You are on page 1of 7

11 May 2012

President & CEO

Message from the

Dear Colleagues,

In six months time, we have seen steps, leaps, and bounds towards universal coverage. We are seeing more excitement in PhilHealth than we have seen in a long time and I would like to thank everyone for such a quick and massive response. Imperfections are natural at this point, but we must stay committed to continuously improving and just getting things done. Remember our Corporate Thrusts. Undertaking systemic and sometimes uncomfortable organizational strengthening measures equips us to provide better products and services. Simpler, broader benefits and easier transaction services create better experiences for our customers. As we continue to show that we offer something worth paying for, our membership base will increase. This increase in market share will give us greater influence over the behavior of health care providers. And doing so in a manner that steers the industry towards efficiency, equity, and security will secure better health outcomes for all our members and the nation as a whole. You will find that everything weve been so busy with attack at least one thrust area while enabling othersan orchestrated movement where each component supports another.

For membership, weve always known that voluntary membership is problematic and to provide sufficient support, we need to keep our premiums at a certain level, therefore the poorest quintiles will always need some form of subsidy. Therefore the strategy is to expand the formal sectorenroll what we can enroll in groups (whether formally employed or through less formal groups) and make sure these groups, especially the large ones, are contributing properly. Then we do everything we can to ensure that the poorest segments are being covered by government. Maximizing these two areas will minimize the voluntary segment or IPP. This segment we attack by strengthening our value propositionmaking our benefits such a good investment and our services so convenient that enrollment becomes a no-brainer. For benefits, two things: Simple and staggering. Developing a per-case payment scheme and fixing its implementation will allow members to know exactly what they can count on from us, and this clarity creates empowerment. Expanding benefits to cover health care needs we didnt used to ensures that we provide the totality of carefrom prevention to cure, for the young and old, from the cheapest to the most catastrophic. For services, nothing less than customer delight. We inform, we guide, we empower every member, and we imbue our transactions with the speed and ease to rival those of the best customer service companies. For health care providers, we ensure the quality and accessibility of care. We will develop the leverage we need to compel providers to treat our members properly and set up shop at isolated and difficult areas. This begins by knowing who these providers are and how they operate. We broaden our membership base to convince them to partner with us: Instead of servicing 10-15% of the market, we will offer them over 94 million Filipinos as long as they can make sure these people are cared for.

08 May 2012

Finally, we strengthen our ability to deliver. For organizational strengthening, we go back to the drawing board. We revisit our goals and strategy, we identify the areas we need to excel in, and we align everythingour finances, our human resources, and the way we generate our business intelligenceto these. After a comprehensive approach is designed, we move. Hindi puro plano. Dapat, panalo. In addition, we also fix our IT systems so that these really facilitate our business, we try out more effective team structures, and we generate the information we need for decision-makingwhether these are hospital profiles, performance data, or in-depth analyses. Remember our battle cry as we saturate the industry with our initiatives: Bawat Pilipino, miyembro; Bawat miyembro, protektado; Kalusugan natin, segurado. This is our goal and we will besiege the corporation and the wider industry with reforms until we get there. And truly, it has been an onslaught. I am proud to present updates on some of the initiatives the corporation is working on. I hope these show you the importance of your work and how it contributes to a comprehensive and strategic solution. Let these demonstrate our collective wisdom and energythat we see the problems, we know our responsibilities, and we have launched an assault. Read on with this in mind: How can I be part of the solution today?

Case Rates and No Balance Billing A per-case payment scheme was implemented to provide clarity and predictability to customers, enhance the speed and efficiency of our transactions, and control costs. It also facilitates No Balance Billing (NBB), allowing our poorest countrymen to access health care with zero co-payment, and soon other classes as well.
At present, we have rates for 23 conditions. Assessment of the first 23 case rates has commenced and more than 20 professional medical societies have been invited to take part in this. Around 29 more are being developed and together these constitute about 80% of the most commonly reimbursed conditions. The new case rate groupings have been sent to the PROs and various professional medical societies, and consultations are ongoing. In order to ensure that PhilHealth members, specially those belonging to the sponsored program, are able to fully reap the benefits of the case rates and no balance billing policy, two circulars shall be released within the month. First is the circular defining what an NBB bed entails and providing specific measures to ensure that patients know what they are entitled to. Second is the circular detailing sanctions on violators of case payment and NBB. The PhilHealth CARES nurses, through exit interviews, will also monitor NBB implementation. A stricter monitoring mechanism will be put in place once the circulars have been published.

