem and the connection among all 3 P - Patients, Providers, and Payers on the sticky note. I will avoid explaining each step between Patients, Providers, and Payers. And hence we will only touch on parts that should have been influenced by Healthtech companies using technology.
The connection between Patients, Providers, and Payers (There is also TPA between Providers and Payers, but we have excluded that to make it simpler)
There are sets of rules and processes among these stakeholders to create a net positive for all 3 P. Let me list a few:
The risk assessment (The pre-insurance purchase): The risk assessment, conducted before purchasing health insurance, aims to evaluate the individual's risk profile. During this process, individuals are typically asked about their age, habits, pre-existing conditions, and other relevant information. Currently, this work is mainly performed by insurance brokers or agents. However, the system remains flawed, relying on a one-size-fits-all approach.
The Treatment (At Providers): At the provider's end, if the insurance is cashless, the healthcare professional delivers treatment covered by the claim. To receive payment for this treatment from payers, providers must present a "Source of Truth." Providers adhere to specific rules and regulations set by payers and regulators. In the case of mental illness treatment, providers must require a mental illness certificate before offering free treatment under the insurance claim.
Payers payout to Providers: When payers reimburse providers for patient treatment, they demand a "Source of Truth" to ensure fair billing and prevent fraudulent claims. These sources of truth may include Electronic Medical Records (EMR), Electronic Health Records (EHR), Discharge Summaries, Medical Bills, etc.
Currently, around 95% of these processes are offline and paper-based, and all three stakeholders - patients, providers, and payers - operate independently. As a result, the payer is not fully integrated into the core healthcare system. However, integrating patients, providers, and payers can yield remarkable results by eliminating subjectivity from the entire system.
This story involves one of our users who experienced the magic of our AI model - AASHA. Initially, the user denied any signs of mental illness when we assessed them. However, after sharing the AASHA assessment, the user opened up and provided all the relevant information, validating the effectiveness of our AI model. We have excluded some personal information from the assessment video.
Recently, a user uploaded their health records (7 records) and requested a thorough analysis. While our AI model, AASHA, is not live yet, we evaluated the user's health vitals, asked questions, and compiled a final evaluation video.
Mental illness can be identified by two means
Evaluation of visible signs (Most patients struggle to answers or create information asymmetry)
Evaluation of Health indicators (For example low and high Serum Sodium can be the cause of Confusion, High total bilirubin can be the cause of Alzheimer's disease etc.)
After evaluating the user's health records, it was evident that they did not have any chronic diseases. However, among the five abnormal health indicators, three strongly indicated the presence of a mental illness. As a result, we proceeded to ask questions to assess the possibility of mental illness based on visible signs. Naturally, users tend to create some informal asymmetry during this process. Nevertheless, when we shared the final evaluation video, the user confirmed the accuracy of our AI model's indications.
Here is the AASHA’s (Jile Health AI Model) evaluation Video - Click Here
An intriguing observation emerged when AASHA evaluated the user's mental health based on health indicators - there was a clear indication of irritability. When I reached out to the user to validate this finding, he initially denied experiencing such feelings. However, upon sharing AASHA's evaluation video, the user eventually admitted to feeling sadder and experiencing depression for the past few months, along with other key indicators. This was a remarkable moment, as it highlighted how technology can build trust and facilitate open communication between users and healthcare providers. And this was the first time, I experienced how technology creates Trust.
By integrating patients, providers, and payers and leveraging our LLM-based AI model, we can create a transformative healthcare system. The AI-driven "Source of Truth" eliminates information gaps and subjectivity, enhancing patient experiences, reducing costs, and making healthcare more accessible and affordable for all. I am sure you are still thinking, how?
Personalized Risk profile and pre-evaluation
No information asymmetry and hence no fraudulent
10-star Patients experience
10-star Providers experience
Reduce the Healthcare Insurance premium by multifold (You can simply imagine the premium if 1.4 billion Indians get insured under Health Insurance).
Convert a passive product such as Health Insurance into an Active, personalized, and incentive-driven one.
In the above case, with a pre-existing "Source of Truth" about patients, payers, and providers would have no difficulty including mental illness in insurance claims. Importantly, patients wouldn't need to explicitly disclose their mental health condition. We firmly believe that we can work this magic for 1.2 billion Indians! After spending more than 10 months evaluating various healthcare infrastructures and gaining insights into India's patients, providers, and payers ecosystem, we are confident that we possess all the necessary ingredients to create a connected healthcare system. This system would revolutionize healthcare by making quality medical services personalized and affordable for every individual in our country.
The example presented above is just one of the many use cases of the Healthtech system that we are actively developing at Jile Health. Our mission is to make quality healthcare accessible and affordable to the bottom 90% of Indians. We are eager to engage in conversations with you to share HOW and WHY we believe this vision is attainable and how our Healthtech solutions can drive positive change.
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