Philhealth Link: Innovation

the

PHILHEALTHLINK PROJECT

What is the PhilHealth Link Project? A novel project initiated by PhilHealth Region Office 8 in compliance with DOH Administrative Order No. 0036, Series of 2010, or the Aquino Health Agenda. In this health reform program, PhilHealth was tasked to improve the management of the National Health Insurance Program through investments in modern information technology and innovations that will strengthen the linkages between members and providers with the PhilHealth Offices. This project will also address the lack of membership and contribution verification protocols and systems within the local health care system. Basically, it will make the hospital earn more from PhilHealth by lessening lost income caused by non-filing members. This project will enhance the communication lines between the PhilHealth office and our health care providers. It will make our system information available at the most integral part of the treatment process, admission.

Introduction: • PhilHealthLINK was first piloted in Northern Samar Provincial Hospital, Catarman, Northern Samar. • It was then dubbed as PhilHealth Membership Verification System with the main purpose of identifying who among those admitted in NSPH are PhilHealth members.

Proof of Concept: • Records at Northern Samar Provincial Hospital revealed that P-AdR increased from 19% to 55% in the first month of implementation (November 2010). It grew to 75% on the following month (December 2010).

PhilHealthLINK Communication Center • PhilHealthLINK Communication Center (PLCC) is a refinement on the Membership Verification System methodology. • It introduced the concept of PhilHealthLINK-Coordinators & PhilHealthLINKAgents

Aaawww… Admitted as Charity / Non-PhilHealth

Hindi ko alam.. Ano yan? PhilHealth? Ambot…

PROBLEMS: 1. Administrative cost for IEC; 2. Member retention on IEC; 3. Control on availment;

4. Convenience of members; 5. Technical support for hospitals.

SOLUTION:

POINT OF SERVICE Approach

PhilHealthLINK

Name, B-Day, Address of? 1. Patient 2. Spouse 3. Parents 4. Children

Member: Found / Not Found

PHILHEALTH CLERK

COORDINATOR

AGENT

Memorandum of Agreement: I. Province: • Remuneration AND PhilHealth Premiums of PL Coordinator and Agents; • Communication equipments; II. PhilHealth: • Allow access to PhilHealth Database; • Office space and other logistical requirements; • Supervision of PL-Agents detailed; • Provide statistical reports; • Formulate capability building initiatives.

Project Managers (Province/PhilHealth): 1. Reports to Office of the Provincial Governor/ Regional Vice-President; 2. Oversee Project Implementation; 3. Review existing Hospital policies and recommend enhancements 4. Review performance outputs and direct operation; 5. Venue to err-out concerns and sharing of best practices.

COST: Postpaid UnliCall/Text (P600/month)

PL - Coordinator: 1. Hospital based; 2. Reports to Chief of Hospital or Provincial Manager; 3. Gather pertinent data of ALL admissions; 4. COST: Existing Hosp. Personnel or Minimum Wage (P250/day)

PL - Agent: 1. PhilHealth based; 2. Reports to PLCC Supervisor; 3. Receives and Process data gathered by PLCoordinator; 4. COST: Lowest PhilHealth SG for JO’s (P400/day)