Product Development Units The financial support we provide is the cornerstone of our business, our reason for being. It is why we increased our premiums and why we must now deliver. Having transformed the traditional relay system into cross-functional teams, the Health Finance Policy Sector is rapidly developing four groups of benefits to offer better value to our customers.
To communicate the new and upcoming benefits easily and rapidly to our external stakeholders, a Benefits Caravan will be organized on May 9 to 11 and May 14 to 16 where the 4 Benefit Teams will be expected to provide a detailed orientation about the benefits to their counterparts in the PROs. The objective is to strengthen the ability of PROs to communicate or cascade this information to health care providers in their regions. A communication plan for launching and informing stakeholders about these benefits is in the works.

Inpatient Benefits These involve the expansion of case rates, the development of a unified dialysis benefit package, and creation of a global payment scheme.
The unified dialysis benefit package, pegged at Php 180,000 per year, will move away from the transactional mentality and instead emphasize the need for continuity of care. The new dialysis benefit package will utilize a top-up or copayment approach that essentially provides year-round dialysis at minimal co-payment. An Emergency Room treatment package is currently being studied. Updates on case rates are given above.

11 May 2012

Global Budget Payment Scheme Global payments are advanced, bulk payments designed to give health care providers the capital needed to improve their services and facilities. Providers must comply with NBB and other conditions (e.g. maintain or increase enrollment, ensure provision of medicines, not charge user fees or require deposits upon admission, continuously provide customer assistance, have an eclaims system, etc.) to qualify for this payment scheme.
This has been approved in principle by the Board. A circular and office order are ready for routing. In the interim, select hospitals and LGUs have been invited to discuss the program in detail. After this has been approved by the Board, regional AQAS teams shall begin surveying hospitals and contracting with hospital or LGU sytems. By the 3rd week of June, all providers on board will be trained to use the e-Claims system.

Primary Care Benefits These support the more frequent, outpatient needs of sponsored and organized group members.
PCB 1 provides a Php 500 per family payment rate (PFPR) per annum to all accredited primary care providers. This enhanced outpatient benefit package now includes lipid profile testing. PCB 1 also incentivizes electronic reporting by RHUs by providing an additional Php 100 PFPR for encoded data submission. All sponsored members are currently being assigned to primary care providers. design of quality incentives are also underway. Impact evaluation studies and the

PCB 2, a 400-peso outpatient drug package providing medicines for chronic conditions such as hypertension and diabetes utilizing a voucher mechanism, is slated for board approval. The team is also actively engaging pharmaceutical companies who are willing to provide lower rates for PhilHealth members.

Special Benefits These include the development of benefit packages for catastrophic illnesses and PhilHealth Plus, which is a program that provides complementary basic benefits and discounted medicines and services to our basic benefits.
The selected catastrophic conditions are breast cancer, prostate cancer, childhood leukemia, and renal transplantation. A draft mother circular, a rate and service circular, a contract with providers of specialized care, and implementing guidelines are currently being finalized. Reference hospitals are also being selected considering standards of care and costing. Consultations with various stakeholders (patient groups, drug companies, and health care providers) have been held. This has been discussed in the board and final approval will be soon be requested. The complementary basic benefit part of PhilHealth Plus has been approved in principle by the board while the discounts for medicines and services are being expanded. In the case of the complementary basic benefit, the team is currently collecting data on premium rates and benefit packages used by private HMOs.

MDG Benefits These include the enhancement of existing MDG benefits and the development of a rabies benefit package.
Effective May 3, all PhilHealth members are entitled to the rabies benefit package. This package was crafted in close coordination with the Infectious Disease Office of the Department of Health thus it complements the initial free vaccine dose provided by all DOH animal bite centers. The rabies benefit package will be officially launched on 18 May in the City of Malabon. As for other MDG benefits, the team has reviewed utilization rates and patterns and has conducted focus group discussions with various stakeholders. Recognizing that UHC will not be possible without ensuring the health of mothers and babies, the 1MOM or One Municipality, One MCP campaign will be launched soon.

Customer Segment Teams While our products are important, the way we reach and serve our customers are half the reason why they do or do not choose to enroll. The Member Management Group has been restructured into teams devoted to creating an informed, empowered, and guided membership base in a manner that is tailor-fit to the needs and conditions of each segment.

