AN IDG CUSTOM SOLUTIONS INITIATIVE IN ASSOCIATION WITH
TRANSFORMING BUSINESS THROUGH JUDICIOUS APPLICATION OF IT
PLUS aarogyasri is a unique community health insurance scheme formulated by the andhra Pradesh government, under the aarogyasri Health Care trust, to bring quality medical care within the reach of the poor in the state. the trust realized that the success of this scheme depended upon a web-based solution that would utilize It to provide visibility, robustness, speed and transparency in operations.
INTERVIEW girish rao, Head - IT, Marico, believes job rotation helps provide for workers’ overall development and boosts company loyalty.
TRANSFORMERS CASE STUDY
Ensuring Accessible Healthcare Aarogyasri is a unique community health insurance scheme formulated by the Andhra Pradesh Government, under the Aarogyasri Health Care Trust, to bring quality medical care within the reach of the poor in the state. The Trust realized that the
success of this scheme depended upon a webbased solution that would utilize IT to provide visibility, robustness, speed and transparency in operations.
Company Aarogyasri Healthcare Trust, Government of Andhra Pradesh Industry Government offering Social Development Solutions
Custom solutions Group TATA CONSULTANCY SERVICES
ollaboration between the private sector and the government in the delivery of health services is a recent phenomenon in Andhra Pradesh. One such initiative is the Aarogyasri Community Health Insurance Scheme, a state-funded health insurance scheme run by the Aarogyasri Health Care Trust, which provides financial protection to BPL (Below Poverty Line) families for the treatment of serious ailments requiring hospitalization and surgery. The scheme was introduced after a pilot study period and then was slowly implemented in a phased manner, with additional regions of the state covered in each phase. The state government finances 100% of the premiums for state residents who fall below the poverty level. Catastrophic (inpatient) care is provided primarily by private providers (the network does include some public facilities, but the majority of the network providers remain private facilities), and administrative services are provided jointly by a private insurer along with the Aarogyasri Trust. Aarogyasri beneficiaries have access to facilities they would not otherwise be able to access due to financial barriers. For example, Apollo Hospitals is one of the leading high-end hospital chains in India. The Apollo Hospital in Hyderabad is a member of the Aarogyasri network and provides care to hundreds of Aarogyasri members each month. So, even though network eligibility requirements are somewhat stringent, the benefits of being a network provider are many. Quick payment timelines, additional patient volumes and thus revenues alone are an attractive enough proposition for both public and private hospitals to improve their operating procedures and align with the eligibility requirements for Aarogyasri. According to N Srikanth, IAS, CEO, Aarogyasri Healthcare Trust, “There is a need to provide quality healthcare services for all. The government of Andhra Pradesh has launched Rajiv Aarogyasri scheme with the objective of providing quality tertiary healthcare services to the poor. In fact, Rajiv Aarogyasri scheme has generated a sense of security among them.”
the It platform of aarogyasri is a live example of how technology can be leveraged to offer efficient and prompt health care service.” Mr. n srIKantH, Ias CEO, AAROGYASRI HEALTH CARE TRUST
to all the stakeholders – in the form of timely information on health camps, case registrations, pre-authorization requests, expenses, fund allocations and re-allocations among others. Availability of critical operational information such as occupancy records, clinical notes, surgery details for each case, claims, expenses, fund allocation, re-allocation and business-critical information including repeat cases, yearly insurance reports, disorder/ailment reports and claim reports were some of the requirements. In addition, other important information on bed capacity, in-patient/ out-patient records, surgery discharge reports, pre-authorization reports as well as information to monitor patient records, surgery discharge reports, and other weekly reports was required for the successful implementation of the scheme. The Trust embarked upon the scheme with a small IT vendor providing an IT solution. However, the vendor was not able to deliver up to their expectations. M o re ove r , t he sc he me was catching on rapidly throughout the state and the Trust realized that it would have to scale up quickly with an IT solution to deal with the escalating number of transactions. In addition, the growing popularity of the scheme put pressure on the Government to roll it out across all the districts.
85%
BusIness sItuatIon The Trust recognized that the key to making the scheme a success was to make realtime information available
of below-thepoverty line households in the state are covered under the scheme
TRANSFORMERS CASE STUDY
The Aarogyasri Trust realized that it required a partner who could provide an end-to-end solution including hosting, development, deployment and maintenance. TCS, with its excellent track record, vast technical expertise and proven ability to scale up rapidly, was chosen to partner the Aarogyasri Trust for this prestigious engagement.