Coordinators

Agents

RVP

Project Manager

Center Head

Asst. Center Head

PL Agent

PL Agent

PL Agent

PL Agent

Membership Other Transactions No. of Days Province/Hospital Total No. of Members Percent Members Percent not MDR Contribution covered by calls Inquiries Found Found not Found Found Verified s Verified Northern Samar (8 out of 8 Hospitals participating) Northern Samar Prov. 177 Hospital 3608 2293 64% 1315 36% 0 0 Allen Dist. Hospital 171 871 779 89% 92 11% 0 0 GB Tan Mem. Hospital 177 113 76 67% 37 24% 0 0 San Antonio Dist. Hospital 143 11 7 64% 4 36% 0 0 Catubig District Hospital 145 307 248 81% 59 19% 0 0 Gamay District Hospital 145 165 124 75% 41 25% 0 0 Capul District Hospital 145 104 98 94% 6 6% 0 0 Biri District Hospital 145 4 4 100% 0 0% 0 0 Eastern Samar (10 out of 11 Hospitals with 1 RHU's participating)*remaining hospital not yet accredited (Homonhon District Hospital) Eastern Samar Prov. Hospital 160 1552 1006 65% 546 35% 0 5 Felipe Abrigo Mem. Hospital 177 945 609 65% 336 36% 0 1 Albino Duran Mem. Hospital 177 1014 750 65% 264 26% 0 0 Can-avid Mun. Hospital 177 344 257 65% 87 25% 0 0 Arteche Dist. Hospital 177 147 111 65% 36 24% 0 0 Llorente Mun. Hospital 175 76 63 65% 13 17% 0 0 Quinapondan Comm. Hospital 120 195 143 65% 52 27% 0 0 Gen. McArthur Mun. Hospital 171 128 81 65% 47 37% 0 0 Taft Dist. Hospital 177 160 113 65% 47 29% 0 0 Oras District Hospital 120 198 143 65% 55 28% 0 0 Dolores Municipal Hospital 135 182 121 65% 61 34% 0 0 RHU Lawaan 69 4 4 100% 0 0% 0 0

Province/Hospital

No. of Days covered by calls

Leyte (15 out 15 Hospitals with 2 RHU's participating) Leyte Prov. Hospital 177 Western Leyte Prov. Hospital Tabango Community Hospital Burauen District Hospital Ormoc District Hospital Hilongos District Hospital Schistosomiasis Hospital Villaba Comm. Hospital Tacloban City Hospital Abuyog District Hospital Carigara Dist. Hospital Kananga mun. Hospital

131 131 134 121 122 130 129 119 117 121 104

Northwestern Leyte Dist. Hosp 120 Dr. M.B. Veloso Mem. Hosp 114 EVRMC 127 RHU Tanauan 85 RHU Ipil 114 Biliran ( 1 out of 1 Hospital with 5 RHU's participating) Biliran Prov'l Hospital 121 RHU Almeria 121 RHU Biliran 121 RHU Naval 121 RHU Kawayan 121 RHU Caibiran 121 (3 out of 6 Hospitals participating) Western Samar Samar Prov'l Hospital 116 Basey District Hospital 138 Calbayog District Hospital 135 Southern Leyte (3 out of 7 Hospitals participating) Sogod District Hospital 92 Anahawan District Hospital 92

Padre Burgos Comm. Hospital Pintuyan District Hospital

92

Membership Members not Percent Found Found

Percent not Found

Other Transactions Contributions MDR Verified Verified

Total No. of Inquiries

Members Found

3437

2750

80%

687

20%

10

30

386

371

96%

15

4%

0

0

468 219 131 3 29 87 669 298 89 5

374 217 75 3 29 79 449 286 82 3

80% 99% 57% 100% 100% 91% 67% 96% 92% 60%

94 2 56 0 0 8 220 12 7 2

20% 1% 43% 0% 0% 9% 33% 4% 8% 40%

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

20 645 4 5 5

20 567 4 5 5

100% 88% 100% 100% 100%

0 78 0 0 0

0% 12% 0% 0% 0%

0 0 5 0 0

0 0 10 0 0

34 6 4 1 89 70

27 5 4 1 61 40

79% 83% 100% 100% 69% 57%

7 1 0 0 28 30

21% 17% 0% 0% 31% 43%

0 0 0 0 0 0

0 0 0 0 0 0

162 60 972

140 56 587

86% 93% 60%

22 4 385

14% 7% 40%

0 0 0

0 0 0

37 66

14 32

38% 48%

23 34

62% 50%

0 0

0 0

5

3

60% 0%

2

40%

0

0

Province Northern Samar Eastern Samar Western Samar Biliran Leyte Southern Leyte Total

