DRAFT – For Discussion Purposes Only

© Infosys Consulting 20201

Covid-19: Impact and Opportunities Ahead.A healthcare Industry Point of View

April 2020

Ed Francis, Global Head of Life Sciences – Infosys Consulting Ellen Vanbuskirk, Deepika Mor, Alpika Juhi, SrinivasaReddy IdamakantiVenkata, Bilal Chaudhry

2

Business Disruption Across Ecosystem

As governments intensify restrictions business leaders

are faced with the challenges of business continuity

risks, sudden changes in volume, real-time decision-

making, workforce productivity and security risks.

Patient Access

Low income population is affected due to lack of

primary care. 97% physician practices

experienced revenue cut by half as patient

volume declines.

Exhausted Front Line Workers

Mentally and physically exhausted with long working

hours, inadequate protection and risk of infection.

Over 22,000 front line workers are infected with over

100 deaths worldwide (till 15 Apr).(WHO)

Consumer Debt

Increasing default by consumer on loans, due to

joblessness. More than 1 in 4 Americans have

trouble paying medical bills hence increased

hesitance in getting treatment or undergoing

medical tests.

Financial Insolvency

Worldwide frozen markets leading to credit

crunch likely to be followed by corporate

bankruptcy. 70% of US market is consumer

driven and unemployment is predicted to rise by

20% in USA (Moody’s).

Hospital Care

Hospital routine services and elective surgeries

have ceased, non essential staff are being

furloughed . Supply Chain is disrupted.

Supply Chain

Sudden surge in demand for drugs, vitamins, antibiotics, and other medical

necessities. Newer export and transport restrictions stranded supplies which

hospitals need to fight infection.

Key Takeaway

COVID-19 New Daily Cases Worldwide by Region

C O V I D - 1 9 S t a t i s t i c s ( a s o f 0 6 M a y 2 0 2 0 )

GLOBAL STATISTICS USA STATISTICS

Source: www.statista.com

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COVID 19- The World was Position for Pandemic

Global TravelUnrestricted global travel for reasons like business, tourism, religious and

medical purpose helped spread the virus in every country on the map.

Fragile & Vulnerable Population• Expanding and aging populations.

• 70% of the deaths worldwide are due to cancer, diabetes and heart diseases.

• Economically unstable population with compromised immune system

Lack of Primary CarePrimary care can take care of the majority of people’s healthcare needs.

However, developed countries spend more on expensive infrastructure

and specializations than inexpensive primary care, preventive medicine

and generic medications.

Hospital beds/1000 people

Japan – 13.4South Korea – 11.5

Russia – 8.2Switzerland – 4.7

China – 4.2Australia – 3.8

Italy – 3.4USA – 2.9

UK – 2.8

Healthcare Infrastructure• Rising labor cost and staff shortage

• Operating hospitals at close to capacity in order to

maximize profits.

Medication Response• Development of micro-resistance in people against antivirals, antibiotics and

antimalarial medications

• Lack of access of vaccine in some while vaccine hesitancy in other cases

due to lack of trust in vaccines

On a global level the Healthcare Industry has been transitioning through a very disruptive time Pre-COVID-19 with a change in business model. A lot of factors are

responsible for the current fragile state of Healthcare systems making the global environment ripe for a world wide pandemic.

4

Story from the front- Getting ready for COVID War

I have just finished the night shift on the COVID-19 ward. I

look at myself in the mirror: I have a C on my nose from the

FFP2 (N95) mask I wear all the time, deep marks on my face

left by the elastic bands; my eyes look tired, my hair is damp

with sweat. I am not a doctor and a woman any longer —

now I am just a doctor, a soldier in the war against the virus.”

