You are on page 1of 30

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 & PhilHealthLINK-
Agents
PhilHealth?
Ambot
Aaawww Admitted as
Charity / Non-PhilHealth
Hindi ko alam..
Ano yan?
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
COORDINATOR AGENT
PHILHEALTH
CLERK
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.

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 PL-
Coordinator;
4. COST: Lowest PhilHealth SG for JOs (P400/day)
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.





COST: Postpaid UnliCall/Text
(P600/month)
Coordinators Agents
Project
Manager

Center Head

Asst. Center
Head
RVP

PL Agent

PL Agent

PL Agent

PL Agent
Province/Hospital
No. 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
Province/Hospital
No. of Days covered
by calls
Membership Other Transactions
Total No. of
Inquiries
Members
Found
Percent Found
Members not
Found
Percent not
Found
MDR 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 131
386 371 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 0
RHU 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 92
5 3 60% 2 40% 0 0
Pintuyan District Hospital 0%
Province
No. of Days
covered by calls
Membership Other Transactions
Total 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/Hospital
No. of Days
covered by calls
Membership Other Transactions
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 0
Calbayog District
Hospital
20
163 86 53% 77 47% 0 0
Total 481 298 62% 183 38% 0 0
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
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%
HOSPITALS
INCOME PER BED
HOSPITAL
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%
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%
-
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 Samar
Southern Leyte
Biliran
Western Samar
DOH
Admission versus Inquiries
PhilHealthLink Status
0
20,000
40,000
60,000
80,000
100,000
120,000
2012
Inquiries
Members
Found
Members
not Found
2013
Inquiries
Members
Found
Members
not 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
PhilHealthLink Status
Province
CY 2012 2013 (Jan-August)
ADMISS
ION
Total
No. of
Inquirie
s
%
Member
s Found
%
Member
s not
Found
Total
No. 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%

4,086
Southern
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
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-Leyte)
26,978,620
24%
86,373,138
76%
2011 - Benefit Payment
Plink_BP
Non_Plink_BP
161,273,245
74%
55,285,242
26%
2012 - Benefit Payment
Plink_BP
Non_Plink_BP
59,127,743
83%
11,866,758
17%
2013 - Benefit Payment
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
Province Hospital
Total
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 table
Eastern
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
PHILHEALTHLINK
EXPANSION 2.0
BENEFIT PAYMENT OF RHUS
LGUS # OF LGUS
# OF LGUS
WITH NO
INCOME 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%
PLINK IN RHUS
No. Inquiries Found Not Found
%
Found Amount
Eastern Samar
1
RHU Lawaan
39 36 3 92% 288,000.00
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
TOTAL 290 219 71 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!!!