‘NHA building Health Exchange Platform’

2 min read . Updated: 11 Dec 2022, 11:33 PM IST Priyanka Sharma

National Health Authority CEO R.S. Sharma

The Health Exchange Platform is a digital public good that aims to digitize the health insurance industry.

NEW DELHI : The National Health Authority (NHA) is setting up a health exchange platform that will digitize and simply the process of filing health insurance claims, NHA CEO R.S. Sharma said in an interview. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) will be the first insurance scheme in the world to implement this digital solution, with the platform to be rolled out in Haryana, followed by a pan-India launch. Sharma also spoke about the problem of the missing middle, NITI Aayog’s term for those who are not poor enough to be covered by government insurance, nor rich enough to afford private care.Edited excerpts:

What is being done to include the missing middle in PM-JAY as discussed in the NITI Aayog report?

Assuring accessibility of healthcare services at an affordable rate is at the core of PM-JAY. The scheme was launched with a beneficiary base of 107 million families and has now been expanded to 147 million families by the 33 states/UTs. NHA is working in collaboration with different ministries to expand the coverage of the PM-JAY ecosystem to the eligible population, who otherwise do not have access to healthcare protection. We are engaging with the NITI Aayog and other ministries to identify other missing groups and devise mechanisms to extend the healthcare protection to them by using different modes of financing. Recently, NHA entered into an MoU with the Ministry of Social Justice and Empowerment (MoSJE) to expand healthcare services to the transgender population.

What is the present status of the Health Exchange Platform?

The Health Exchange Platform is a digital public good that aims to digitize the health insurance industry. It is a simplified workflow with standardized communication protocol between payer and provider to enable digitization of claims processing for health insurance, in accordance with IRDAI guidelines. NHA plans to roll out the portal in Haryana. Later, it will be scaled to pan-India in a phased manner. This will make PM-JAY the first insurance scheme in the world to implement this digital solution. Meanwhile, NHA has published the sandbox for this gateway to encourage the players in market to develop digital solutions for health claims exchange.

How is NHA securing Ayushman Bharat Health Account (ABHA) and Ayushman Bharat Digital Mission (ABDM)?

Security and privacy are the core principles of the ABDM implementation. The entire ABDM architecture is based on a federated model where data stays where it is created and no data is stored centrally. Only the data of registries such as Health Facility Registry (HFR), Health Professional Registry (HPR) and Ayushman Bharat Health Account (ABHA) are stored, in a tier-3 cloud platform.

NHA has a Security Operation Centre (SOC) which monitors security postures (alerts and incidents) of cloud infrastructure. They also conduct security assessment of all NHA apps. On top of that, NHA has a team of security experts over and above security experts of Master Service Provider & Cloud Service Provider.

ABOUT THE AUTHOR

Priyanka Sharma

Priyanka Shamra is a health and pharma journalist with nearly nine years of field reporting experience. She is a special correspondent with Mint. Her beat includes covering the Ministry of Health and Department of Pharmaceuticals. She also covers the Ministry of Women and Child Development and the Department of Biotechnology.