PHILHEALTH LINK: INNOVATION

8/11/2019 PHILHEALTH LINK: INNOVATION

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the

PHILHEALTHLINK

PROJECT


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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 moderninformation 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 linesbetween 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.


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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 CenterPhilHealthLINK Communication Center (PLCC) is a refinement on the

Membership Verification System methodology.

It introduced the concept of PhilHealthLINK-Coordinators & PhilHealthLINK-

Agents


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PhilHealth?

Ambot

Aaawww Admitted as

Charity / Non-PhilHealthHindi ko alam..

Ano yan?


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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 SERVICEApproach

PhilHealthLINK


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Name, B-Day, Address

of?1. Patient

2. Spouse

3. Parents

4. Children

Member:

Found /Not Found


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COORDINATOR AGENT

PHILHEALTH

CLERK


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Project Managers (Province/PhilHealth):

1. Reports to Office of the ProvincialGovernor/ 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 sharingof best practices.

PL - Coordinator:

1. Hospital based;2. Reports to Chief of Hospital or Provincial Manager;

3. Gather pertinent data of ALLadmissions;4. COST: Existing Hosp. Personnel or Minimum Wage

P250/da

PL - Agent:

1. PhilHealth based;

2. Reports to PLCC Supervisor;

3. Receives and Process data gathered by PL-Coordinator;

4. COST:Lowest PhilHealth SG for JOs (P400/day)

Memorandum of Agreement:

I. Province:

Remuneration ANDPhilHealth Premiums of

PL Coordinator and Agents;

Communication equipments;

II. PhilHealth:

Allow access to PhilHealth Database;

Office space and other logisticalrequirements;

Supervision of PL-Agents detailed; Provide statistical reports;

Formulate capability building initiatives.

COST: Postpaid UnliCall/Text

(P600/month)


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Coordinators Agents


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Project

Manager

Center Head

Asst. Center

Head

RVP

PL Agent

PL Agent

PL Agent

PL Agent


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Province/HospitalNo. of Days

covered by calls

Membership Other Transactions

Total No. of

Inquiries

Members

Found

Percent

Found

Members

not Found

Percent not

Found

MDR

Verified

Contribution

s Verified

Northern Samar (8 out of 8 Hospitals participating)

Northern Samar Prov.

Hospital 177 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


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Province/HospitalNo. of Days covered

by calls


Total No. of

Inquiries

Members

FoundPercent Found

Members not

Found

Percent not

FoundMDR Verified

Contributions

Verified

Leyte (15 out 15 Hospitals with 2 RHU's participating)

Leyte Prov. Hospital 177 3437 2750 80% 687 20% 10 30

Western Leyte Prov. Hospital 131386 371 96% 15 4% 0 0

Tabango Community Hospital 131 468 374 80% 94 20% 0 0

Burauen District Hospital 134 219 217 99% 2 1% 0 0

Ormoc District Hospital 121 131 75 57% 56 43% 0 0

Hilongos District Hospital 122 3 3 100% 0 0% 0 0

Schistosomiasis Hospital 130 29 29 100% 0 0% 0 0

Villaba Comm. Hospital 129 87 79 91% 8 9% 0 0

Tacloban City Hospital 119 669 449 67% 220 33% 0 0

Abuyog District Hospital 117 298 286 96% 12 4% 0 0

Carigara Dist. Hospital 121 89 82 92% 7 8% 0 0

Kananga mun. Hospital 104 5 3 60% 2 40% 0 0

Northwestern Leyte Dist. Hosp 120 20 20 100% 0 0% 0 0

Dr. M.B. Veloso Mem. Hosp 114 645 567 88% 78 12% 0 0

EVRMC 127 4 4 100% 0 0% 5 10

RHU Tanauan 85 5 5 100% 0 0% 0 0

RHU Ipil 114 5 5 100% 0 0% 0 0

Biliran ( 1 out of 1 Hospital with 5 RHU's participating)

Biliran Prov'l Hospital 121 34 27 79% 7 21% 0 0

RHU Almeria 121 6 5 83% 1 17% 0 0

RHU Biliran 121 4 4 100% 0 0% 0 0

RHU Naval 121 1 1 100% 0 0% 0 0RHU Kawayan 121 89 61 69% 28 31% 0 0

RHU Caibiran 121 70 40 57% 30 43% 0 0

Western Samar (3 out of 6 Hospitals participating)

Samar Prov'l Hospital 116 162 140 86% 22 14% 0 0

Basey District Hospital 138 60 56 93% 4 7% 0 0

Calbayog District Hospital 135 972 587 60% 385 40% 0 0

Southern Leyte (3 out of 7 Hospitals participating)

Sogod District Hospital 92 37 14 38% 23 62% 0 0

Anahawan District Hospital 92 66 32 48% 34 50% 0 0

Padre Burgos Comm. Hospital 925 3 60% 2 40% 0 0

Pintuyan District Hospital 0%


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Province No. of Dayscovered by calls