“This is not a time for panic but a time for action driven by

cooperation and concern for safety—not short-term profits

“Before starting my shift, I have to don the protective gear

— this is when I get the adrenaline rush: you are in the

room with your colleagues, you try cracking a joke, but our

eyes reflect our worry about protecting ourselves

adequately as we carry out correctly all the steps in

dressing: gloves, gown, second pair of gloves, glasses, cap,

mask, visor, shoes, shoe covers…and tape over tape to

keep everything sealed. The person who helps you dress

writes your name and your role on your lab coat with a red

marker, because when we are so costumed nobody

recognizes anybody else. And when she says “Done,” it’s

time to enter the ward.”

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The pandemic could be an agent of change for the Healthcare industry

Payer

Industry wide call for value-based models instead of fee for service model &

offering premier customer experience at low transparent costs. Quest for

efficiency and control leading to mergers & acquisitions

Regulatory Agencies

Regulatory bodies like CMS pushed towards value-based models, tightening

HIPAA privacy guidelines & continued efforts to expand health coverage

options esp. focused on Individual health market.

Provider

Inadequate number of large government/private facilities with critical care

units & ventilators, medical products and frontline workers.

Supply Chain

Just in time healthcare supply chain led to unavailability of gear needed to fight

COVID. A lack of view from planning to procurement into the medical records.

Patient

Eroding primary care and historical practice model of face to face care.

Vaccine hesitancy and compromised immune system.

Diagnostic

Inadequate technology, processess and resources to manage the dynamics

of disease identification, categorisation and diagnosis.

Payer

Increasing focus on making holistic Insurance Products, faster claims

processing driven by technology. Urgent need of cybersecurity as work moves

online & new ways of creating provider-payer contract.

Regulatory Agencies

Introduction of sweeping array of flexibilities, norms to expand care

capacity and rapid measures to ramp up healthcare workforce.

Provider

Increased adoption of Telehealth, RPM, focus on primary care, use of

alternative medicine & improved provider to people ratio as per regions.

Supply Chain

Agile processess envisioned and designed via the use of technology to

deliver the better outcomes in the healthcare industry.

Patient

Stress for heathy life-style, primary care and new entrants in healthcare provision like

increased adoption of telehealth, medical devices and lower resistance to vaccine adoption.

Diagnostic

New enhanced technology, accelerate interoperability, and EHR used for disease

diagnosis which result in better prognosis.

Today Future

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Impact and Actions –Health Care

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Common Elements

Stakeholders

ProviderPayer

Impact and Action for Healthcare Value Chain and Key Healthcare Stakeholders

GovernmentRegulatorsConsumer

Care

Management

Global Supply Chain Clinical Data

Exchanges

IOP and Data

Standards

Financial

Benefit

Design

Provider Relations

Claims Value

Stream

Pharmacy Benefit

Manager

Facilities and

Capacity

Electronic Health

Records

Primary Care

Access

Front Line

Workers

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The pandemic is presenting number of opportunities and challenges for the Payer

CH

AL

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• Opportunity to enroll more people

into low premium individual plans

• Increase memberships through

special enrollment period

• Relaxed regulation for Medical

Policy review of New and

emerging Primary Care Models

• Adoption of AI to process claims

faster, determine the eligibility of

claims

• Automation of manual tasks like

form verification

• Greater inclination towards

adoption of home delivery models

• Redesign and standardize Prior

Authorization Process -

Implementation of broad, system-

wide authorization for early or

emergency refills for chronic

medications

• Greater collaboration between

provider and Payer for

digitalization

• Payer with higher members with

Remote Patient Monitoring

devices can shorten Provider

reimbursement

• Lack of affordable coverage for

critical services

• Payer shoulder a smaller part of

the cost of essential medical care.

• Financial Uncertainty -

determining eligibility criteria for

claims, shrinking membership

• High volumes of claims

processing

• Difficulty determining the eligibility

of claims

• Potential for increase in denials

due to inaccurate COVID ICD,

CPT and HCPC Codes

• Cybersecurity- higher risk of data

theft related to EHR,PHR

• Lack of access to early medication

refills from pharmacy for chronic

diseases

• Administrative barriers on

Pharmacists to dispense

emergency refills

• Due to Financial impact of

COVID, providers will be

unwilling to take risk and hence

there is potential for Providers to

cancel value based contracts

• Providers will seek to have

reimbursement expedited due

to financial impact of COVID

Benefit Design Claims Value Stream Pharmacy Benefit Manager Provider Relations

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The pandemic is presenting number of opportunities and challenges for the Provider

CH

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• Use of augmented reality (AR) and

virtual reality (VR) for primary

care**

• Virtual appointment to the patients

who require primary care.