the aarogyasri scheme has been a great success in the districts where it has been introduced, and has provided the client with the following benefits:
tCs solutIon
Quick and accurate decision-making due to availability of real-time information
TCS developed the ICT website - http://www. aarogyasri.org, the primary channel through which the Aarogyasri Scheme was utilized by the target groups. This website portal, the core of the scheme, was a workflow-oriented integrated system which addressed all the needs of the target groups. Each phase of a patient’s journey through the system, from in/out patient registration, surgery updates, discharge updates to claim settlements among others, was routed through the ICT. According to Babu Ahmed, IAS, Former CEO, Aarogyasri Healthcare Trust, “Aarogyasri revolutionizes public health through conviction and innovative ICT application. The ICT solution developed for this unique scheme has absorbed all the complexities of the scheme and made it user-friendly, thus helping implement the scheme in efficient manner involving various end users and stake holders. “ Seeking care does not require any kind of expenditure from the patient’s side. On the backend, the provider must submit a pre-authorization to the insurance company or to Aarogyasri Healthcare Trust. The insurance company/Trust appoints medical officers who work on pre-authorizations. After pre-authorization and treatment, the
after using ICt to power the aP rural employment guarantee scheme, the solution for aarogyasri is the next instance of leveraging the power of ICt on a massive scale for the benefit of the common man.” late Y.s. raJaseKHara reddY, FORMER CHIEF MINISTER OF AP
Flagging of irregularities to the appropriate authorities at the correct time, leading to fewer opportunities for fraud Transformation of the project into a flagship brand for the AP government due to the implementation of critical business applications and solutions Tracking of worker productivity and performance Efficient accounting due to online reconciliation systems Low-cost solution due to the employment of open source technologies e-Office solution for complete office automation system
insurance company or Trust (depending on which procedure the beneficiary was enrolled in) will settle claims from hospitals within seven days of receipt of claim, discharge summary, and a satisfaction letter from the patient. Some of the important modules of the solution include registering the patient for the scheme, providing preauthorization for the surgery and treatment requests placed by the network hospitals, processing all the claims submitted by the hospitals and dealing with electronic payments to hospitals. Apart from these functions, TCS also worked with Aarogyasri to provide back-end support which included setting up a call center to attend calls from the beneficiaries and resolve their queries. The call center also serves as a telemedicine system over a toll free number across Andhra Pradesh. A grievance addressal mechanism ensured that all issues raised were monitored and successfully addressed. The module also ensured automatic hospital empanelment into the Aarogyasri Scheme. On the accounts front, the module could deal with all internal payments and receipts processed, as well as the online reconciliations.
Custom Solutions Group TATA CONSULTANCY SERVICES
It also automatically generates income tax-related forms to the service partners. “It is not an exaggeration to say that if IT stops, the entire Aarogyasri programme will stop. The programme depends on IT every second,” says J. Satyanarayana, IAS, then Principal Secretary - Health, Medical & Family Welfare Government of AP. “In fact, our former Chief Minister, Sri Y.S. Rajasekhara Reddy, used to say that we should use IT to improve every aspect of the common man’s life,” he adds. The site was designed to provide real time information about the number of medical camps, people screened, cases registered, in/out patients, pre-authorizations, surgeries/therapies and insurance amount claimed thereof. The TCS team utilized its proprietary DigiGov framework and made necessary customizations. The team also drew upon the expertise of the Performance Excellence Group (PEG) and the Consulting Group to provide the client with Business Data Analysis Software. The cost-effective solution was built on open source technologies such as Java, Redhat and Tomcat. Rising to the challenge in a record time of thirty days, TCS was, thus, able to provide a cost effective and end-to-end solution that utilized technology. TCS continues to be a part of the joint ICT team and is thus able to constantly improve and upgrade the solution to the continuous satisfaction of all the stakeholders.
Internal Monitoring and Evaluation Monitoring and collecting information on Aarogyasri operations is the responsibility of the insurer and the Aarogyasri Trust. The insurers are mandated to coordinate and ensure proper implementation of the scheme to the satisfaction of the Trust. The insurer must review progress with the Trust on a daily basis and is responsible for implementing suggestions of the Trust for effectively running the scheme. The most important aspect for monitoring the services provided is the technology platform. All hospitals are required to share patient history and detailed information about symptoms and test results for each patient. The dedicated Aarogyasri project office of the insurance company is required to be established at a location that is convenient for the facilitation of co-ordination between the Trust and the insurer’s administrative offices. The Aarogyasri project office must report to the CEO of the Trust on a daily basis. A dedicated MIS department within the project office is responsible for working with network hospitals and Aarogya
Mithras to collect and report data on a real-time basis. This department also has a sub-unit with operators who collect hourly information from the Aarogya Mithras, regional co-ordinators, and district co-ordinators, among others. The insurer’s IT department is also responsible for ensuring that the Aarogyasri website is updated and functional. The website contains all documents relevant to e-pre-authorization, claim settlement, and reimbursement. Through the website, realtime follow-up is maintained between providers, the insurer, and the Trust. The website captures all data collected by the system on a 24-hour basis.