Membership Other TransactionsTotal No. of

Inquiries

Members

Found

Percent

Found

Members

not Found

Percent not

Found

MDR

Verified

Contributio

ns Verified

Northern Samar 20 883 632 72% 251 28% 0 0

Eastern Samar 20 730 475 65% 255 35% 0 5

Western Samar 20 481 298 62% 183 38% 0 0

Biliran 20 19 17 89% 2 11% 0 0

Leyte 20 1333 996 75% 337 25% 5 15

Southern Leyte 20 16 8 50% 8 50% 0 0

Total 3,462 2,426 69% 1,036 31% 5 15

B. Calls Per Hospital/Province

Province/HospitalNo. of Days

covered by calls


Total No. of

Inquiries

Members

Found

Percent

Found

Members

not Found

Percent not

Found

MDR

Verified

Contributio

ns Verified

Western Samar (3 out of 6 Hospitals participating)

Samar Prov'l Hospital 20 305 204 67% 101 33% 0 0

Basey District Hospital 20 13 8 62% 5 38% 0 0Calbayog District

Hospital20

163 86 53% 77 47% 0 0

Total 481 298 62% 183 38% 0 0


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ADMISSIONS FOR CY 2010

PhilHealth Non-PhilHealth Total % Availment

Calbayog District Hospital 5 1,944 1,949 0%

Samar Provincial Hospital 1,507 9,135 10,642 14%Total 1,512 11,079 12,591 12%

PhilHealthLINK JULY TO DECEMBER 2011

PhilHealth Non-PhilHealth Total % Availment

Calbayog District Hospital 587 385 972 60%

Samar Provincial Hospital 140 22 162 86%

522 299 821 64%

CY 2010 ADMISSIONS @ 40% AVAILMENT

PhilHealth Non-PhilHealth % Availment

Calbayog District Hospital 780 1,169 1,949 40%

Samar Provincial Hospital 4,257 6,385 10,642 40%

Total 5,036 7,555 12,591 40%

RETURN OF INVESTMENT

PhilHealth Admssions 5,036

Multiply: Average Value per Claim 8,500.00

Total 42,806,000.00

Less: Cost of Investment 38,852,100.00

Net Income 3,953,900.00


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ADMISSION FOR CY 2011

TOTAL ADMISSION PHILHEALTH % AVAILMENT

CAN-AVID MUNICIPAL HOSPITAL 1,282 280 22%

ORAS DISTRICT HOSPITAL 1,456 106 7%

ORMOC DISTRICT HOSPITAL 11,198 3036 27%

PHILHEALTHLINK (2012)

TOTAL ADMISSION PHILHEALTH % AVAILMENT

CAN-AVID MUNICIPAL HOSPITAL 1014 562 55.42%

ORAS DISTRICT HOSPITAL 1062 321 30.23%

ORMOC DISTRICT HOSPITAL 10768 4477 42%


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HOSPITALS


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INCOME PER BEDHOSPITAL

NAME

2007 income

per bed

2008 income

per bed %

2009 income

per bed %

2010 income

per bed %

2011 income

per bed %

2012 income

per bed %

2013 income

per bed %

bed

capacit

y

LEYTE 38,270.05 36,549.57 -4% 61,794.39 69% 97,770.81 58% 151,808.39 55% 279,264.58 84% 452,717.59 62% 965

BILIRAN 171,271.20 134,161.01 -22% 237,588.42 77% 241,432.90 2% 262,228.53 9% 361,010.90 38% 430,316.13 19% 75

SOUTHERN

LEYTE 19,252.09 24,438.97 27% 61,557.28 152% 74,018.52 20% 156,784.44 112% 167,412.67 7% 307,468.51 84% 245

NORTHERN

SAMAR 26,543.83 24,191.46 -9% 37,981.90 57% 57,185.05 51% 93,171.00 63% 170,215.29 83% 253,988.51 49% 325

EASTERN

SAMAR 29,452.34 23,350.05 -21% 35,768.60 53% 46,496.30 30% 63,858.58 37% 149,564.47 134% 241,189.72 61% 300

SAMAR 13,480.08 9,915.21 -26% 8,906.39 -10% 16,339.11 83% 28,889.98 77% 74,748.19 159% 186,833.18 150% 245

AVERAGE

PER BED 49,711.60 42,101.05 -15% 73,932.83 76% 88,873.78 20% 126,123.49 42% 200,369.35 59% 312,085.61 56% 2,155

HOSPITAL NAME 2008 2009 2010 2011 2012 2013

SAMAR -26% -10% 83% 77% 159% 150%

SOUTHERN LEYTE 27% 152% 20% 112% 7% 84%

LEYTE -4% 69% 58% 55% 84% 62%

EASTERN SAMAR -21% 53% 30% 37% 134% 61%

NORTHERN

SAMAR -9% 57% 51% 63% 83% 49%

BILIRAN -22% 77% 2% 9% 38% 19%

AVERAGE PER

BED -15% 76% 20% 42% 59% 56%


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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%


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-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

ADMISSION 2012 Total No. of Inquiries

2013Proj.