• Use of data driven approach such

as HR analytics in the primary

care.

• Creation of make shift hospitals

for managing the COVID patients.

• Public funding and Priority

approvals by the government and

regulators for manufacturing of

medical equipment and PPEs.

• Creation of one standard, secured,

integrated Electronic Health

Records System which can be

used across all the hospitals for

faster access to patient data which

would help in better patient

treatment outcomes.

• Providing (virtual and in person)

training to HCPs.

• Adhering to latest data privacy and

confidentiality laws.

• Use of technology in patient

care such as telemedicine,

Virtual appointment & Treatment

and remote patient monitoring.

• Equipping a HCPs to accurately

code medical procedures,

streamlines communication

across the health system,

reducing administrative and

rework costs at a time when

resources are stretched by the

COVID.

• Reduced access to the primary care for

regular patients as most of the primary

care providers are utilized for COVID

care.

• Reduction in the number of face to face

appointments between patients and

primary care providers.

• Independent physician practices

reducing hours, taking pay cuts, and

furloughing staff

• Severe shortage of hospitals and

medical equipment for treating COVID

patients.

• Shortage of hospital beds, ICUs and

Ventilators.

• Financial limitations of the hospitals for

upgrading to EHR, difficulty in the

integration of different systems,

• Lack of immediate and secure access to

the EHR for the hospital and hospital

staff.

• Lack of training to EHR for the HCPs.

• Possibilities of cyber attacks which could

lead to data breach and data loss.

• Scarcity of front line workers for ICU

care of COVID patients.

• Aging (Immunocompromised)

frontline workers used in the COVID

care.

• Scarcity of the personal protective

equipment for the HCPs involved in

treating COVID patients.

Primary Care Access Facilities & Capacity Electronic Health Records Front Line Workers

OP

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**https://www.zdnet.com/article/vr-ar-and-the-nhs-how-virtual-and-augmented-reality-will-change-healthcare/

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The pandemic is presenting number of opportunities and challenges for the Stakeholders

CH

AL

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ES

• Use of mobile applications/virtual appointments for

identifying the COVID patients.

• Faster claims processing

• Reduce or eliminate surprise billing

• Greater availability of providers through Telehealth

• Expansion of coverage of Health plans - like mental health

services administered through audio only calls

• Regulatory changes to facilitate increased acceptance of

Virtual Health and RPM.

• Lower cost of care with Virtual Primary care services and

remote monitoring

• Clarifying legislation of definition of Telehealth Providers

• Clarifying legislation for Telehealth Prescribing.

• Use of secured, integrated data standards for exchange

of information between different regulators.

• Designing one standard regulatory guideline which is

acceptable all over the world.

• Leveraging media (print/electronic) for COVID awareness

and prevention of disease spread.

• Leveraging technology such as mobile applications to

identify the symptomatic patients and taking steps to

quarantine.

• Greater collaboration between regulators, manufacturing

companies and government for adequate supply of medical

products and equipment.

Consumer Regulators Government

OP

PO

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• https://www.haynesboone.com/alerts/regulators-expand-opportunities-for-telehealth-services-under-COVID-19-shadow

• ** https://www.finoit.com/blog/top-10-healthcare-challenges/

• High percentage of consumers getting infected with

COVID.

• Uncertainty on the extent of organ tissue damage to

patients because of COVID.

• Risk of losing insurance due to economic slowdown

• High Volume of First Pass rejection

• Rising cost of premium

• Lack of Advanced Health Technology **

• Electronic Data breaches

• Lack advanced architecture and data management

systems.