No. of Days Total No. of Members covered by calls Inquiries Found 20 883 632 20 730 475 20 481 298 20 19 17 20 1333 996 20 16 8 3,462 2,426

Membership Other Transactions Percent Members Percent not MDR Contributio Found not Found Found Verified ns Verified 72% 251 28% 0 0 65% 255 35% 0 5 62% 183 38% 0 0 89% 2 11% 0 0 75% 337 25% 5 15 50% 8 50% 0 0 69% 1,036 31% 5 15

B. Calls Per Hospital/Province Province/Hospital

Samar Prov'l Hospital Basey District Hospital Calbayog District Hospital Total

Membership Other Transactions No. of Days Total No. of Members Percent Members Percent not MDR Contributio covered by calls Inquiries Found Found not Found Found Verified ns Verified Western Samar (3 out of 6 Hospitals participating) 20 0 0 305 204 67% 101 33% 20 13 8 62% 5 38% 0 0 20

163 481

86 298

53% 62%

77 183

47% 38%

0 0

0 0

ADMISSIONS FOR CY 2010 Calbayog District Hospital Samar Provincial Hospital Total

PhilHealth Non-PhilHealth 5 1,944 1,507 9,135 1,512 11,079

Total 1,949 10,642 12,591

% Availment 0% 14% 12%

PhilHealth Non-PhilHealth 587 385 140 22 522 299

Total 972 162 821

% Availment 60% 86% 64%

1,949 10,642 12,591

% Availment 40% 40% 40%

PhilHealthLINK JULY TO DECEMBER 2011 Calbayog District Hospital Samar Provincial Hospital

CY 2010 ADMISSIONS @ 40% AVAILMENT Calbayog District Hospital Samar Provincial Hospital Total

RETURN OF INVESTMENT PhilHealth Admssions Multiply: Average Value per Claim Total Less: Cost of Investment Net Income