08 May 2012

NHTS-PR
The enrollment of the 5.2 million NHTS-PR households has already been auto-renewed in the database. To facilitate availment, all accredited health care providers have been given copies of the NHTS list and/or were given access to the IHCP portal where an online list is available. MDRs printed on yellow paper will be given out starting May, while IDs will be distributed in July. Information Angels devoted to advocating PhilHealth and assisting members at different locations (ex. CHTs in communities, RNHeals in facilities, etc.) have been activated. The team is maintaining close coordination with DSWD and will launch the 5Ps Month or PhilHealth para sa Pantawid Pamilyang Pilipino Program this coming July. For this, a joint circular has already been signed by PhilHealth and has already been sent to DSWS for signature. To further ease availment of the 4Ps families, a circular that will allow availment upon presentation of authentic DSWD 4Ps IDs is coming up. A preliminary biometric data capture activity was conducted in Oriental Mindoro last 18 April. The team reported that approximately 30% of registrants had amendments in their data records. Thus, to ensure easy availment, some leniency will be applied to membership data records to give room for minor spelling discrepancies.

LGU-Sponsored
Efforts to convince LGUs to lock in enrollment for two years before July hits are ongoing. I have asked for daily performance updates in this area and I am very happy with the response from several regions. In fact, my office has been flooded with invitations for MOA-signing. I commend those who have actively engaged their local leaders. Continue to sell PhilHealth with pride in what we offer. Currently, we have already achieved 80% of our LGU-sponsored enrollment in 2011thats 3.7 million families. We have two months go, and I believe we can shoot past 100% before that time is up. For our brothers and sisters in ARMM, a board resolution has been approved allowing ARMM to pay a lower premium rate. If negotiations push through, we will have universal coverage in ARMM. IDs for this segment will be distributed in August. In the meantime, all PROs have been instructed to continue using the old cardboard PhilHealth Identification Card.

Individually Paying Program and Organized Groups


A new policy contract has been drafted where members must enroll for an entire year and can pay in installment, thus ensuring continuous coverage and strengthening a longer-term view of health insurance. The iGroup is the new organized group scheme where minimum required membership is down to 50 from Kasapis 1,000. iGroups will be given a whopping 10% premium discount, entitlement to the primary care benefit package, and have the option to lock-in enrollment as well. Consultations with potential iGroup clients have started and the reception is overwhelming. Circulars and implementing guidelines will be out by May. As for the IPP, Corporation has currently enrolled about 4.5 million members out of the 10 million working in the informal economy. To capture this market, the team will utilize strategic means such as mobile and web solutions, and bring PhilHealth closer to the people by increasing our presence, especially in high traffic areas.

Formal Sector
Patterned after the excellent work that some of our regions have done before, Task Fore ICE convened these regions and came up with a unified mapping guidelines. Soon, all employers will have our Race to UHC logo posted in their doors or buildings. Bawat empleyado miyembro, Bawat empleyado protektado, Kalusugan namin dito, segurado. All employers with more than 10 employees will be required to submit their employees records online through the enhanced EPRS 2.0 (Electronic Premium and Reporting System). This can deload service offices of large groups of clients while making transactions more convenient for employers. With EPRS 2.1 coming soon, employers will be able to pay online as well. Recognizing that job order contractors are the hidden population in the formal sector, the team will seek the Boards endorsement to the Civil Service Commission and the Department of Labor and Employment to allow employers to automatically deduct PhilHealth premium contributions from salaries of Job Order Contractors. Finally, A MOA with PAG-IBIG on database-sharing for the employed sector is expected to be completed by the end of May.

NCR Strategy Team Highly populated areas like NCR are beset with unique challenges and a tremendous workload, requiring a special strategy that can address these conditions.
A task force has been created to develop this strategy. Their initiatives include caravans that promote PhilHealth and facilitates transactions and the establishment of Express stations. Soon, strategies for other areas facing similar conditions, such as Metro Cebu and Davao City, may be developed.

11 May 2012

PhilHealth Express Like satellite offices, smaller stations set up in high-traffic areas will make transacting with us more convenient for our customers and deload our LHIOs. Express stations can generate PINs, IDs, and MDRs, make membership data revisions, collection premiums, and address inquiries.
Already approved in principle by the Board, PhilHealth Express will heighten PhilHealths presence in malls, LRT/MRT stations, and other high-density areas.

PhilHealth on Wheels These are caravans that can visit barangays, corporations, and big events to conduct information campaigns and provide transaction services. A full-service desk will be deployed on-site.
A proposal has been submitted to development partners who may assist us in financing.