• Cybersecurity

• Creating complete awareness on COVID

• Taking appropriate measures to prevent COVID spread.

• Taking measures for the adequate supply for medicines

and medical equipment.

• Providing financial support to all the stakeholders

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The pandemic is presenting number of opportunities and challenges for the Common Elements

CH

AL

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NG

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• Data integration by use of technology

• Care Coordination

• Patient Stratification and engagement

using data variables that cover

demographics, severity predictors,

admission information, hospitalization

information, therapies used, and

discharge information.

• Use of automation and robotics.

• Creating a comprehensive BCP.

• Using offset short term supply

interruptions with alternate supply

arrangements

• Exploring new technology like Blockchain

• Merge Clinical Data into the supply chain

process. Support RPM to the distribution

and tracking across the Healthcare

System

• Develop cash flow projections to assess

and create immediate action plan

• Work on maintaining liquidity and access to

capital

• Delay non-essential program and projects

• Standardization of data

• Use of data analytics

• Legacy data modernization

• Use of technology to make system

interoperable so that the data flows

freely

• Manual and fragmented process

• Limited access to the data.

• Poor data quality

• Lack of coordination and standardization

• Limited Visibility and Transparency

• Over dependence on manual process.

• Lack of robust BCP

• Shortage of medical and diagnostic

equipment due to global lockdown

• Increased Cost for Existing Health Plans

• Declining Revenue

• Worker’s Compensation

• Greater Reliance on Government

Programs

• High volume of Severe Claims Processing

• Lack of standardization and

interoperability of data

• Resistant to make information available

as open data, which are up-to-date,

provided in accessible format *.

• Existing privacy and confidentiality

laws.

• Non-availability of standard and good

quality data.

Care Management Global Supply Chain Financial Clinical Data Exchanges IOP

and Data Standards

OP

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Impact and direction going forward: Payer

Sta

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• Gain Operational efficiency by setting up dedicated

teams and offices

• Apply simple technological solution to process high

volume of claims, modification of products and

cybersecurity

• Invest in infrastructure for telehealth, digital

health & through medical policy review establish

benefit design to cover remote patient monitoring

• Design technological strategies for easier access

to data & system interoperability

• Formulize digital strategy at organization level to

become more patient-centric and adapt to value-

based model

• Stress on strategy to support new capabilities &

applications

New regulations &

directives released

by the government

Modification of current

Products for COVID

High volume of

COVID claims

Unmanaged Care -

selection of provider or

network without utilization

review

Increased demand for Care

management for discharged

COVID patients

Difficulty enrolling

Provider into Medicaid

Regulatory move towards

removal of administrative

barriers towards adoption

Telehealth

Difficulty reinforcing

Telehealth, especially for

Medicaid

47M+ Americans lost jobs in the middle of a global pandemic that also probably means they’re losing their health

insurance, too

High Cybersecurity

threats

Lay off temporary resources

to focus on other core

processes by government

payers

Call for greater access

to Medication,

expanding Medicaid

coverage

High no of fraud

claims

Prediction based on current situation - government payers hiring temporary workers to take care of homeless population like distribution of PPE, hygiene

supplies & conduct door to door testing

IMPACT

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Impact Recommendations Going forward

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Impact and direction going forward: Provider

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• Creating awareness on COVID and taking

appropriate measures to prevent disease spread.

• Providing assistance to the HCPs by giving them

PPE and financial support.

• Develop strategies to leverage technology and EHR,

ePROs, e-diaries for disease and patient management.

• Review Medical Malpractice to include Virtual Healthcare

Services.

• Increased focus on virtual treatment and moving towards

preventive care.

• Increase Provider capacity through virtual Healthcare

services and RPM.

• Use NLP/ML to create FAQ on consumer /patient portals to

create social media medical neighborhoods to assist in self

care.

• Maximize the usage of technology such as EHR, ePROs,

e-diaries for patient care.