PhilHealth Non-PhilHealth 780 1,169 4,257 6,385 5,036 7,555

5,036 8,500.00 42,806,000.00 38,852,100.00 3,953,900.00

ADMISSION FOR CY 2011 TOTAL ADMISSION

PHILHEALTH

% AVAILMENT

CAN-AVID MUNICIPAL HOSPITAL

1,282

280

22%

ORAS DISTRICT HOSPITAL

1,456

106

7%

11,198

3036

27%

ORMOC DISTRICT HOSPITAL

PHILHEALTHLINK (2012) TOTAL ADMISSION

PHILHEALTH

% AVAILMENT

CAN-AVID MUNICIPAL HOSPITAL

1014

562

55.42%

ORAS DISTRICT HOSPITAL

1062

321

30.23%

10768

4477

42%

ORMOC DISTRICT HOSPITAL

HOSPITALS

INCOME PER BED HOSPITAL NAME LEYTE

BILIRAN SOUTHERN LEYTE NORTHERN SAMAR EASTERN SAMAR SAMAR AVERAGE PER BED

2007 income 2008 income per bed per bed %

2009 income per bed %

2010 income per bed %

2011 income per bed %

38,270.05

36,549.57 -4%

61,794.39 69%

171,271.20

134,161.01 -22%

237,588.42 77%

19,252.09

24,438.97 27%

61,557.28 152%

74,018.52 20%

156,784.44 112%

26,543.83

24,191.46 -9%

37,981.90 57%

57,185.05 51%

29,452.34

23,350.05 -21%

35,768.60 53%

13,480.08

9,915.21 -26%

49,711.60

42,101.05 -15%

HOSPITAL NAME SAMAR

2013 income per bed %

bed capacit y

151,808.39 55%

279,264.58 84%

452,717.59 62%

965

262,228.53

361,010.90 38%

430,316.13 19%

75

167,412.67

7%

307,468.51 84%

245

93,171.00 63%

170,215.29 83%

253,988.51 49%

325

46,496.30 30%

63,858.58 37%

149,564.47 134%

241,189.72 61%

300

8,906.39 -10%

16,339.11 83%

28,889.98 77%

74,748.19 159%

186,833.18 150%

245

73,932.83 76%

88,873.78 20%

126,123.49 42%

200,369.35 59%

312,085.61 56%

2,155

2008

97,770.81 58%

2012 income per bed %

241,432.90

2009

2%

2010

2011

9%

2012

2013

-26%

-10%

83%

77%

159%

150%

SOUTHERN LEYTE

27%

152%

20%

112%

7%

84%

LEYTE

-4%

69%

58%

55%

84%

62%

EASTERN SAMAR NORTHERN SAMAR

-21%

53%

30%

37%

134%

61%

-9%

57%

51%

63%

83%

49%

BILIRAN AVERAGE PER BED

-22%

77%

2%

9%

38%

19%

-15%

76%

20%

42%

59%

56%

Hospital Participation Province

No. of Hospitals

PhilHealthLink

%

Leyte

15

15

100%

Northern Samar

8

8

100%

Biliran

1

1

100%

Eastern Samar

11

10

91%

Southern Leyte

6

5

83%

Western Samar

6

3

50%

DOH

2

1

100%

TOTAL

49

44

90%

Admission versus Inquiries 80,000

70,000

60,000

50,000

Leyte Northern Samar

40,000

Eastern Samar Southern Leyte

Biliran

30,000

Western Samar DOH

20,000

10,000

-

ADMISSION

2012 Total No. of Inquiries

2013Proj.

PhilHealthLink Status TOTAL 20% increase in calls

120,000

100,000

70% 68%

80,000

2012 2012 Inquiries 2012 Members Found

60,000

32%

2012 Members not Found

30%

Jan-August 2013 2013 Inquiries

40,000

Jan-August 2013 Members Found Jan-August 2013 Members not Found

20,000

0 2012 Inquiries

Members Found

Members not Found

2013 Inquiries

2012

Members Found

Members not Found

Jan-August 2013

2012 Province

TOTAL

2012 Members Inquiries Found

93,087

63,238

Jan-August 2013 Members Members 2013 Members not not Inquiries Found Found Found

29,849

111,366

77,930

33,437

PhilHealthLink Status CY 2012 Total Province ADMISS No. of ION Inquirie s Leyte

49,943

%

2013 (Jan-August)

Member s Found

%

Total Member No. of s not Inquirie Found s

%

Proj.

%

Membe rs Found

%

Member s not Found

44,690

89%

31,422

70% 13,268

34,874

70% 52,311 105%

39,615

76%

12,696

18,169

77%

13,021

72% 5,148

10,902

46% 16,353

69%

11,691

71%

4,662

12,581

98%

8,370

67% 4,211

7,629

60% 11,444

90%

7,766

68%

3,678

12,115

213% 7,800

64% 4,315

6,604

116% 9,906

174%

6,074

61%

3,833

Biliran 7,541 Southern Leyte 9,478

4,954

66%

2,355

48% 2,599

6,390

85%

9,585

127%

5,499

57%

4,086

472

5%

212

45% 260

4,247

45%

6,371

67%

3,917

61%

2,454

DOH

106

58

55% 48

3,598

3,369

62%

2,028

77,930

70%

Northern Samar 23,703 Eastern Samar 12,784 Western Samar 5,681

TOTAL

109,130

93,087

85%

63,238 68%

29,849

5,397

74,244 68% 111,366 102%

33,437

STATUS IN PERCENTAGE AND ABSOLUTE NUMBER - Leyte Call Volume (Found/Not-Found)

Call Volume (Found/Not-Found)

