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April - 2012 - issue > In Conversation
Opportunities Galore in Healthcare Industry Today
Vimali Swamy
Sunday, April 1, 2012
Tony Mira, Group CEO & Founder, Ajuba Solutions Pvt Ltd, shares his thoughts on the emerging opportunities in the healthcare BPO segment

How has health care outsourcing evolved over the last decade?

Over the last decade the health care system in the U.S. has become more and more complicated. The more the government meddles with the health care system the more complicated it becomes and the more opportunities it creates for companies like us to take advantage of the system. With HIPAA, ICD-10 transition, Accountable Care Organizations (ACOs), and electronic medical records, there will be greater pressure on the system to process the claims. With that complexity, health care providers need support from companies like us to maneuver through these changes.

How is Ajuba exploiting the opportunities presented by the new policies?

For the last couple of years the U.S. health care space is going through some major changes. One such major change is electronic medical records. This has become a major reform that is creating paperless information flow from the patient to the physician to the hospital to the insurance company. Another major reform is the ICD 9 conversion to ICD 10. This is a huge undertaking with over 30,000 codes being transferred into over 170,000 diagnosis codes. So there are various reforms and changes in the health care that is putting pressure on the sector in the U.S. and these pressures are creating opportunities for companies like Ajuba. Now we are helping maneuver our clients in the U.S. through these major changes.

Why this sudden transition from ICD 9 to ICD 10? What are the challenges involved in the transition?

U.S. is one of the last countries in the world to switch from ICD 9 to ICD 10; other countries in the world have been using ICD 10 for several years now. Once U.S. also adapts this global health care identification system, the industry will be able to better diagnose cases, better track diagnosis for better treatment. There is a large pool of employees who are experts in ICD 9; they know the 30,000 different codes of ICD 9 very well. Now, they have to get fully trained and certified in the 170,000 codes of ICD 10. This is a major pain point and this puts serious pressure on the system. For example, if they are coding 20 medical charts per hour in ICD 9, with ICD 10 they will not be able to do that. The coding has become so complex that their performance or efficiency will drop by at least 60 percent. So there will be a major shortage with the existing number of employees, as it is going to take more people to do the same amount of work.

There will be a certain number of medical coding experts in the U.S., who at their stage of career, are not ready to get trained in a new system. Instead they will opt for retirement or move away from the field. And the new comers are not going to be as productive or efficient as the veterans. These two factors are going to create immense pressure that is going to transform into opportunities for companies like Ajuba, who has the required expertise, and the technology advantages to be able to jump in and provide the resources, the services, and the staffing to the major health care players in the U.S.

What are plans of Ajuba for India?

We are presently concentrating on the U.S. market. Based on the new activities and opportunities in the U.S. we are both technologically and operationally getting ourselves in place to explore these opportunities. We are also expanding facility wise and are hiring additional people. All these are in order to meet the increasing demand that we are expecting to have soon.

How competitive is the health care outsourcing market?

The market is extremely competitive and equally fragmented. It is in a way similar to the Y2K time, everybody regardless of their experience is trying to grab a little of the pie. There are also players who are trying to cash in on the opportunity for a short term. In the end, only the best companies survive. We have been in the industry for several years now and are an exclusive health care boutique organization. We are investing time, technology and resources in the space to be a part of this change for a very long term and not a short term. There are not many companies in this space who have the bandwidth and longevity that Ajuba comes with.

A major change happening in the health care sector is that, the health care buyers are starting to become very careful on who they go with. With health care there are major compliance issues, fraudulent issues, and privacy issues, which can basically bankrupt the clients and the companies. Health care system will not pick anybody but the company that can provide the best resources, best solutions and has the best resources in place, to guaranty them the protection they need at a competitive price.

What will be the road ahead like?

The future plan is to continue doing what we do best, but to keep on adding resources, adding technology, and building infrastructure. We have a great foundation of people, process and technology, and we are trying to take that foundation and build on that. To this foundation we will add more human resources with the required expertise. We are also looking at different ways to service the market, through mobile technology, voice technology, electronic technology, and more.

The health care buyer is very technologically advanced and they are looking at different ways to do thing. When we go to our clients we do not tell them that this is the way we do the job, rather we let them tell us how they want it to be done and customize accordingly. We are an organization that works with the clients to solve their problems. We are a flexible and elastic organization that can customize and plug into the way our clients are doing the job.

Cheaper is not the way to do business in this space. You have to have the right solution and the right model. If you go into the space with the only advantage of having the cheaper solution, then you will only survive for a very short time. In order to take advantage of the opportunities, you will have to make the initial investment to put resources in place. At the end of day it is all about execution and quality.

(As told to Vimali Swamy)

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