Limited access to

primary care

Lack of Infrastructure

for upgrading to EHR

Shortage of HCPs

which is resulting in long

working hours

Complete revival and

functioning of the hospitals

Use of alternative methods

such as digital platform for

treating non-COVID patients

Focusing on available patient

data for treatment and better

prognosis

Increased focus on

Virtual treatment and

preventive care

Use of volunteers, recruiting

retired HCPs and providing

ICU crash courses to other

physicians

$16 billion - estimated out-of-pocket costs for hospital stays & doctor visits

Shortage of

hospitals for COVID

care

Increased reliance

technology and on

digital data

Building makeshift

hospitals for treating

COVID patients

S&P estimates that Americans on insurer plans could wind up paying $3.5 billion in out-of-pocket costs collectively under a moderate outbreak scenario, for

hospital stays and doctor visits beyond initial testing. Under a severe outbreak, patient out-of-pocket costs could top $16 billion.

IMPACT

TILL NOW

Impact Recommendations Going forward

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Impact

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Impact and direction going forward: Stakeholders

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• Leveraging technology along with media

(print/electronic) for disease awareness and

prevention of disease spread.

• Expansion of coverage of Health plans - like mental

health services administered through audio only

calls

• Leverage available patient data, literature data and

information from epidemiologists for prevention of

disease spread.

• Invest and develop robust, integrated, secured

technology and data management systems.

• Increased collaboration between stakeholders

(regulators/agencies/pharmaceutical companies) for

sharing and usage of data which will enable better

outcomes.

Creating awareness on COVID

and take measures for

prevention of disease spread

Lack of advanced

technology and data

management systems

Increase in the number

of COVID patients

Develop drugs/vaccines

for the treatment of

COVID.

Priority approvals of

drug/vaccine approvals by

regulators and government.

Regulators investing in

advanced technology and

data management system

Development of

robust, integrated,

secured technology

and data management

systems

Identifying the COVID patients,

tracking the primary & secondary

contacts, quarantine the patients

and providing the care.

2 Trillion – Stimulus package by the US Government agency *

Uncertainty on the extent

of organ tissue damage to

patients because of

COVID

Reviewing available data

and taking measures to

prevent disease spread

Identifying the

epidemiology of the

disease

*https://www.brookings.edu/blog/up-front/2020/03/25/where-is-the-u-s-government-getting-all-the-money-its-spending-in-the-coronavirus-crisis/

IMPACT

TILL NOW

Recommendations Going forwardImpact

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Impact and direction going forward: Common Elements

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• Maintain liquidity by stopping non-

essential projects

• Using alternate supply arrangements

for managing the scarcity of medical

equipment

• Be prepared for potential shifts due to regulatory

Impacts

• Creating a comprehensive BCP.

• Come up with new business models that focus on

Cost, Access and Quality

• Use of new technology like AI, ML, and Robotics

• Application of Blockchain to bring transparency in

medical supplies, providers and financials.

Disrupted supply of medical

gears in hospitals

Shrinking

memberships**

Greater reliance on

government plans

collation of all data

pertaining to COVID is

leading to administrative

chaos***

Scarcity of medical and

diagnostic equipment due to

global lockdown

Increasing costs due to

implementation special

measures*

Increasing cost of

existing plans

$38.5 Bn – $115.4 Bn – The range in US dollars the epidemic could cost to Medicare*

Upfront reimbursements

of claims Increasing no of hospitals

cancel profitable elective

surgeries or procedures

Burden of increased

Worker’s compensation

of people in essential

services

Special measures like - cost-sharing waivers, relaxed hospital restrictions, special enrollment periods

** Rising unemployment leading to millions uninsured in the middle of a national health crisis

*** Lack of standardization of data leading to chaxos while collation of data for COVID

IMPACT

TILL NOW

Recommendations Going forward

Limited Visibility & Transparency

in care management

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Impact

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Digital – A new Frontier

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Role of Digital

ENGAGEMENT

• New Primary Care Model

• Virtual Reality to increase disease

awareness

• Remote Patient Monitoring

AI/ ML/AUTOMATED SOLUTIONS

ROBOTICS

• Robotic Front line Workers

• Connected machines utilized to improve

quality of care

• Artificial Intelligence based Robotic

Process

REAL WORLD DATA (RWD)