Overseas Workers Program


Efforts to strengthen our social media networks and email response systems (through facebook, email, etc.) are being undertaken in order to target this electronic-savvy group. We are also engaging manning agencies, embassies, migrant organizations, and religious groups to help us find more effective ways to reach out to OFWs. The team will soon link up with Filipino schools.

PhilHealth CARES Customer assistance at point-of-care, specifically hospitals, has been very effective in improving utilization rates. This strategy is now being rolled-out nationwide.
530 Nurses have been deployed to various government and private hospitals. Their key functions are to give information, guide members through the processes, help members gets MDRs or provide an alternative, and administer a support value exit survey.

Performance Commitment Contract With the reduction of accreditation functions came an opportunity to push for quality through a more powerful toolcontracts.
Beginning May 1, 2012, facilities will be required to sign performance commitments. Through these contracts, PhilHealth will insist on electronic data submission, negotiate better rates for certain disease conditions, and provide incentives for providers that adhere to NBB, uphold quality standards, or set up facilities at war-torn, geographically-isolated, or disadvantaged areas.

Auto-accreditation of PMA physicians as PhilHealth PHCPs This initiative attempts to form synergies with some of our most influential partnersdoctors.
Discussions are ongoing with the Philippine Medical Association on the automatic accreditation of PMA members as PhilHealth professional health care providers. In return, PMA will be collecting annual accreditation fees and premium payments on PhilHealths behalf and strongly support the implementation of PhilHealth policies. A board resolution is expected by the end of the month.

Amnesty for IHCPs Offenses of certain IHCPs will be forgiven now but we will implement much stricter measures to regulate them.
We will be pushing for amnesty of all decided and pending cases under Arbitration filed on or before December 31, 2011. This recognizes the leniency desired by the Board given that as facts of decided cases are presented, the resulting decision usually justifies the leniency. After securing a board approval, we will ensure that subsequent cases after the period will be resolved within a year and decisions are implemented firmly.

Accredited Collecting Partners Another group of partners is being encouraged to provide quality service and do same day time-posting.
In line with our objectives of ensuring our customers delight, we want banks to treat our members like their A-list clients. Gone are the days when our members can only pay on selected hours and days of the week. We will take the risk of not having as many accredited collecting partners with the assurance that the few who are left will take care of our members and ensure timely posting of their payments.

Enterprise Architecture Designed to support executive decision-making, the Nerve Center attacks four major information areas through initiatives that not only develop the primary tools and mechanisms, but also build the necessary complement systems
The design of the enterprise architecture is currently being finalized.

08 May 2012

The Nerve Center Designed to support executive decision-making, the Nerve Center attacks four major information areas through initiatives that develop the primary tools and mechanisms for collecting and packaging data and build the necessary complementary and support systems needed to put that information to use. Balanced Scorecard (BSC) An improved performance measurement and strategy management system will provide a better means for clarifying, communicating, and improving corporate strategy and measuring ourselves as we execute it. More importantly, planning and strategy functions need to be anchored in our mission and vision, and linked to our budget system, incentive structure, and data flow.
This umbrella project involves the development of the balanced scorecard and accompanying system, four complement systems (budget, planning, performance evaluation and rewards, and data flow) and two supporting ones (a communication plan and a monitoring and evaluation system for the project).

Task Force BSC A multi-disciplinary task force has been created to fast-track the development of balanced scorecards and integrate them with all the relevant systems, with the Corporate Dashboard as a jump-off point.
The Dashboard has been presented to the DOH and donor agencies. The team is in the process of revisiting the corporations mission, vision, and values and setting a 2-month timetable for the project. Heavy consultation will be conducted, the first two on May 10-11 and May 17-18 and a corporate-wide scorecard is due by the start of June.

Hospital Dossier Extensive and strategically crafted hospital profiles give us the information leverage (e.g. financial statements and utilization data) needed to regulate and negotiate with facilities, in order to safeguard our members well-being more effectively.
Preliminary work has been done, including the identification of information that must be contained by the dossier and the creation of a prototype for a web-based interface. Identifying the necessary information (primarily financial information) and effectively requiring this information from facilities (e.g. through the performance commitment contract) are key.

Dashboard Info Support Special research and data collection efforts are occasionally needed to provide specific and in-depth analysis of the other information areas.
Research needs are being assessed and prioritized. Foremost on our list are determining the impact of our financial risk protection strategies across all population segments and creating a support value survey. For the former, we are collaborating with DOH and NSO in the 2012 Family Income and Expenditure Survey, which will commence in June. For the latter, we shall utilize our 530 CARES nurses to conduct exit interviews on support value.

