1. Free Paper Bonne Sante’16 25th Aug’16
C M C H I S T N
Free Paper
Bonne Sante’16
25th Aug’16

2. About us.. Vidal Health TPA Pvt. Ltd. Established in April 2002
IRDA license : to
Handle more than 28 million lives
Largest Hospital Network in India
hospitals in 813 locations
2000+ corporate and govt. Clients
5 Million plus Enrolment contract for FY in RSBY
India’s 1st TPA to have ISO 9001:2008 &ISO 22301:2012
Among few companies to have ISO 27001:2013
Vidal Healthcare Services Pvt. Ltd. is the holding company of Vidal Health TPA Pvt. Ltd. (Formerly ttk Healthcare TPA Pvt. Ltd.) Vidal Healthcare Services has established itself as a preferred provider of integrated health and wellness solutions that include workplace wellness programs and worksite clinics to the corporate sector in India.

3. Proud Of...

4. Certification & Recognition
ISO 22301:2012 certification for
Business Continuity Management System.
ISO 9001:2008 certification for all operational processes
ISO 27001:2013 certification for Information security
CII- EXIM Bank award for Business Excellence in the SME category
1st TPA in India to be certified ISO 9001:2008 & ISO 22301:2012 together
One of the few TPAs in India to have IS security certification and only TPA awarded by EXIM Bank
We are open for external IT / IS Audits

5. Our Role in CMCHIS

6. Our Pride – Tamil Nadu Chief Minister Scheme
Lead TPA with 40% - Share Handling 14 districts-Covering 167Cr Lives
Particular
Count
Business Share
40%
Experience in District
22/32
Families
62 Lakh
Lives
167 Cr
Claims Settled #.
6.57 lakh
Claims Settled Amt.
1100 Cr.

7. Physical Cards available
Operation Excellence-Administration( TATS)
End to end administration support for a seamless experience
Focus on quality, efficiency and accuracy
Enrolment
T.A.Ts
Smart Cards Same Day
Pre-authorization
& discharge
6* hours
Claims Processing
3* working days
Call centre Grievances
Immediate Response
Physical Cards available
* In Average

8. Smart Card Enrolment & Distribution
97% Smart Card Enrolled & Distributed

9. Claims Handling

10. Contribution towards CMCHIS
Quality
Through stringent Internal Processes & Systems for :
a. TAT
b. Scrutiny of Preauths & Claims .
c. Qualitative balancing of the interests of beneficiaries , Hospitals and Insurer .
d. Prompt redressal of Grievances.
Service to beneficiaries
Effectively coordinated with Hospitals in performing Health Camps ,even in far off areas and areas in need ,to increase screening & curb Communicable diseases.
Eg. Monsoon Camps, Mega Health Camps in Pudukottai by top Tertiary Healthcare providers.

11. Health Camp & Mega Camp
Nearly 6000 Health Camp & 450 Mega Health Conducted
Successfully Mega Camp conducted in Pudukottai District Feb’16

12. Achievements Immediate Grievance Redressals.
Identified deviations from CMCHIS norms leading around 25 Hospitals to undergo disciplinary action , thus protecting patients’ interests & safeguarding quality concerns.
No deviation from TAT till date.
Arranged refunds of around Rs 28 lakh from the Hospitals to aggrieved beneficiaries in cases of money collection over & above package rates.

13. UIIC Appreciation Recognition of TN Scheme Health Camp
Implementation of the Project
Received From District Collectors

14. Critical Analysis of CMCHIS
Equality , Accessibility, Quality
Improved peoples’ confidence in Healthcare system& Helped Increase Life expectancy
Health is Wealth A Healthy population leads to faster Human Development , which is being realised in TN. The Scheme is contributing immensely towards the goal of “Health for All” & placed Tamil Nadu on an accelerated path towards Universal Health Coverage.
All top Tertiary health care providers are part of CMCHIS and expensive procedures such as Liver Transplant , Cochlear Implantation , advanced procedures such as Stem Cell transplantation are covered.
Drastic fall in out of pocket expenditure on Healthcare, preventing BPL families from vicious cycle of poverty.

15. Strengthening of Govt Health Systems
Patient migration from Govt to Private Hospitals ,even for complex procedures has come down.
Today, despite the option of Corporate Hospitals, people are going to Govt Hospitals even for Advanced Tertiary care procedures .
Visible improvements in Govt infrastructure & taking up of complex procedures.
Today ,many Govt Hospitals are on the path of NABH accreditation. Eg. Paramakudi GH – NABH accredited.
Patients aren’t waiting for expensive implants in Govt Hospitals due to CMCHIS.

16. PARAMAKUDI GH ,Ramanathapuram Dt – N A B H Accredited
Ramanathapuram GH

17. Providing hope & faster healthcare solutions
1. Cashless system- Providing hope & immediate healthcare for Haemodialysis, Cancer care, Cardiology , Emergencies and many life threatening illnesses. 2.Providing Follow Up ,with Food and transportation led to better surgical outcomes. 3. Diagnostic procedures helped screening many serious illnesses and leading to early detection and management. 4.CMCHIS has become an exemplary & succesful Healthcare model for other Indian states and gained international recognition.

18. Suggestions Quality Expanding coverage More Technology solutions
Implementation of NABH criteria
More Technology solutions
For enrolment & beneficiary data.
Misuse & Fraud identification.
Increase in Sum Insured
To cater to the whole family for
the year in case of unexpected
/ additional illnesses .
Expanding coverage
To include Geriatrics ,
Wellness packages etc.
Increasing Flexibility
To cover any lifesaving
treatment if indicated, for
BPL families through a
TNHSP-UIIC Committee approval
from Corpus Fund – No BPL
patient may die for unaffordability
in healthcare.
Coverage to APL families

19. Thank you