Leyte

Northern Samar

Eastern SamarSouthern Leyte

Biliran

Western Samar

DOH

Admission versus Inquiries


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PhilHealthLink Status

0

20,000

40,000

60,000

80,000

100,000

120,000

2012Inquiries

MembersFound

Membersnot Found

2013Inquiries

MembersFound

Membersnot Found

2012 Jan-August 2013

TOTAL

2012 2012 Inquiries

2012 Members Found

2012 Members not Found

Jan-August 2013 2013 Inquiries

Jan-August 2013 Members Found

Jan-August 2013 Members not Found

30%

Province

2012 Jan-August 2013

2012

Inquiries

Members

Found

Members

not

Found

2013

Inquiries

Members

Found

Members

not

Found

TOTAL 93,087 63,238 29,849 111,366 77,930 33,437

68%

32%

70%

20%increase

in calls


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Province

CY 2012 2013 (Jan-August)

ADMISS

ION

TotalNo. of

Inquirie

s

%Member

s Found%

Member

s not

Found

TotalNo. of

Inquirie

s

% Proj. %

Membe

rs

Found

%

Member

s not

Found

Leyte 49,943 44,690 89% 31,422 70% 13,268 34,874 70% 52,311 105% 39,615 76% 12,696

Northern

Samar 23,703 18,169 77% 13,021 72% 5,148 10,902 46% 16,353 69% 11,691 71% 4,662

Eastern

Samar 12,784 12,581 98% 8,370 67% 4,211 7,629 60% 11,444 90% 7,766 68% 3,678

Western

Samar 5,681 12,115 213% 7,800 64% 4,315 6,604 116% 9,906 174% 6,074 61% 3,833

Biliran 7,541 4,954 66% 2,355 48% 2,599 6,390 85% 9,585 127% 5,499 57% 4,086Southern

Leyte 9,478 472 5% 212 45% 260 4,247 45% 6,371 67% 3,917 61% 2,454

DOH 106 58 55% 48 3,598 5,397 3,369 62% 2,028

TOTAL 109,130 93,087 85% 63,238 68% 29,849 74,244 68% 111,366 102% 77,930 70% 33,437

S S C G


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STATUS IN PERCENTAGE AND

ABSOLUTE NUMBER - Leyte

4,856

959

30,011

12,454

19,458

6,261

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 Calls 2012 Calls 2013 Calls

Call Volume(Found/Not-Found)

Not-Found

Found

4,856

959

30,011

12,454

19,458

6,261

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2011 Calls 2012 Calls 2013 Calls

Call Volume(Found/Not-Found)

Not-Found

Found

PLINK IMPACT (BENEFIT PAYMENT L )


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PLINK IMPACT (BENEFIT PAYMENT-Leyte)

26,978,62024%

86,373,13876%

2011 - Benefit Payment

Plink_BP

Non_Plink_BP

161,273,24574%

55,285,24226%


Plink_BP

Non_Plink_BP

59,127,74383%

11,866,75817%


Plink_BP

Non_Plink_BP


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PhilHealthLink IMPACT

TOTAL BENEFITPAYMENT 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%


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Province HospitalTotal

Beds

2013

Inquiries Coordi

nator Agent

Cellph

one

with

Load Source

Compu

ter Source

Tables

and

Chairs Proposal

Leyte 15 665 34,874 14 3 3

Phic and

Province 2 Phic

2 tables/3

chairs

1

Comp;1

table

Northern

Samar 8 325 10,902 10 3 6 Phic o 3 chairs

3 comp;

1 tableEastern

Samar 11 300 7,629 11 2 2 Province 2 Phic 2

Southern

Leyte 6 245 6,604 6 1 1 Phic 1 Phic 1

Biliran 1 75 6,390 2 1 1 Phic 0 1 chair 1 comp

Western

Samar 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 1166 1 1 1 Phic 1 Phic 1

TOTAL 35 1490 40 11 7


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PHILHEALTHLINK

EXPANSION 2.0


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BENEFIT PAYMENT OF RHUS

LGUS # OF LGUS

# OF LGUS

WITH NOINCOME OR

LESS 200K IN

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%


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WHAT IS THE GAME PLAN?


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WHAT IS THE GAME PLAN?

WHAT DO WE NEED?

1. PHILHEALTH DOH ORDER

2. MANPOWER AND LOGISTICS

3. TRAINING

4. INCENTIVE


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Thank you

Be POSITIVE

Th is Can Be

Done!!!

PHILHEALTH LINK: INNOVATION

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