AND ANALYTICS

• Leveraging Data as a Platform (DaaP) to

extract insights

• Improve coordination of care with data

insights

• Interoperability and open platforms to

improve quality of care

BLOCKCHAIN

• AI Based Patient Screening

• Clinical Driven Healthcare Supply Chain

• AI/ML Clinical outcomes to Revenue Cycle

• Patient Data Management & Faster

Insurance claims Processing

• Donation Tracking & Cross Border

Payment

• Medical materials supply chain

tracking

ENABLERS

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• Integrating improved outcomes to

reimbursement , showing true costs incentivize

health care stakeholders to commit to broader

data sharing and integration. Implementing and

integrating digital systems .

• Medical text understanding of claims data

through ML to reduce claim time and FWA

claims by quickly identifying procedure

inaccuracies.

• Link Clinical outcomes to reimbursement across

the health care supply chain

• Advance prep work to meet the demands of the

consumer and provider as the spread of COVID-

19 has broken the weak links in the health care

supply chain.

• Adoption of AI/ML provides new insights into

a wide range of aspects

• Including logistics, warehouse management,

collaboration, and supply chain

• Demand matching – A more transparent supply

chain with full connections to clinical data will

reveal weak points before they are stressed in

times of crisis

AI technologies being deployed in recent days and

weeks are sensors to predict which COVID-19

patients are at risk of developing complications such

as sepsis or respiratory failure and virtual clinical

assistants to screen patients before they arrive at a

facility

AI platform was able to analyze coughing sounds

and crowd size collected by the handheld device in

real-time, then use that data to accurately predict

daily illness rates in each clinic,

AI/ ML/Automated solutions

Assessment of

Healthcare Supply Chain

AI/ML in an clinical outcome

based connected Revenue CycleCOVID AI Patient Screening1 2 3

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• Robots are currently used in some surgical

procedures, dispensing medications and

transporting items within a Hospital

• Design human centered AI to develop

autonomous Machines to expand robotic fleet.

• ACO has introduced an AI based predictive

model that analyzes patient demographics,

social determinants of health, claims and clinical

activity to determine which patients need the

most outreach

• Smart machines that increase productivity for

healthcare providers to get the information they

need .

• Test results and scan reports are immediate

and can be shared with patient and doctor in

real-time

• COVID has accelerated the use of Robotic front

line workers. In a US Senior Care Facility in CT, a

telepresence robot delivers items to residents

and some have computer screen face to allow

communication with Doctors, Nurses and family

• Using Telepresence Robots to reduce the

unnecessary risk to healthcare Workers .

Telepresence robots ask basic questions, brief

history to screen the possible COVID patient

• Utilized for repetitive tasks so focus is on more

complex tasks

• . Solution that autonomously navigate a hospital

to perform collaborative tasks with nursing staff.

• Establish central management of growing robotic

fleets, and create collaboration between Human

Healthcare workers, Patients, and Robots

Connected machines (IOT)

utilized to improve quality of careRobotic Front Line Workers AI based Robotic Process 1 2 3

Robotics

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• Fuel Internet of Medical Things (IoMT) to bring

together patient and performance data

• Work group collaboration to improve

processes and data control in research and

academia

• Increase partnership opportunities promoting a

shared culture and mindset.

• Improve financials reviewing claims data and

improve payer / provider relationships

• RWD on hospital capacity, high-risk populations

and the impact of interventions during the

COVID-19 pandemic

• Leverage data to improve patients understanding

of treatment plans

• Big data analytics to examine unstructured data

to uncover patient patterns and correlations

• DaaP – utilization to gain traction with value

based care model proposed in the U.S. market

• Government leveraging large sets of data to

review trends:

• Ex: population health demographics,

healthcare expenditures, diseases trends

• Create new product development for medical

and consumer devices

Real World Data (RWD) and Analytics

Improve coordination of care

with data insightsInteroperability and open platforms

to improve quality of care

Leveraging Data as a Platform

(DaaP) to extract insights1 2 3

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• Leveraging Virtual Reality for application with

educational value:

• Ex: Clinicians trained in 3D surgical

environment

• Creating new ways of assisting patients with

pain management & mental illnesses find a

better way to cope.

