oDoc, Sri Lanka’s largest digital health company that helps patients to get medical advice, medicines and lab tests from the comfort and safety of their own homes, is building the country’s first Health & Insurance Super App, explains Heshan Fernando, oDoc’s Chief Executive.
oDoc has partnered with Vidal Health, India’s leading TPA with a growing presence in international markets, to enable insurance companies to outsource their entire insurance administration process and to create a seamless customer experience across the healthcare and insurance verticals in Sri Lanka.
Can you give us a brief overview of how oDoc has evolved and progressed over the years?
oDoc is Sri Lanka’s largest digital health company, serving over 200,000 patients, 1,000 doctors and 75 corporates. We enable patients to get medical advice, medicines and lab tests from the comfort & safety of their own homes.
We do this through the oDoc app, which allows patients to consult SLMC registered doctors via video, audio, or text. Employers and insurers provide oDoc to their employees and policyholders as a cherished health benefit.
Founded in 2016, we are building Sri Lanka’s Health & Insurance Super App: a consumer-centric digital ecosystem that coordinates and integrates every aspect of a user’s healthcare journey from doctors consultations to health insurance management, bridges the online to offline divide and puts healthcare on the same side as insurance. Starting with just one or two consultations every few days, oDoc has now grown to handle over 1,000 consultations each week.
The healthcare system is incentivised to over-prescribe medication, investigations and procedures. This is something we want to fundamentally change. At oDoc, we are putting healthcare on the same side as insurance. Our goal is to provide proactive primary & secondary care in order to prevent sickness and avoid hospital visits. This results in lower claims for insurers and more affordable insurance for consumers.
Having laid the foundation for the healthcare industry in Sri Lanka, we are now starting on the insurance industry. To this end, we recently launched a ThirdParty Administration (TPA) product along with Vidal Health of India to enable insurance companies to outsource their claims management process. This TPA layer simplifies the billing experience for our users and enables us to integrate both digital and physical health services, drastically reducing complexity, improving efficiencies and reducing fraud.
This will create a seamless customer experience across the healthcare and insurance verticals in Sri Lanka and bring us closer to our vision of making high-quality healthcare universally accessible, affordable and personal.
Tell us about your partnership with Vidal Health of India. How will it be a game-changer for oDoc?
oDoc has partnered with Vidal Health, India’s leading TPA, to enable insurance companies to outsource their entire insurance administration process.
Third-Party Administration (TPA) supports insurance companies in their operational services of policyholder enrolment, benefits management, cashless hospitalisation, claims processing and fraud prevention.
We believe that providing world-class TPA services will enable insurance companies in Sri Lanka to reduce overheads, ensure negotiated and time-bound rates with hospitals and reduce fraud whilst gaining the ability to focus on their core operations. Policyholders will benefit by getting a superior customer experience with easier access to information (through an app and 24/7 call centre), shorter wait times at hospital discharge and industry-leading customer service levels. In mature and dynamic markets, all insurance companies outsource these services to TPAs; hence it’s only a matter of time for Sri Lanka. We believe this will increase the overall efficiency of the insurance industry in the country.
This partnership will enhance the standard of TPA services in the country; thus, driving significant completive advantages to insurance companies that adopt the platform.
How does this TPA solution work?
oDoc enables Insurance companies to outsource the entire insurance administration process covering the end-to-end solution from enrolling policyholders to payment of claims.
The TPA solution is powered by Vidal Health’s globally recognised proprietary TPA system, ‘Vings’. This state of the art system currently manages over 120 million policyholders and combines rule-based auto adjudication with AL/ML-based fraud management, advanced analytics and predictive modelling.
It comprises five million-plus edit combination checks with ICD, CPT, CDT, HCPCS and drug codes validating medical necessity, duplications, gender specifications, coding error and more. The system adjudicates claims requests by validating the documents submitted, policy rules and Table of Benefits given by insurance providers, the treatment undergone by policyholders and then settles the claim according to the settlement parameters agreed with the insurance provider.
What kind of impact do you envision this new solution will have on your customers and insurance service providers? How will it transform the market here?
We expect insurance companies to gain the following benefits:
- Total visibility on policyholder claims
- A fully automated rule-based system for claims adjudication
- 24/7 approval process
- Float fund management and payment settlements
- Enrolment of policyholders and unique ID card issuance
- Improved productivity and minimal operational overheads due to process automation
- Reduced cost due to negotiated rates with hospitals and fraud detection
- MIS and business intelligence
And Policyholders to gain the following benefits:
- Cashless hospitalization access to leading hospitals in Sri Lanka, India, and GCC countries
- Ability to monitor and manage claim requests via the oDoc app
- Frictionless claims reimbursement facilities
- 24/7 dedicated trilingual customer care hotline
- Medical second opinion service
- Exclusive discounts through the oDoc Loyalty Program