Paramount Health Group
presents
Future of Primary Care in
HEALTH INSURANCE
The Problems Today
Competence
Lack of in depth understanding or knowledge on any
particular ailment. Attributed to insufficient qualifications,
not updating their skills, outdated practices.
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
Choice Of Provider
 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.
 Past association with the doctor, referrals by relatives or friends are the
key factors that operate in choice of doctor.
 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
 A facility less than a couple of kms from their homes.
 Residential locality, hygienic surroundings.
 Air conditioned, friendly atmosphere, reception facility to organize
stream of patients, waiting rooms, attendants.
 Sound proof consultation rooms, an extra facility with bed, drips, for
emergency cases
 Delivery centres that offer holistic services will be definitely preferred
 The time and convenience factors make it easier when general
consultants, doctors from different specialties and diagnostic
service facilities are under one roof.
 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%
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 face
competition
and will I be
able to
sustain it?
Will I lose
my
patients?
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.