By the SAST Team

The state of Karnataka has shown itself to be a pioneer in the Indian healthcare sector over the past decade. In 2009, the Suvarna Arogya Suraksha Trust (SAST) was established by the Government of Karnataka as an implementing agency to facilitate the delivery of healthcare assurance schemes in the state. SAST currently oversees the implementation of nine health insurance schemes, ranging from a program designed to help victims of road traffic accidents to one that provides tertiary care treatment to below poverty line residents of Karnataka. While the existing schemes are thorough and wide-reaching, limited awareness and access to care remains a challenge. In order to close existing gaps in coverage and to ensure that quality care is provided to residents, the government is rolling out a scheme named Arogya Bhagya to provide Universal Health Coverage (UHC) in the state. Upon successful implementation of the scheme, Karnataka will become the first state in India to provide UHC to its residents. As such, the implementation, utilization and monitoring of the scheme will serve as a model from which other states may garner insights.

During the implementation of Arogya Bhagya, there are numerous processes that must be well thought-out and clearly defined in order to ensure that the scheme is comprehensive and successful. The patient experience from the first visit to a healthcare facility up until completion of follow-up care needs to be carefully designed and accounted for. For the same, the operations and administrative processes of SAST when rolling out the scheme must be deliberate and considerate of a host of external and internal factors. How will the referral protocol be structured? What will be the strategy for empanelling hospitals under the scheme? What is the most effective way to maximize enrollment expeditiously? How will the implementation be monitored? Clear answers to these procedural questions are a necessity for Arogya Bhagya to be successfully implemented and impactful.  

In thinking about these questions, our team began to notice an opportunity that offered the potential to streamline scheme oversight, improve beneficiary experience and maximize efficiency. While some of the processes that SAST oversees are digitized, for example claims review, many of these critical processes are not carried out on a digital platform. What if digital platforms could be used to track the beneficiary experience from first contact with a healthcare provider until final discharge? The possibilities for improving the patient experience would be significant. For digitizing SAST operations, we noted that it first would be necessary to review SAST procedures and protocol in order to help change processes to make them more logical, transparent, and efficacious.  

Our team is now further investigating the role that digitization, process development and clean data collection and analysis could play in our efforts to improve the capacity of SAST and to aid in realizing the vision of UHC. Digitization and refinement of SAST processes would offer a wide-ranging number of benefits to the organization, the beneficiaries, and the medical care providers. By implementing digital mechanisms for collecting and analyzing data, SAST would be able to greater utilize data driven decision making when determining how to improve upon scheme implementation and other processes. The automation of processes would allow for greater access to information for SAST officials, medical care providers and beneficiaries. The information channels could be accessed by a wide range of stakeholders, thereby improving experience and efficiency. In addition, the streamlining of such processes on digital and accessible platforms would facilitate greater transparency and accountability, the importance of which cannot be overstated. These outcomes are merely a few examples of the progress that digitization could facilitate.    

Our team envisions that digitization of processes is not merely an impactful disruption that will enhance the implementation of Arogya Bhagya and other SAST schemes, but it is a system that has the capacity to shift the way in which SAST operates and evolves for many years to come. It will be an intervention in keeping with the spirit of change and innovation that Karnataka’s healthcare sector has shown and will continue to show in the coming years.