Medi Assist is a big deal in India’s health insurance sector. The largest third-party administrator (TPA) in the country by a considerable distance, it has been a lifeline to health insurers since its inception in 1999, nearly two decades ago. TPAs, for those unfamiliar, are organisations that help coordinate the claims settlement process for health insurers.
Medi Assist was the product of the Insurance Regulatory and Development Authority’s (IRDA) realisation that processing health insurance claims in-house was neither feasible nor sustainable for insurers. In response, it opened the door for TPAs in 2001. TPAs, IRDA reasoned, were critical to ensuring that people trusted that large health insurers would be nimble enough to respond to individual claims in a timely manner. Insurers could outsource their claims processing to TPAs, who could achieve economies of scale by working with multiple insurers as well as corporates. By the early 2000s, TPAs had begun to mushroom throughout the country. But even in this sprawl, Medi Assist stood out.
Aggressive, ambitious and determined to win, Medi Assist hired the best talent in the industry—including former senior officials from public insurance companies. It forged alliances with large insurers and corporates, and as health insurance premiums grew from over Rs 1,000 crore ($135.7 million) in 2002-03 to Rs 30,392 crore ($4.12 billion) in 2016-17, Medi Assist grew to become India’s largest TPA.
Along the way, Medi Assist has navigated some serious challenges. For example, when large insurance companies began moving their administration in-house instead of outsourcing it to TPAs. In response, Medi Assist decided to develop a strong portfolio of corporates—including IT consulting giants Infosys and TCS—which ensured it kept a sizable chunk of the group insurance business. Group insurance accounts for nearly 40% of the entire health insurance sector. As of today, Medi Assist’s group insurance portfolio rakes in premiums worth Rs 4,800 ($651.3 million) crores. This accounts for four-fifths of the Rs 6,000 crore ($814.1 million) of health insurance premiums serviced by Medi Assist and almost a third of all premiums collected under group policies in 2016-2017—Rs 14,718 crore ($2 billion).
These survival instincts also led Medi Assist to diversify into a tech-heavy managed care company under the Medi Buddy brand in 2015. This was in response to public insurers—who have over 60% market share when it comes to health insurance—deciding to float their own TPA.
Today, Medi Assist employs nearly 5,500 people. Given that it works with over 20 insurers, close to 6,000 corporates, and over 13,000 empanelled healthcare providers, it is arguably the largest storehouse of digital health data in India. Around 10,000 of the hospitals empanelled with Medi Assist share structured data digitally via Medi Buddy. Now it is expanding into a one-stop shop for everything healthcare—wellness, preventive care, pharmacy and doctor consultations.
But this expansion won’t prove easy.