The National Health Authority (NHA), under the Union Ministry of Health and Family Welfare (MoHFW), has reviewed the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and the Ayushman Bharat Digital Mission (ABDM), with a focus on expanding beneficiary coverage, improving healthcare delivery, strengthening financial protection and accelerating digital health adoption.
A two-day National Review Meeting, held in Kolkata on November 5 and 6, brought together senior officials from States and Union Territories to assess the progress of the two flagship initiatives and draw up priorities for their next phase of implementation.
The discussions focused on using technology, data analytics, automation and artificial intelligence (AI) to improve operational efficiency, transparency, accountability and health outcomes.
Addressing the meeting, NHA Chief Executive Officer Dr. Sunil Kumar Barnwal said the next phase must move beyond expanding coverage to ensuring that beneficiaries receive better-quality healthcare.
“Every rupee spent on healthcare must lead to better care for our people,” he said, emphasising that technology, data and AI could strengthen implementation and support more informed decision-making. He added that the focus must increasingly shift from financing treatment to achieving better health outcomes.
Barnwal also highlighted the progress made in West Bengal following its integration with the national AB PM-JAY platform, noting that more than four crore Ayushman Cards had been generated within a short period.
West Bengal enrols 4.2 crore beneficiaries under AB PM-JAY
West Bengal Chief Secretary Manoj Kumar Aggarwal said the state was committed to strengthening the implementation of AB PM-JAY and making it more comprehensive and people-centric.
He stressed that financial protection during hospitalisation must be complemented by a strong primary healthcare system to promote preventive care, enable early detection of diseases and reduce the burden on hospitals.
“Healthcare should never push a family into poverty. AB PM-JAY is a game changer in ensuring healthcare security for every eligible family,” he said.
West Bengal Principal Secretary, Department of Health and Family Welfare, Narayan Swaroop Nigam said the state had joined AB PM-JAY as the 36th participating state. Since the scheme’s launch in West Bengal on August 16, 2026, around 4.2 crore beneficiaries have been enrolled and 2.2 lakh people have received treatment under it.
He described AB PM-JAY and ABDM as complementary pillars of healthcare transformation, combining financial protection with digital empowerment.
Focus on wider coverage, fraud prevention and faster claims
The review examined measures to ensure that all eligible beneficiaries are covered under AB PM-JAY and are adequately informed about the scheme’s benefits. Officials also discussed ways to improve the adoption of ABDM across healthcare facilities and coordinate the implementation of both initiatives to provide seamless access to services.
Strengthening claims processing and preventing fraud were important areas of deliberation. A dedicated session on the National Anti-Fraud Unit (NAFU) and auto-adjudication examined the role of automation in claims settlement, including its impact on processing time, operational costs and the quality of adjudication.
The meeting emphasised regular fraud reviews, stronger monitoring systems and improved institutional capacity of State Anti-Fraud Units to ensure transparency and accountability.
Officials also reviewed the operationalisation of the National Health Claims Exchange (NHCX). They highlighted the need for ABDM-enabled Hospital Information Systems in empanelled hospitals to facilitate integration with the platform, expedite claims processing and improve the accuracy of adjudication.
Digital health facilities and AI-based solutions
The meeting reviewed the Model Digital Health Facility Framework and implementation experiences from Tripura. Discussions highlighted that successful digitisation requires more than installing digital systems. It also involves redesigning institutional workflows, improving processes and regularly training healthcare personnel.
The role of AI in strengthening healthcare systems was another key area of discussion. Prof. Phaneendra Yalavarthy of TANUH, IISc Bengaluru, presented the Benchmarking Open Data Platform for Health AI (BODH), which enables the evaluation of health AI models using Indian datasets.
States were encouraged to use the platform to assess the performance and suitability of AI solutions before adopting them and to incorporate BODH-based benchmarking into their healthcare AI procurement processes.
The Health Analytics and Artificial Intelligence Unit (HAAU) also presented findings on data quality. The discussions underlined the need to strengthen institutional capacity for data analytics and evidence-based decision-making. States committed to establishing dedicated analytics and AI teams to support planning and targeted interventions.
Sandbox 2.0 demonstrates AI-assisted ABDM integration
A demonstration of Sandbox 2.0, enhanced with agentic AI capabilities, showcased how AI-assisted tools could simplify and speed up ABDM integration.
During the demonstration, an ABDM Milestone 1 integration for ABHA creation was completed in real time. The exercise illustrated the potential to reduce technical effort and integration time, facilitating faster onboarding of technology partners and Hospital Information System providers while reducing dependence on manual technical support.
The meeting also featured a demonstration of NHA’s Ambient AI-enabled Voice Scribe, which converts doctor-patient conversations into structured clinical records in multiple Indian languages. Doctors review and approve the records before they are linked to ABHA.
The technology is expected to reduce the documentation burden on doctors, streamline clinical workflows and accelerate the digitisation of healthcare facilities.
Cybersecurity and health financing among key priorities
On the second day, discussions covered health financing models, convergence of health schemes, digital integration and cybersecurity.
Dr. Darez Ahamed, Secretary, Health and Family Welfare, Government of Tamil Nadu, shared the state’s experience in implementing insurance and assurance-based health coverage models. The discussion highlighted the importance of selecting a model suited to the risks being addressed, supported by ring-fenced funds and timely payments to hospitals.
The session on scheme convergence explored the possibility of States using NHA’s IT platform to implement their own health schemes. Its existing health benefit packages, empanelled hospital network and fraud-detection mechanisms were discussed as potential tools for standardising implementation and strengthening monitoring.
Given the sensitive nature of information handled by national digital health platforms, cybersecurity received particular attention. Officials discussed threats such as phishing attacks, fraudulent websites and applications, credential leaks and third-party vulnerabilities.
States were advised to designate dedicated cybersecurity leads, strengthen authentication and access controls, and conduct regular security audits of applications and APIs to protect digital health infrastructure and health data.
The two-day meeting comprised 15 sessions covering programme implementation, operational efficiency, digital health infrastructure and emerging technological interventions.
The review concluded with a shared roadmap for the next phase of AB PM-JAY and ABDM, emphasising sustained Centre-State coordination, wider beneficiary coverage, timely access to quality healthcare, stronger financial protection and improved health outcomes.
The Ministry reiterated its commitment to strengthening both initiatives through effective implementation, secure and interoperable digital systems, reliable data, robust monitoring and the responsible adoption of emerging technologies.
(PIB)