E-Claims To facilitate an otherwise tedious claims process and push towards quick, paperless, online transactions, all claims will soon be processed electronically.
Standards and specifications have already been set and in order to facilitate the scale-up of the system, the corporation will soon accredit HITP or Health Information Technology Providers. By December 31, 2012, all Level 3 and Level 4 hospitals should already be on e-Claims.

Corporate Center As we continue to expand the program, we deserve to have a decent corporate center, something we can truly call our own.
We will be getting a loan to build this as well as respective buildings in the regions. Reserve funds should not just be used to pay for benefits but also to support our operations. For this, I have instructed our CLC to solicit proposals from banks, and see who can provide the best interest rate.

Streamlining Operations A number of processes are being reassessed and streamlined to ensure effectiveness and efficiency.
In order to lessen the turnaround time of policies and ensure completed staff work by policy making units within the corporation, we are amending the PhilHealth Corporate Issuance System to allow for a more collaborative and less hierarchical approach to policy-making. Soon, we will allow members to claim benefit payments or encash stale cheques of Php 5000.00 or less in cash. With this comes the creation of an Operations Revolving Fund for PhilHealth Member Assistance Centers and Local Health Insurance Offices, which will enable payment of utilities and immediate needs.

11 May 2012

There are several other things that we have simmering right now. We hope to make our procurement and financial management systems the most transparent in the country and to consistently produce robust financial statements and unqualified audit reports. Were looking into starting an internship program to attract a different breed of applicants and advocates. A small grant has allowed us to start with a few interns who will begin working with us this month. Wed also like to hold POLE seminars for specific, priority groups before the next big one in 2013. Area and regional offices who are interested in hosting and co-developing seminars with the same flavor as the POLE we enjoyed may approach us. A committee has also been formed to design and launch a new uniform to bring in a more professional look by next year. Another has been formed to look into the adoption of workplace policies that enforce respectful and ethical behavior. We are currently finding ways to procure a fleet of service vehicles so that our people can finally reach isolated areas and engage communities more proactively. I understand that we all need certain resources to do our jobs better. Energizing training seminars, a professional look, a safe and pleasant workplace, and means to get around are critical to sustaining our drive. Apart from that, I am particularly keen on giving our job order and contractual employees job security. Unfortunately the years budget is both limited and pre-determined so for now, we can only do this minimally. If we reach our 60 billion pesos premium collection, I assure you we can execute this faster and to a larger extent. Notice that we are trying to achieve a balance between initiatives that help us achieve targets within a short term and those that improve the systems that drive our long-term success. These underlying systems should not be left out even as we try to generate some quick wins and solutions for the present because these systems are what ensure that PhilHealth succeeds past this administration. Another balance we need to strike is this: These initiatives may seem promising, but spectacular plans need to be followed through by equally spectacular implementation. Several of the initiatives above are currently in the development phase and even as this is ongoing, we need to build better implementation mechanisms so that they are executed by airtight operations. Right now, we are focusing on crafting responsive policies that reflect a broad, thorough, and long-term view of the situation. By July, these policies should be in place and we will then concentrate on implementation. I would like to enjoin all those who have ideas on how we can do things better or who would like to get more involved to approach us. My teams email address is opceo.philhealth@gmail.com. Feedback is more than welcome. The past six months have been unbelievably great for PhilHeath and for myself, and I have everyone to thank. All these reforms would not have been possible without your full trust and confidence, your hard work and your dedication. I am grateful for the unwavering support that each one of you has accorded me. I promise to give you the leadership that you all deserve. There will be many more reforms and updates to come. I am very pleased to see that some departments and groups have stepped up to the plate: They have taken the initiative of reorganizing themselves and developing projects to fulfill their functions better. I hope to see the same fervor and innovation from everyone else. Have pride in our program, have pride in yourselves. PhilHealth is the only agency created to concretize solidarity within the nation and the only payer that has everybodys back. Such an enormous privilege also comes with enormous responsibilities, and so this year, let none of us be seen walking towards our goals. We will all be running. And on February 17, 2012, we will celebrate our one-year sprint with the rest of the country. The PhilHealth Run for Health and Hope v3: 18 years, 18 cities, 180,000 runners. Lets get there.

Your partner,

Dr. Eduardo P. Banzon