Benefits The Aarogyasri Scheme has been a great success in all the districts where it has been introduced and has enabled quick and accurate decision-making due to availability of real-time information. It has also been able to flag irregularities to the appropriate authorities at the correct time, leading to fewer opportunities for fraud. Other benefits include tracking employee productivity and performance, efficient and accurate accounting due to online reconciliation systems and enabling e-Office solution that provides a complete office automation system. The solution employed open source technologies to keep costs low and it has now become a flagship brand for the AP government due to the implementation of critical business applications and solutions. The scheme has been instrumental in conducting around thirteen lakh surgeries/ therapies. Over fifty lakh people have been screened across thirty thousand health camps and more than Rs. 3600 crore have been claimed since April 2007. The average premium per family is around Rs. 300 per year to cover up to 2 lakh towards the surgeries/ therapies. Around 330 network hospitals are part of the empanelment. “IT platform of Aarogyasri is a live example of how technology can be leveraged to offer efficient and prompt health care service,” says Srikanth. There have been several attempts to introduce similar schemes in other states, but Andhra Pradesh has been one of the only states to successfully roll out the scheme. This was primarily possible due to the intelligent use of technology. According to Late Y.S. Rajasekhara Reddy, Former Chief Minister of Andhra Pradesh, “After using ICT to power the AP Rural Employment Guarantee Scheme, the solution for Aarogyasri is the next instance of leveraging the power of ICT on a massive scale for the benefit of the common man.”
TRANSFORMERS INTERVIEW
ROTATE TO
RETAIN Talented staff can be the pillars of an IT department’s success story. Girish Rao, Head - IT, Marico believes job rotation helps both: it provides for workers’ overall development and boosts company loyalty.
Girish Rao,
Head - IT, Marico
CUSTOM SOLUTIONS GROUP TATA CONSULTANCY SERVICES
There is tough competition among players in the consumer products industry. How can IT contribute in the strategic plans of Marico to help it outdo its competition? A key aspect to devising a good strategy is to read the customer’s mind. As we do not directly interact with our end consumers, it becomes all the more important that we get a feel of what is happening at the retail store. IT has played its part here by helping design a distributor automation software called MIDAS, an offline system which is integrated with MiNET, a online system developed inhouse connecting all stakeholders. Decision makers in the supply chain make their demand forecasts by studying the data analysis from MIDAS. We then work backwards and plan so as to keep our inventory to a minimum. At the same time, a better insight into the current processes helps the sourcing department buy the best of raw materials for the least prices. How was you experiment with virtualization? What prompted it? A little before our hardware refresh cycle, we had found out that most of our servers were fi ve years old and maintaining them was proving to be an expensive proposition. We decided to replace and consolidate them using virtualization. Virtualization helped reduce the number of physical servers from 30 to three and the number of racks from fi ve to two, while downtime was slashed from six hours to 15 minutes. There was also a significant achievement in power saving to the tune of around 70 percent. What is your strategy to scale IT infrastructure with growth? I am a strong proponent of maintaining a regular upgrade cycle of a duration of around three to four years. This ensures that we are abreast of the latest in technology. New technology often brings in more flexibility and power and a technology upgrade helps employees exploit the latest features. However, before we sign a deal, we ensure that the vendor is an established player in the space and that there has a clear road map for that product. This has been a long-standing norm with us. What is the most significant challenge in curbing attrition in recent years? Have you been successful? Retaining talent is very important to us. As a member in the IT department moves up the ladder, he acquires business knowledge that helps him contribute to the organization in a more significant manner. We take a number of steps, such as job rotation
and allowing staff to switch roles from business departments to IT, and vice versa, to help staff remain engaged in their jobs. For instance, I would like to typically shift an infrastructure team member to applications development and the other way around during some phase in their career. At the same time, we scout for fresh talent to help build the talent pipeline. We have had good success with retaining IT staff that have been with us for a considerable number of years. At that level, the worker’s project management skills weigh in as heavily as his or her core knowledge of IT and we ensure that there is enough opportunity for learning. At the entry level, we have had limited success in retaining talent as we compete with the IT industry. Why did you decide to go for a media management portal? We spend around Rs 160 crore, including media (Rs 92 crore) and non-media (Rs 68 crore), on advertising. Managing this huge volumes of transactions between the company’s media management team and media agencies was an important agenda item for us. The system lacked transparency and visibility because of which analyzing the ASP (advertising and sales promotion) spend was not straightforward. A B2B media management portal could act as the middle-man between Marico’s media management team and media agencies. In order to ensure smooth data transfer between the systems and on-line controls like budget checks and data validations, integration with the existing ERP was a must. Unless both the teams used the portal adequately, the required information would not be present in it. The project went live in June 2008. Before we had the portal, processing media bills took about 15 days, but with the system it took less than fi ve days. The new system reduced the chances of duplication during bill processing. Earlier, the final closure of the estimates of media vendors was carried out via phone — a process that used to take a week. Now it takes about two-three days.
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