• Tele behavioral Health- Artificial intelligence and

data analytics to power a comprehensive remote

monitoring platform.

Engagement

• Continuous ongoing monitoring of patient

vitals and relay information back to the Provider

• A growing shift of Providers relying on wireless

connectivity

• The “smart pill’ – swallowed by patients to get

real-time information on patient’s well-being.

First smart pill approved in U.S. by FDA in 2017

• Reducing physical barriers regardless of

geographical area. Vital in pandemics like

COVID-19

• Provider productivity and quality of care

significantly increases. As well as a reduction in

cost of care.

• Providers are using AI based online

screening and triage tools to assure that

patients gain access to the right level of care

Post COVID- New

Primary Care Model

Virtual Reality to increase

disease awarenessCOVID – Remote Patient

Monitoring 1 2 3

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• Blockchain-based platforms can enable users to

trace the demand and the supply chains of

medical supplies, included the recording and

tracking of epidemic prevention materials, such

as masks, gloves and other protective gear.

• Smart Contracts between stakeholders - rule-

based protocols where contracts are executed

when conditions are met.

• Blockchain can provide a mechanism for health

systems to continually update factories with the

latest product requirements and specifications,

almost like a production auction.

• Donation-tracking platform: Distrust regarding

donations has been an issue during COVID. With

Blockchain, donors can see where funds are

most urgently needed & track their donations until

provided with a verification that their donations

have been received.

• Cross-border payments: UN World Food

Program introduced Blockchain technology for

projects, such as distributing aid to vendors,

arranging money transfers for more than 10,000

refugees, and auditing beneficiary spending, it

managed to reduce bank transfer fees by almost

98%..

• Single source of information: securely

manage health records ensuring

interoperability without compromising patient

privacy & security. Records include patients’

data, treatments given, and any progress

detected.

• Insurance claims: Blockchain-based collective

claim-sharing platform can function

to process coronavirus claims, helping the firm

to reduce paperwork & back-and-forth document

delivery to clinics & mitigate the risk of infection

from face-to-face contact.

Blockchain

Patient Data Management &

Faster Insurance claims

Processing

Donation Tracking &

Cross Border PaymentMedical materials

supply chain tracking1 2 3

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Path Forward

24

Path Forward

STABILIZE RECONFIGURE TRANSFORM

Address the near term

and immediate needs

to stabilize the

industry needs

Retool and reconfigure the approach, processes and tools to address the medium term challenges

Provide a clear roadmap around how the changes across the spectrum would impact your business

25

STABILIZE – In the near term (0-3 months)

• Operational Efficiency – setup dedicated to handle

COVID related administrative work

• Modification of current products for COVID - removal

of prior authorization

• Identification of potential sources cybersecurity risks

• Payer expediate reimbursement to Provider

• Payers should initiate Social Determinates into all

Care Management Process, and connect with

Community Health Services into care plans

• Automation of manual tasks related to COVID

claims processing

• Establish infrastrcuture to build DaaP (Data as a

Platform) cabailites

• Leverage AI/ML tools to review existing medical

claims data for potential FWA risks

• Identify appropriate Supply Chain methodologies

to decrease Manfacturer to Provider times

• Leverage existing virtual health functionality into

high risk healthcare units

• Enable chatbots into business units to gain

effeciencies.

• Leveraging technology along with media

(print/electronic) for disease awareness and

prevention of disease spread.

• Expansion of coverage of Health plans - like mental

health services administered through audio only

calls.

• Improvement of Mental Health Service through

Virtual Health Services and RPM

• Align Cost and Volume – determine staffing needs,

vendor costs and negotiate payment terms

• Carefully Track COVID expenses – example - extra

labor costs, labor shortages due to self-quarantine.

