In a Nutshell: The days of holistic family doctors are receding in the corporatized and technologized US health system. In India, the situation is similar, but the economics are more stringent, and skepticism around insurance results in even less emphasis on preventative care and higher personal healthcare expenditures than in the US. Even Healthcare is a new type of managed care provider in India. It builds trust in India’s health system by encouraging consumers to use their country’s robust health infrastructure. Even Healthcare helps Indians lead healthier lives and provides a model for moving care systems forward elsewhere, including in the US.
As a British Indian educated in the UK, Mayank Banerjee learned to view healthcare through the lens of Britain’s National Health Service (NHS). In the UK, general practitioner and nurse consultations are free to all who have been in the country for at least a day. British citizens and UK residents can also access free secondary care services.
In India, healthcare operates under a multipayer structure similar to the structure in the US. Public and private health insurance providers and primarily publicly funded hospitals function in a complex web.
Health insurance focuses on covering extended hospitalization costs, but not as much on preventive care. Healthcare is inexpensive, and most Indians carry health insurance for the tax rebates it offers, paying incidental charges out of pocket as needed instead of using the country’s robust health system to its full advantage.
Banerjee and colleagues and friends Matilde Giglio and Alessandro Davide Ialongo realized the lack of preventative care meant Indians are among the highest out-of-pocket payers in healthcare in the world. The global average out-of-pocket healthcare expenditure is about 20%, whereas India’s is close to 60%.
The friends saw an opportunity to introduce Indians to a delivery system that incentivized preventive care. Even Healthcare addresses the preventative care gap through affordable plans that offer access to specialists whose sole responsibility is to manage members’ care and keep them healthy and out of hospitals. Even Healthcare helps free patients from the burden of working through India’s complex multipayer system.
“Because everything is free at the point of purchase, we encourage our clients to use us even if they’re just dealing with a sneeze on a Sunday morning,” said Nikhil Kant, Even Healthcare’s Head of Brand. “If you speak to your doctor and get tested more often, you’ll learn about your issues much earlier in life and help prevent bad outcomes from occurring.”
Building Trust Through a Healthcare Ecosystem
Kant said Even Healthcare provides a robust cure for healthcare dysfunction in India because it addresses the cultural limitations and lack of trust inherent in the traditional system.
Healthcare in India is comparatively cheap because providers compete for out-of-pocket payments. India has diagnostic center reps that function like pharmaceutical reps in the US, rewarding doctors who refer patients. This prompts Indians to assume the system is out to get them, and they tend to avoid using it until health situations grow so acute there’s no longer any choice.
“The traditional system incentivizes doctors to overtreat patients by giving them medicines and tests they don’t need,” Kant said. “With Even Healthcare, that doesn’t exist. An Even Healthcare doctor’s only incentive is to keep you healthy.”
Even Heathcare’s plans include complete tests, medical history, and family history to determine what each patient is at risk for. All of that comes without additional costs.
When diagnostics determine a patient has a family history of diabetes, Even Healthcare immediately puts the patient on a managed care program for diabetes remission and control. An endocrinologist, a dietitian, and a general physician will work with the patient to make lifestyle and dietary changes and set up regular tests.
“Half of Even Healthcare members who have diabetes did not know they had it until our doctors prescribed a test for them, and now we’re able to catch it and control it,” Kant said. “We’re always on top of your health to ensure your HbA1C levels or glucose levels are under control.”
Strong Execution Framework Boosts Efficiency and Effectiveness
In about two and a half years of operation, Even Healthcare has won the trust of tens of thousands of patients and families and expanded nationwide. The company also performs workforce healthcare management for more than 50 companies that grant managed care plans as an employee benefit.
It’s not just the emphasis on preventive care that makes the system work. Even Healthcare’s single-payer structure and focus on technology simplify care delivery.
Even Healthcare’s sophisticated app is a locus for booking, delivering care, and storing comprehensive medical records. Chat functions in the app handle all communications with practitioners.
The app also includes a scanner function to combat cost uncertainty among healthcare consumers. It looks at aggregate cost data to determine a procedure’s average or typical cost in a particular area to help members determine whether the cost of service they’re choosing aligns with established patterns.
“We preload it with a certain amount that we know is the average cost of a procedure in the patient’s area,” Kant said. “Patients go to the diagnostic center of their choosing.”
The Even Healthcare app also takes advantage of India’s Unified Payments Interface (UPI), a system that unifies all bank backend operations on a consistent digital platform. Payment through the UPI happens through QR codes that phones can scan.
“After patients receive their procedures, they scan the UPI QR code through our app, and the payment’s done,” Kant said. “You don’t pay a penny and upload your prescriptions and bills later for us to verify.”
Adding to the convenience of using Even Healthcare is its internal electronic medical records system, which stores patient data with extreme layers of encryption and security and makes it interoperable within the doctors’ ecosystem.
“Because of all of this, we’re able to better control health outcomes,” Kant said.
Reviving the Family Doctor Ethos of Preventive Care
For all the NHS’s imperfections, its single-payer infrastructure provides a streamlined patient experience that decouples costs from care. Britons argue about the NHS’s effectiveness in political contexts, not at the point of purchase.
That’s what Even Healthcare strives to accomplish for Indian health consumers in a different context. Even Healthcare’s health plans stress cost and coverage transparency and aim to serve various constituencies.
Even Care, the company’s core product, provides free and unlimited consultations with Even Healthcare doctors through a 24/7 personal care team, such as the one outlined in the diabetes example above.
Other plans include group health insurance through partner insurers that fit the Indian model. Even Plus and Even Lite provide outpatient, inpatient, hospitalization, daycare, and emergency coverage. Both include free tests, tax savings, and free specialist consultations across India. Even Plus includes cashless hospitalization, emergency care across India, and family group coverage.
Although many Even Healthcare customers with traditional health insurance initially choose Even Care as a care supplement, significant numbers of those customers migrate to an insurance plan after they experience the service upgrade Even Healthcare provides.
“Because we can layer on the service experience, we’re able to provide a very strong member experience to people, even when they’re in the hospital,” Kant said. “For example, we have a claims buddy process where if you have an unfortunate incident of hospitalization, there’s a person attached to you who will do the paperwork, speak to the insurers, and get everything aligned for you so that all you focus on is your recovery.”
Even Healthcare allows health consumers to use India’s high-quality health infrastructure in a way that dispenses with complexity. It’s a model that can have applicability in other health markets, such as in the US, where transitioning to a single-payer system seems politically out of reach.
“In India, for the longest time, people had family doctors who knew everything about you and your family’s history,” Kant said. “We’re trying to bring that back through a more tech-first approach.”