100%

90%

45,000 959 12,454

40,000

6,261

80%

12,454

35,000

70% 30,000 60% 25,000 Not-Found

50%

Found 40%

4,856 30,011

6,261

Found

20,000

19,458 15,000

30,011

30% 10,000

20%

5,000

10%

19,458 959 4,856

0%

2011 Calls

2012 Calls

2013 Calls

Not-Found

2011 Calls

2012 Calls

2013 Calls

PLINK IMPACT (BENEFIT PAYMENT-Leyte) 2011 - Benefit Payment 26,978,620 24%

Plink_BP 86,373,138 76%

Non_Plink_BP

2012 - Benefit Payment

2013 - Benefit Payment

55,285,242 26% Plink_BP

11,866,758 17%

161,273,245 74%

Plink_BP 59,127,743 83%

Non_Plink_BP

Non_Plink_BP

PhilHealthLink IMPACT TOTAL BENEFIT PAYMENT

Plink Payment

%

2011

341,961,466.01

62,722,883.85

18%

2012

541,734,676.98

304,369,509.64

56%

2013

194,545,266.49

124,017,730.69

64%

PhilHealthLink Status Total Beds

Cellph 2013 one Inquiries Coordi with nator Agent Load

Leyte Northern Samar Eastern Samar Southern Leyte

15

665

34,874

14

3

3

8

325

10,902

10

3

6

Tables Compu and Source ter Source Chairs Proposal 1 Phic and 2 tables/3 Comp;1 Province 2 Phic chairs table 3 comp; Phic o 3 chairs 1 table

11

300

7,629

11

2

2

Province

2

Phic

2

6

245

6,604

6

1

1

Phic

1

Phic

1

Biliran Western Samar

1

75

6,390

2

1

1

Phic

0

6

245

4,247

9

2

2

Phic

2

Phic

2

DOH

2

275

3,598

1

1

1

Phic

1

Phic

1

Tacloban

1

25

1

1

1

Phic

1

Phic

1

TOTAL

35

1490

40

11

Province Hospital

1166

7

1 chair

1 comp

PHILHEALTHLINK EXPANSION 2.0

BENEFIT PAYMENT OF RHUS

LGUS

# OF LGUS WITH NO INCOME OR LESS 200K IN # OF LGUS 2013

2010

2011

2012

2013 proj

growth 2012-2013

BILIRAN

8

1

233,021.88

320,702.73

502,581.64 524,257.03

104%

LEYTE

34

10

74,992.06

195,257.35

471,768.53 408,650.00

87%

EASTERN SAMAR

22

14

42,438.64

67,991.82

147,077.27 206,640.91

140%

SAMAR

14

11

1,428.57

70,850.00

214,778.57 197,542.86

92%

NORTHERN SAMAR

16

11

13,125.00

98,578.13

195,515.63 171,881.25

88%

SOUTHERN LEYTE

16

12

19,675.00

40,671.88

91,603.13

109,756.25

120%

PLINK IN RHUS No.

% Not Found Found

Inquiries

Found

Amount

39

36

3

92%

288,000.00

Eastern Samar RHU Lawaan 1

Leyte 2

RHU Tanauan

5

5

0

100%

40,000.00

3

RHU Javier

5

5

0

100%

40,000.00

4

RHU Ipil

5

5

0

100%

40,000.00

Biliran 5

RHU Almeria

6

5

1

83%

40,000.00

6

RHU Biliran

4

4

0

100%

32,000.00

7

RHU Culaba

14

12

2

86%

96,000.00

8

RHU Kawayan

139

104

35

75%

832,000.00

9

RHU Caibiran

70

40

30

57%

320,000.00

10

RHU Cabugcayan

3

3

0

100%

24,000.00

290

219

71

TOTAL

76% 1,752,000.00

WHAT IS THE GAME PLAN? WHAT DO WE NEED? 1. PHILHEALTH DOH ORDER 2. MANPOWER AND LOGISTICS 3. TRAINING 4. INCENTIVE

Thank you Be POSITIVE This Can Be Done!!!