• Implement FHIR Data Standards and open API's

across the E2E.

• Setting up COVID specific hospitals, and

optimization of scarce resources based on priority

and use of retired HCPs.

• Ability to manage the short term supply of medical

equipment with alternate supply arrangements

• Improve the revenue Cycle efficiencies through

Process Automation.

Stakeholders Common Components

ProviderDigitalPayer

26

RECONFIGURE – In the medium term (4-12 months)

• Business Continuity Plan - re-evaluate to deal with

not just physical, natural disaster but also medical

disaster like COVID, Improve access to care

• Remove all cost for COVID Testing, Cover the cost of

vaccines, removing co-pays for Vaccines

• Submit plans to meet the new requirements to the

State Department of Insurance and other regulatory

agencies.

• Use AI/ML to screen cases that need Care

Management, eligibilty determinatin for COVID

claims

• Use Cloud Services to implement a layered, in-

depth cyber-defense strategy across data and

networks

• Scale DaaP across pipleline for high impact areas

across all healthcare channels

• AI/ML functionalites enabled to review more

complex with Predictive Analytics to reduce

bottlenecks

• Automate supply chain functionalites within various

departments plus leverage Predictive Analytics

to increase effciencies and meet consumer

demands

• Virtual health –continuously introduce

healthcare applications to leverage RWD to

improve quality of care

• Develop strategies to leverage technology and

Electronic Health Records, ePROs, e-diaries for

disease management.

• Invest in training of HCPs and building of

infrastructure for chatbots, analytics, telemedicine,

digital health and Remote Patient Monitoring (RPM).

• Develop a financial rescue plan and communicate to

all stakeholders.

• Use AI/Predictive Analytics to identify and managed

the volume of COVID patients and create treatment

protocols

• Investment in Information Technology which will

help all the stakeholders involved in Healthcare

industry

• Expediate Interoperability across all facilities,

functions, and workforce.

• Review Medical Malpractice to include Virtual

Healthcare Services

• Develop a fully connected supply chain driven by

clinical data, from Patient diagnosis to Discharge.

Stakeholders Common Components

ProviderDigitalPayer

27

Stakeholders Common Components

ProviderDigitalPayer

TRANSFORM – In the long term (12-24 months)

• Focus on expanding access to coverage to various

group of population

• Follow an infrastructure strategy to support new

capabilities and applications

• Patient – Centric Approach - Formulize digital

strategy at organization level to become more

patient-centric and adapt to value-based model

• AI and Automation to help free up more resources

and time to focus on other core processes

• Integrate & provide access to patient record

information, claims, benefits, costs, patient

registration, and staff management for better

claims processing

• Leverage cloud functionality with RWD and

encourage data sharing while protecting patient

identifiers with robust functionality

• Establish a mature DaaP across all healthcare

business units

• Build out a mature medical claims review process

with AI/ML for FWA while introducing road

maps and preventive measures

• Reimagine Supply Chain with digital tools to

decrease overall costs and overhead

• Increase overall satisifaction of Patient and

Provider with fully integrated virtual health

capabilites

• Increased collaboration between stakeholders

(regulators/agencies/pharmaceutical companies) for

sharing and usage of information.

• Usage of Global Data Standards for exchange of

data for consistent and credible analytics and

reporting.

• Introduce lower premium individual health plans to

cover costs in case of pandemics like COVID.

• Introducing new business models that focus on

Cost, Access and Quality

• Use of new technology like AI, ML, and Robotics

etc.

• Move from the traditional value based care to

preventive care

• Increase Provider capacity through virtual

Healthcare services and remote patient monitoring

• Use NLP/ML to create FAQ on consumer /patient

portals to create social media medical

neighborhoods to assist in self care

• Evaluating the COLUMBIA-SUICIDE SEVERITY

RATING SCALE for the HCPs and taking

appropriate measures for HCPs recovery.